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Provider Notice Issued 06/24/2022

Date:   June 24,2022

To:       All Medical Assistance Program Providers

Re:      Emergency Medical Coverage for Persons Not Meeting Immigration Status with COVID-19 Diagnosis


This notice details the requirements for extending emergency medical coverage for persons aged 19 and older who do not meet immigration status and have a COVID-19 diagnosis or suspected diagnosis.
Emergency medical coverage for a person with a COVID-19 diagnosis or suspected diagnosis is initially authorized for 60 days. The coverage period begins the earlier of:

  • The date of COVID-19 diagnosis or suspected diagnosis on a completed HFS 3801 or other documentation; or
  • The date the emergency medical application is received by the Department of Human Services or the Department of Healthcare and Family Services

Providers requesting coverage for a COVID-19 related individual must email the application to

If additional coverage is needed beyond the initial 60 days, the provider must email a request for the extension.

If extended coverage is needed beyond 120 days, the provider must email the request to the address above. Providers may request continued extended coverage at 60-day intervals. The following medical documentation is required:

  • Facility name providing service
  • Attending physician contact information
  • Physician's statement identifying the dates of service being reviewed (beyond the 120th day through the end of the COVID-19 illness/treatment)
  • The admission history and current physical examination from the current facility
  • 1-2 page clearly readable summary of care delivered at the facility including a plan for further care
  • Copies of all progress notes and test results within the past one week, and
  • HFS 3801 Report of Medical Treatment (if available).

Questions regarding this notice may be directed to the Bureau of All Kids at 866-255-5437.

Kelly Cunningham, Administrator
Division of Medical Programs


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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director

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