Ill. Admin. Code tit. 59 § 125.80

Current through Register Vol. 48, No. 45, November 8, 2024

Section 125.80 - Recipient financial support

a) During DLA planning, financial support for the recipient's continued treatment/habilitation services and other needs must be considered. Designated staff will assist the recipient, family or guardian in understanding their respective liabilities for treatment/habilitation and in accessing available financial resources. The required authorizations to investigate or access assets, income or benefits must be secured.

b) Sources to contact for information are the recipient, family or guardian at admission, during treatment/habilitation or prior to discharge. Sources which may be considered include insurance carriers, funding agencies, e.g., Social Security offices, federal fiscal intermediaries (Blue Cross/Blue Shield or E.D.S. Federal Corporation), and the Department of Public Aid (the single State agency for Medicaid and administering agency for public assistance and the State supplement), and township assistance agencies.

c) Resources which may be available for support based on recipient eligibility include:

1) Private funding

A) Recipient's personal funds, e.g., assets which are negotiable or can be liquidated;

B) Income, from employment, from assets, estates, trusts, and facility trust funds;

C) Family funds, e.g., voluntary or due to legal liability.

2) Third party payments

A) Private insurance (disability and/or medical) carried by the recipient or family;

B) Health maintenance organization plans (HMOs);

C) Black lung disease benefits ( 30 U.S.C.A. 924(1981));

D) Civilian Health and Medical Program of the Uniformed Services (CHAMPUS/CHAMPVA) ( 38 U.S.C.A. 601(1981));

E) Medicare, which is short-term hospital and medical insurance ( 42 U.S.C.A. 1395b - 1(1981));

F) Medicaid, which is public medical assistance for the aged, blind and disabled ( 42 U.S.C.A. 1396a(1981) ).

3) Federal/state/local benefits/other

A) Social Security Retirement and Survivors Benefits (SSDI) ( 42 U.S.C.A. 401(1981)) which is based on wage earners and employers contributions;

B) Supplemental Security Income (SSI) ( 42 U.S.C.A. 1381(1981)), a federal income maintenance program for aged, blind and disabled, which also requires documentation to establish disability for the blind and disabled by the Department's Bureau of Disability Adjudication Services;

C) Railroad Retirement benefits ( 45 U.S.C.A. 231(1981)) and Veterans' Administration benefits ( 38 U.S.C.A. 521, 541, and 542(1981)).

D) General/township assistance, state supplemental payments and Bureau of Employment Security Benefits, Department of Labor.

E) Private industry professional groups, labor unions and other organizations.

4) Local school district services or funding

When a recipient aged 3 to 21 years is handicapped as defined in Section 14-1.02 of the School Code [105 ILCS 5/14-1.02] and has not been graduated from high school, the recipient is probably eligible to receive special education services from a local school district. The parent or guardian should be assisted in obtaining these services or funding.

5) Department sources

There is a variety of purchase of care programs for the mentally ill, developmentally disabled or alcohol abusers for which individuals may qualify.

Ill. Admin. Code tit. 59, § 125.80