State of Illinois
90th General Assembly
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90_HB0442

      305 ILCS 5/5-2            from Ch. 23, par. 5-2
          Amends the Public Aid Code.  Requires the  Department  of
      Public  Aid  and  the Governor to provide a plan for Medicaid
      coverage of women during and up to 60 days after pregnancy by
      July 1, 1997 (now, April 1, 1990).  Requires  that  the  plan
      establish  an income eligibility standard equal to 185% (now,
      133%) of the federal poverty line.  Effective immediately.
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 1        AN ACT to amend the Illinois Public Aid Code by  changing
 2    Section 5-2.
 3        Be  it  enacted  by  the People of the State of Illinois,
 4    represented in the General Assembly:
 5        Section 5.  The Illinois Public Aid Code  is  amended  by
 6    changing Section 5-2 as follows:
 7        (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
 8        Sec.   5-2.  Classes   of   Persons   Eligible.   Medical
 9    assistance under this Article shall be available  to  any  of
10    the  following  classes  of persons in respect to whom a plan
11    for coverage has  been  submitted  to  the  Governor  by  the
12    Illinois Department and approved by him:
13        1.  Recipients of basic maintenance grants under Articles
14    III and IV.
15        2.  Persons  otherwise  eligible  for  basic  maintenance
16    under  Articles III and IV but who fail to qualify thereunder
17    on the basis of need, and who have  insufficient  income  and
18    resources  to  meet  the  costs  of  necessary  medical care,
19    including but not  limited  to,  all  persons  who  would  be
20    determined  eligible for such basic maintenance under Article
21    IV by disregarding the maximum  earned  income  permitted  by
22    federal law.
23        3.  Persons  who  would  otherwise qualify for Aid to the
24    Medically Indigent under Article VII.
25        4.  Persons not  eligible  under  any  of  the  preceding
26    paragraphs  who  fall  sick,  are injured, or die, not having
27    sufficient money, property or other  resources  to  meet  the
28    costs  of  necessary  medical  care  or  funeral  and  burial
29    expenses.
30        5. (a)  Women   during   pregnancy,  after  the  fact  of
31        pregnancy has been determined by medical  diagnosis,  and
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 1        during the 60-day period beginning on the last day of the
 2        pregnancy,  together with their infants and children born
 3        after September 30, 1983, whose income and resources  are
 4        insufficient  to meet the costs of necessary medical care
 5        to the maximum extent possible under  Title  XIX  of  the
 6        Federal Social Security Act.
 7             (b)  The  Illinois Department and the Governor shall
 8        provide a plan for coverage of the persons eligible under
 9        paragraph 5(a) by July April 1,  1997  1990.   Such  plan
10        shall  provide ambulatory prenatal care to pregnant women
11        during a presumptive eligibility period and establish  an
12        income eligibility standard that is equal to 185% 133% of
13        the  nonfarm  income official poverty line, as defined by
14        the federal Office of Management and Budget  and  revised
15        annually in accordance with Section 673(2) of the Omnibus
16        Budget Reconciliation Act of 1981, applicable to families
17        of  the  same  size,  provided  that  costs  incurred for
18        medical care are not taken into  account  in  determining
19        such income eligibility.
20             (c)  The   Illinois   Department   may   conduct   a
21        demonstration  in  at  least one county that will provide
22        medical assistance to pregnant women, together with their
23        infants and children up to one year  of  age,  where  the
24        income  eligibility  standard  is  set  up to 185% of the
25        nonfarm income official poverty line, as defined  by  the
26        federal  Office  of  Management and Budget.  The Illinois
27        Department shall seek and obtain necessary  authorization
28        provided   under   federal   law   to  implement  such  a
29        demonstration.  Such demonstration may establish resource
30        standards  that  are  not  more  restrictive  than  those
31        established under Article IV of this Code.
