Illinois General Assembly

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Full Text of SB2052  97th General Assembly



State of Illinois
2011 and 2012


Introduced 2/10/2011, by Sen. Carole Pankau - Kirk W. Dillard - Kyle McCarter


305 ILCS 5/5-2  from Ch. 23, par. 5-2

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning the classes of persons eligible for Medicaid.

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1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-2 as follows:
6    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
7    Sec. 5-2. Classes of Persons Eligible. Medical assistance
8under this Article shall be available to any of the the
9following classes of persons in respect to whom a plan for
10coverage has been submitted to the Governor by the Illinois
11Department and approved by him:
12        1. Recipients of basic maintenance grants under
13    Articles III and IV.
14        2. Persons otherwise eligible for basic maintenance
15    under Articles III and IV, excluding any eligibility
16    requirements that are inconsistent with any federal law or
17    federal regulation, as interpreted by the U.S. Department
18    of Health and Human Services, but who fail to qualify
19    thereunder on the basis of need or who qualify but are not
20    receiving basic maintenance under Article IV, and who have
21    insufficient income and resources to meet the costs of
22    necessary medical care, including but not limited to the
23    following:



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1            (a) All persons otherwise eligible for basic
2        maintenance under Article III but who fail to qualify
3        under that Article on the basis of need and who meet
4        either of the following requirements:
5                (i) their income, as determined by the
6            Illinois Department in accordance with any federal
7            requirements, is equal to or less than 70% in
8            fiscal year 2001, equal to or less than 85% in
9            fiscal year 2002 and until a date to be determined
10            by the Department by rule, and equal to or less
11            than 100% beginning on the date determined by the
12            Department by rule, of the nonfarm income official
13            poverty line, as defined by the federal Office of
14            Management and Budget and revised annually in
15            accordance with Section 673(2) of the Omnibus
16            Budget Reconciliation Act of 1981, applicable to
17            families of the same size; or
18                (ii) their income, after the deduction of
19            costs incurred for medical care and for other types
20            of remedial care, is equal to or less than 70% in
21            fiscal year 2001, equal to or less than 85% in
22            fiscal year 2002 and until a date to be determined
23            by the Department by rule, and equal to or less
24            than 100% beginning on the date determined by the
25            Department by rule, of the nonfarm income official
26            poverty line, as defined in item (i) of this



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1            subparagraph (a).
2            (b) All persons who, excluding any eligibility
3        requirements that are inconsistent with any federal
4        law or federal regulation, as interpreted by the U.S.
5        Department of Health and Human Services, would be
6        determined eligible for such basic maintenance under
7        Article IV by disregarding the maximum earned income
8        permitted by federal law.
9        3. Persons who would otherwise qualify for Aid to the
10    Medically Indigent under Article VII.
11        4. Persons not eligible under any of the preceding
12    paragraphs who fall sick, are injured, or die, not having
13    sufficient money, property or other resources to meet the
14    costs of necessary medical care or funeral and burial
15    expenses.
16        5.(a) Women during pregnancy, after the fact of
17    pregnancy has been determined by medical diagnosis, and
18    during the 60-day period beginning on the last day of the
19    pregnancy, together with their infants and children born
20    after September 30, 1983, whose income and resources are
21    insufficient to meet the costs of necessary medical care to
22    the maximum extent possible under Title XIX of the Federal
23    Social Security Act.
24        (b) The Illinois Department and the Governor shall
25    provide a plan for coverage of the persons eligible under
26    paragraph 5(a) by April 1, 1990. Such plan shall provide



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1    ambulatory prenatal care to pregnant women during a
2    presumptive eligibility period and establish an income
3    eligibility standard that is equal to 133% of the nonfarm
4    income official poverty line, as defined by the federal
5    Office of Management and Budget and revised annually in
6    accordance with Section 673(2) of the Omnibus Budget
7    Reconciliation Act of 1981, applicable to families of the
8    same size, provided that costs incurred for medical care
9    are not taken into account in determining such income
10    eligibility.
11        (c) The Illinois Department may conduct a
12    demonstration in at least one county that will provide
13    medical assistance to pregnant women, together with their
14    infants and children up to one year of age, where the
15    income eligibility standard is set up to 185% of the
16    nonfarm income official poverty line, as defined by the
17    federal Office of Management and Budget. The Illinois
18    Department shall seek and obtain necessary authorization
19    provided under federal law to implement such a
20    demonstration. Such demonstration may establish resource
21    standards that are not more restrictive than those
22    established under Article IV of this Code.
23        6. Persons under the age of 18 who fail to qualify as
24    dependent under Article IV and who have insufficient income
25    and resources to meet the costs of necessary medical care
26    to the maximum extent permitted under Title XIX of the



