The Illinois Department of Healthcare and Family Services (HFS) is responsible for providing healthcare coverage for adults and children who qualify for Medicaid, and for providing Child Support Services to help ensure that Illinois children receive financial support from both parents. The agency is organized into two major divisions, Medical Programs and Child Support Services. In addition, the Office of Inspector General is maintained within the agency, but functions as a separate, independent entity reporting directly to the governor's office.
HFS was formerly the Illinois Department of Public Aid.
Division of Medical Programs
The Division of Medical Programs is responsible for administering the Medical Assistance Programs under the Illinois Public Aid Code and Titles XIX and XXI of the U. S. Social Security Act.
Medical Assistance Programs:
- Provide quality healthcare coverage to low-income families lacking health insurance, children who are wards of the state, low-income senior citizens, individuals with disabilities, elderly in nursing facilities and people struggling with catastrophic medical bills.
- Provide department-funded immunizations, vision and hearing screenings and other preventive services.
- Provide department-funded prenatal services.
- Provide department-funded placements for Illinois seniors receiving nursing services.
- Provide other department-funded medical services such as organ transplants.
- Operate the
- All Kids program, offer Illinois’ uninsured children comprehensive healthcare that includes doctor’s visits, hospital stays, prescription drugs, vision care, dental care and medical devices like eyeglasses and asthma inhalers. Some parents will pay monthly premiums for the coverage.
- Operate the FamilyCare program, offering healthcare coverage to Illinois parents living with their children, 18 years old or younger. FamilyCare also covers relatives who are caring for children in place of their parents. Like All Kids, FamilyCare covers doctor visits, dental care, specialty medical services, hospital care, emergency services, prescription drugs and more. Parents pay co-pays for doctor visits and prescriptions, and parents in FamilyCare Premium pay a monthly premium, depending on the number of family members covered.
- Administer the Health Benefits for Workers with Disabilities (HBWD) program, which allows people, between the ages of 16 and 64, with disabilities to return to work with full Medicaid healthcare benefits, if they qualify financially. HBWD not only encourages enrollees to work, but to increase the number of hours they work.
- Assist Illinois residents requiring chronic renal dialysis with the cost of outpatient and home dialysis through the State Renal program.
- Reimburse Illinois hospitals for emergency room services provided to sexual assault victims.
- Provide assistance to eligible Illinois residents who financially qualify for the Hemophilia program.
- Provide medical assistance for Asylum Applicants and Torture Victims up to 24 months coverage for persons who are not qualified immigrants but who are applicants for asylum in the U.S., or who are non-citizen victims of torture, receiving treatment at a federal funded torture treatment center. Such person must meet all other eligibility criteria.
- Offer Home and Community-Based Services Waivers as an alternative to hospital and nursing facilities.
- Health Insurance Portability and Accountability Act (HIPAA) was signed into federal law in 1996. The main purpose of this law is to protect health insurance coverage for workers and their families when they change or lose their jobs. HIPAA requires the Secretary of the Department of Health and Human Services to adopt standards for electronic transactions, including data elements, standard code sets, unique health identifiers, security safeguards and privacy standards.
- Operate the MEDI program, which is the secure Web portal that allows authorized providers, their staff and related billing services access to a variety of medical Web applications. First-time users of this system must obtain a state of Illinois digital certificate (available through the MEDI Web site). Obtaining a digital certificate is a one-time process, which allows access to confidential information in a highly secure Internet environment. HFS verifies that the certificate holder is an enrolled provider, or that they are associated with an enrolled provider, after the certificate holder completes the MEDI registration page.
One of the primary web applications delivered thru MEDI is the IEC (Internet Electronic Claims) system. This system allows providers and other trusted trading partners to exchange HIPAA X12 transactions with department. The IEC system accepts batch files for claims, claims status inquiries, and eligibility inquiries. They IEC system also supports DDE (Direct Data Entry) of these transactions.
- Administer the Supportive Living program, an alternative to nursing home care for low-income older persons, and persons with physical disabilities, under Medicaid. The program combines apartment-style housing with personal care and other services. Residents are able to live independently and take part in decision-making. HFS obtained a waiver to allow payment for the following services not routinely covered by Medicaid: personal care, housekeeping, laundry, medication oversight, social activities, recreation and 24-hour staff. Resident's income pays the cost of room and board.
- HFS and the Illinois State Board of Education have an interagency agreement which allows them to capture federal matching dollars for School-Based Health Services (SBHS). This covers both the direct services provided by Local Education Agencies (LEAs) and for the administrative costs associated with administering Title XIX and Title XXI (State Children's Health Insurance Program) services.
The Individuals with Disabilities Education Act (IDEA), formerly the Education of the Handicapped Act) and Article 14 of the Illinois School Code mandate a free, appropriate public education for all children ages 3 to 21 with disabilities.
Illinois claims federal dollars for certain therapy services provided to children enrolled in special education programs, and for administrative activities.
LEAs are required to provide, at no cost to parents, special education and related services as outlined in an Individualized Education Program (IEP).
IDEA, as clarified by the Amendments of 1986, (P.L.99-457), includes provisions for other agencies to pay for services.
The Omnibus Budget Reconciliation Act of 1989 (OBRA) allows LEAs to enroll as Medicaid providers and to claim reimbursement for certain health services provided to eligible special education students. LEAs may also perform activities that support administration of the programs. Federal matching funds (FFP) are available for expenditures in support of such activities.
The federal requirement that states provide Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services to eligible children is the foundation used to implement the administrative claiming.
Division of Child Support Services
HFS’ Division of Child Support Services (DCSS) enforces child support payment obligations for children.
DCSE enforces child support payment obligations for:
- Those that receive public assistance from the Illinois Departments of Healthcare and Family Services (HFS) or Human Services (DHS);
- Those no longer on public assistance; and
- Those that have never received public assistance.
A person that is not receiving public assistance may apply for child support services by submitting a signed application to any child support office. There is no charge for this application.
When child support payments are received, whether the custodial parent is a client of the Division of Child Support Services (IV-D case) or not, a centralized unit processes and disburses those payments. HFS established this centralized unit, the State Disbursement Unit (SDU) in October 1999. The SDU is the single collection and disbursement entity for income withholding payments from the non-custodial parent's employer.
DCSE provides the following services:
- Helps parents or guardians locate a non-custodial parent,
- Establishes paternity,
- Gets support payments and health insurance for their child(ren) and
- Reviews and modifies support orders.
- The Division of Child Support Services is authorized by state law to disclose information about "deadbeat" parents. The names and photos of those who owe $5,000 or more in past-due child support under an Illinois order may be published on the Deadbeat Parents Web site.
The Office of Inspector General
The Inspector General is appointed by, and reports to, the governor and is confirmed by the Senate. The mission of the Office of Inspector General (OIG) is to prevent, detect and eliminate fraud, waste, abuse, misconduct and mismanagement in the programs administered by the Illinois Department of Healthcare and Family Services. The OIG also conducts investigations for the Illinois Department of Human Services.