32        6.  Persons under the age of 18 who fail  to  qualify  as
33    dependent  under  Article IV and who have insufficient income
34    and resources to meet the costs of necessary medical care  to
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 1    the  maximum  extent permitted under Title XIX of the Federal
 2    Social Security Act.
 3        7.  Persons who are 18 years of age or younger and  would
 4    qualify as disabled as defined under the Federal Supplemental
 5    Security  Income  Program,  provided medical service for such
 6    persons   would   be   eligible   for    Federal    Financial
 7    Participation,   and   provided   the   Illinois   Department
 8    determines that:
 9             (a)  the person requires a level of care provided by
10        a  hospital,  skilled  nursing  facility, or intermediate
11        care facility, as determined by a physician  licensed  to
12        practice medicine in all its branches;
13             (b)  it  is appropriate to provide such care outside
14        of an institution, as determined by a physician  licensed
15        to practice medicine in all its branches;
16             (c)  the  estimated  amount  which would be expended
17        for care outside the institution is not greater than  the
18        estimated   amount   which   would   be  expended  in  an
19        institution.
20        8.  Persons who become ineligible for  basic  maintenance
21    assistance   under  Article  IV  of  this  Code  in  programs
22    administered by the Illinois  Department  due  to  employment
23    earnings  and persons in assistance units comprised of adults
24    and children who  become  ineligible  for  basic  maintenance
25    assistance  under  Article  VI of this Code due to employment
26    earnings.  The plan for coverage for this  class  of  persons
27    shall:
28             (a)  extend  the  medical assistance coverage for up
29        to 12 months following termination of  basic  maintenance
30        assistance; and
31             (b)  offer  persons  who  have  initially received 6
32        months of the coverage provided in paragraph  (a)  above,
33        the  option  of  receiving  an  additional  6  months  of
34        coverage, subject to the following:
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 1                  (i)  such   coverage   shall   be  pursuant  to
 2             provisions of the federal Social Security Act;
 3                  (ii)  such coverage shall include all  services
 4             covered  while  the  person  was  eligible for basic
 5             maintenance assistance;
 6                  (iii)  no premium shall  be  charged  for  such
 7             coverage; and
 8                  (iv)  such  coverage  shall be suspended in the
 9             event of a person's failure without  good  cause  to
10             file  in  a timely fashion reports required for this
11             coverage under the Social Security Act and  coverage
12             shall  be reinstated upon the filing of such reports
13             if the person remains otherwise eligible.
14        9.  Persons  with  acquired   immunodeficiency   syndrome
15    (AIDS)  or  with AIDS-related conditions with respect to whom
16    there  has  been  a  determination  that  but  for  home   or
17    community-based  services  such individuals would require the
18    level of care provided  in  an  inpatient  hospital,  skilled
19    nursing  facility  or  intermediate care facility the cost of
20    which is reimbursed under this Article.  Assistance shall  be
21    provided  to  such  persons  to  the maximum extent permitted
22    under Title XIX of the Federal Social Security Act.
23        10.  Participants  in  the   long-term   care   insurance
24    partnership  program  established  under  the Partnership for
25    Long-Term Care Act who meet the qualifications for protection
26    of resources described in Section 25 of that Act.
27        The Illinois Department and the Governor shall provide  a
28    plan  for  coverage of the persons eligible under paragraph 7
29    as soon as possible after July 1, 1984.
30        The eligibility of any such person for medical assistance
31    under this Article is not affected  by  the  payment  of  any
32    grant under the Senior Citizens and Disabled Persons Property
33    Tax Relief and Pharmaceutical Assistance Act.  The Department
34    shall   by  rule  establish  the  amounts  of  assets  to  be
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 1    disregarded   in   determining   eligibility   for    medical
 2    assistance,  which shall at a minimum equal the amounts to be
 3    disregarded under the Federal  Supplemental  Security  Income
 4    Program.   The  amount  of  assets  of  a single person to be
 5    disregarded shall not be less than $2,000, and the amount  of
 6    assets  of  a  married  couple to be disregarded shall not be
 7    less than $3,000.
 8        To the extent permitted under  federal  law,  any  person
 9    found  guilty of a second violation of Article VIIIA shall be
10    ineligible for medical  assistance  under  this  Article,  as
11    provided in Section 8A-8.
12        The  eligibility  of  any  person  for medical assistance
13    under this Article shall not be affected by  the  receipt  by
14    the person of donations or benefits from fundraisers held for
15    the  person  in  cases of serious illness, as long as neither
16    the person nor members of the  person's  family  have  actual
17    control over the donations or benefits or the disbursement of
18    the donations or benefits.
19    (Source: P.A. 89-525, eff. 7-19-96.)
20        Section  99.  Effective date.  This Act takes effect upon
21    becoming law.

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