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1    Federal Social Security Act.
2        7. Persons who are under 21 years of age and would
3    qualify as disabled as defined under the Federal
4    Supplemental Security Income Program, provided medical
5    service for such persons would be eligible for Federal
6    Financial Participation, and provided the Illinois
7    Department determines that:
8            (a) the person requires a level of care provided by
9        a hospital, skilled nursing facility, or intermediate
10        care facility, as determined by a physician licensed to
11        practice medicine in all its branches;
12            (b) it is appropriate to provide such care outside
13        of an institution, as determined by a physician
14        licensed to practice medicine in all its branches;
15            (c) the estimated amount which would be expended
16        for care outside the institution is not greater than
17        the estimated amount which would be expended in an
18        institution.
19        8. Persons who become ineligible for basic maintenance
20    assistance under Article IV of this Code in programs
21    administered by the Illinois Department due to employment
22    earnings and persons in assistance units comprised of
23    adults and children who become ineligible for basic
24    maintenance assistance under Article VI of this Code due to
25    employment earnings. The plan for coverage for this class
26    of persons shall:



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1            (a) extend the medical assistance coverage for up
2        to 12 months following termination of basic
3        maintenance assistance; and
4            (b) offer persons who have initially received 6
5        months of the coverage provided in paragraph (a) above,
6        the option of receiving an additional 6 months of
7        coverage, subject to the following:
8                (i) such coverage shall be pursuant to
9            provisions of the federal Social Security Act;
10                (ii) such coverage shall include all services
11            covered while the person was eligible for basic
12            maintenance assistance;
13                (iii) no premium shall be charged for such
14            coverage; and
15                (iv) such coverage shall be suspended in the
16            event of a person's failure without good cause to
17            file in a timely fashion reports required for this
18            coverage under the Social Security Act and
19            coverage shall be reinstated upon the filing of
20            such reports if the person remains otherwise
21            eligible.
22        9. Persons with acquired immunodeficiency syndrome
23    (AIDS) or with AIDS-related conditions with respect to whom
24    there has been a determination that but for home or
25    community-based services such individuals would require
26    the level of care provided in an inpatient hospital,



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1    skilled nursing facility or intermediate care facility the
2    cost of which is reimbursed under this Article. Assistance
3    shall be provided to such persons to the maximum extent
4    permitted under Title XIX of the Federal Social Security
5    Act.
6        10. Participants in the long-term care insurance
7    partnership program established under the Illinois
8    Long-Term Care Partnership Program Act who meet the
9    qualifications for protection of resources described in
10    Section 15 of that Act.
11        11. Persons with disabilities who are employed and
12    eligible for Medicaid, pursuant to Section
13    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
14    subject to federal approval, persons with a medically
15    improved disability who are employed and eligible for
16    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
17    the Social Security Act, as provided by the Illinois
18    Department by rule. In establishing eligibility standards
19    under this paragraph 11, the Department shall, subject to
20    federal approval:
21            (a) set the income eligibility standard at not
22        lower than 350% of the federal poverty level;
23            (b) exempt retirement accounts that the person
24        cannot access without penalty before the age of 59 1/2,
25        and medical savings accounts established pursuant to
26        26 U.S.C. 220;



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1            (c) allow non-exempt assets up to $25,000 as to
2        those assets accumulated during periods of eligibility
3        under this paragraph 11; and
4            (d) continue to apply subparagraphs (b) and (c) in
5        determining the eligibility of the person under this
6        Article even if the person loses eligibility under this
7        paragraph 11.
8        12. Subject to federal approval, persons who are
9    eligible for medical assistance coverage under applicable
10    provisions of the federal Social Security Act and the
11    federal Breast and Cervical Cancer Prevention and
12    Treatment Act of 2000. Those eligible persons are defined
13    to include, but not be limited to, the following persons:
14            (1) persons who have been screened for breast or
15        cervical cancer under the U.S. Centers for Disease
16        Control and Prevention Breast and Cervical Cancer
17        Program established under Title XV of the federal
18        Public Health Services Act in accordance with the
19        requirements of Section 1504 of that Act as
20        administered by the Illinois Department of Public
21        Health; and
22            (2) persons whose screenings under the above
23        program were funded in whole or in part by funds
24        appropriated to the Illinois Department of Public
25        Health for breast or cervical cancer screening.
26        "Medical assistance" under this paragraph 12 shall be



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1    identical to the benefits provided under the State's
2    approved plan under Title XIX of the Social Security Act.
3    The Department must request federal approval of the
4    coverage under this paragraph 12 within 30 days after the
5    effective date of this amendatory Act of the 92nd General
6    Assembly.
7        In addition to the persons who are eligible for medical
8    assistance pursuant to subparagraphs (1) and (2) of this
9    paragraph 12, and to be paid from funds appropriated to the
10    Department for its medical programs, any uninsured person
11    as defined by the Department in rules residing in Illinois
12    who is younger than 65 years of age, who has been screened
13    for breast and cervical cancer in accordance with standards
14    and procedures adopted by the Department of Public Health
15    for screening, and who is referred to the Department by the
16    Department of Public Health as being in need of treatment
17    for breast or cervical cancer is eligible for medical
18    assistance benefits that are consistent with the benefits
19    provided to those persons described in subparagraphs (1)
20    and (2). Medical assistance coverage for the persons who
21    are eligible under the preceding sentence is not dependent
22    on federal approval, but federal moneys may be used to pay
23    for services provided under that coverage upon federal
24    approval.
25        13. Subject to appropriation and to federal approval,
26    persons living with HIV/AIDS who are not otherwise eligible



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1    under this Article and who qualify for services covered
2    under Section 5-5.04 as provided by the Illinois Department
3    by rule.
4        14. Subject to the availability of funds for this
5    purpose, the Department may provide coverage under this
6    Article to persons who reside in Illinois who are not
7    eligible under any of the preceding paragraphs and who meet
8    the income guidelines of paragraph 2(a) of this Section and
9    (i) have an application for asylum pending before the
10    federal Department of Homeland Security or on appeal before
11    a court of competent jurisdiction and are represented
12    either by counsel or by an advocate accredited by the
13    federal Department of Homeland Security and employed by a
14    not-for-profit organization in regard to that application
15    or appeal, or (ii) are receiving services through a
16    federally funded torture treatment center. Medical
17    coverage under this paragraph 14 may be provided for up to
18    24 continuous months from the initial eligibility date so
19    long as an individual continues to satisfy the criteria of
20    this paragraph 14. If an individual has an appeal pending
21    regarding an application for asylum before the Department
22    of Homeland Security, eligibility under this paragraph 14
23    may be extended until a final decision is rendered on the
24    appeal. The Department may adopt rules governing the
25    implementation of this paragraph 14.
26        15. Family Care Eligibility.



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1            (a) A caretaker relative who is 19 years of age or
2        older when countable income is at or below 185% of the
3        Federal Poverty Level Guidelines, as published
4        annually in the Federal Register, for the appropriate
5        family size. A person may not spend down to become
6        eligible under this paragraph 15.
7            (b) Eligibility shall be reviewed annually.
8            (c) Caretaker relatives enrolled under this
9        paragraph 15 in families with countable income above
10        150% and at or below 185% of the Federal Poverty Level
11        Guidelines shall be counted as family members and pay
12        premiums as established under the Children's Health
13        Insurance Program Act.
14            (d) Premiums shall be billed by and payable to the
15        Department or its authorized agent, on a monthly basis.
16            (e) The premium due date is the last day of the
17        month preceding the month of coverage.
18            (f) Individuals shall have a grace period through
19        30 days of coverage to pay the premium.
20            (g) Failure to pay the full monthly premium by the
21        last day of the grace period shall result in
22        termination of coverage.
23            (h) Partial premium payments shall not be
24        refunded.
25            (i) Following termination of an individual's
26        coverage under this paragraph 15, the following action



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1        is required before the individual can be re-enrolled:
2                (1) A new application must be completed and the
3            individual must be determined otherwise eligible.
4                (2) There must be full payment of premiums due
5            under this Code, the Children's Health Insurance
6            Program Act, the Covering ALL KIDS Health
7            Insurance Act, or any other healthcare program
8            administered by the Department for periods in
9            which a premium was owed and not paid for the
10            individual.
11                (3) The first month's premium must be paid if
12            there was an unpaid premium on the date the
13            individual's previous coverage was canceled.
14        The Department is authorized to implement the
15    provisions of this amendatory Act of the 95th General
16    Assembly by adopting the medical assistance rules in effect
17    as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
18    89 Ill. Admin. Code 120.32 along with only those changes
19    necessary to conform to federal Medicaid requirements,
20    federal laws, and federal regulations, including but not
21    limited to Section 1931 of the Social Security Act (42
22    U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
23    of Health and Human Services, and the countable income
24    eligibility standard authorized by this paragraph 15. The
25    Department may not otherwise adopt any rule to implement
26    this increase except as authorized by law, to meet the



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1    eligibility standards authorized by the federal government
2    in the Medicaid State Plan or the Title XXI Plan, or to
3    meet an order from the federal government or any court.
4        16. Subject to appropriation, uninsured persons who
5    are not otherwise eligible under this Section who have been
6    certified and referred by the Department of Public Health
7    as having been screened and found to need diagnostic
8    evaluation or treatment, or both diagnostic evaluation and
9    treatment, for prostate or testicular cancer. For the
10    purposes of this paragraph 16, uninsured persons are those
11    who do not have creditable coverage, as defined under the
12    Health Insurance Portability and Accountability Act, or
13    have otherwise exhausted any insurance benefits they may
14    have had, for prostate or testicular cancer diagnostic
15    evaluation or treatment, or both diagnostic evaluation and
16    treatment. To be eligible, a person must furnish a Social
17    Security number. A person's assets are exempt from
18    consideration in determining eligibility under this
19    paragraph 16. Such persons shall be eligible for medical
20    assistance under this paragraph 16 for so long as they need
21    treatment for the cancer. A person shall be considered to
22    need treatment if, in the opinion of the person's treating
23    physician, the person requires therapy directed toward
24    cure or palliation of prostate or testicular cancer,
25    including recurrent metastatic cancer that is a known or
26    presumed complication of prostate or testicular cancer and



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1    complications resulting from the treatment modalities
2    themselves. Persons who require only routine monitoring
3    services are not considered to need treatment. "Medical
4    assistance" under this paragraph 16 shall be identical to
5    the benefits provided under the State's approved plan under
6    Title XIX of the Social Security Act. Notwithstanding any
7    other provision of law, the Department (i) does not have a
8    claim against the estate of a deceased recipient of
9    services under this paragraph 16 and (ii) does not have a
10    lien against any homestead property or other legal or
11    equitable real property interest owned by a recipient of
12    services under this paragraph 16.
13    In implementing the provisions of Public Act 96-20, the
14Department is authorized to adopt only those rules necessary,
15including emergency rules. Nothing in Public Act 96-20 permits
16the Department to adopt rules or issue a decision that expands
17eligibility for the FamilyCare Program to a person whose income
18exceeds 185% of the Federal Poverty Level as determined from
19time to time by the U.S. Department of Health and Human
20Services, unless the Department is provided with express
21statutory authority.
22    The Illinois Department and the Governor shall provide a
23plan for coverage of the persons eligible under paragraph 7 as
24soon as possible after July 1, 1984.
25    The eligibility of any such person for medical assistance
26under this Article is not affected by the payment of any grant



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1under the Senior Citizens and Disabled Persons Property Tax
2Relief and Pharmaceutical Assistance Act or any distributions
3or items of income described under subparagraph (X) of
4paragraph (2) of subsection (a) of Section 203 of the Illinois
5Income Tax Act. The Department shall by rule establish the
6amounts of assets to be disregarded in determining eligibility
7for medical assistance, which shall at a minimum equal the
8amounts to be disregarded under the Federal Supplemental
9Security Income Program. The amount of assets of a single
10person to be disregarded shall not be less than $2,000, and the
11amount of assets of a married couple to be disregarded shall
12not be less than $3,000.
13    To the extent permitted under federal law, any person found
14guilty of a second violation of Article VIIIA shall be
15ineligible for medical assistance under this Article, as
16provided in Section 8A-8.
17    The eligibility of any person for medical assistance under
18this Article shall not be affected by the receipt by the person
19of donations or benefits from fundraisers held for the person
20in cases of serious illness, as long as neither the person nor
21members of the person's family have actual control over the
22donations or benefits or the disbursement of the donations or
24(Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09;
2596-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff.
268-11-09; 96-567, eff. 1-1-10; 96-1000, eff. 7-2-10; 96-1123,



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1eff. 1-1-11; 96-1270, eff. 7-26-10; revised 9-16-10.)