Illinois General Assembly - Full Text of SB3294

LRB104 18099 KTG 31538 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3294

Introduced 2/3/2026, by Sen. Julie A. Morrison

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-2.03
305 ILCS 5/5-2.03a new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that any person who was initially determined to be eligible for medical assistance and is receiving institutional services or home and community-based services as authorized under the Article shall be presumed eligible for a continuation of coverage for such services during any redetermination process. Requires the Department of Healthcare and Family Services to continue to make payments for such services unless the person experiences a material change in financial circumstances that results in the loss of eligibility. Provides that if the person experiences a material change in financial circumstances that results in the loss of eligibility, the person, or the person's designated caregiver or responsible party, shall notify the Department. Provides that if the Department subsequently conducts a redetermination of eligibility, the Department must provide written notice to the person (i) before the commencement of the redetermination; and (ii) upon conclusion of the redetermination. Requires the Department to develop a process to facilitate the written notifications. Provides that no later than October 1, 2026, the Department shall seek federal authorization to exempt persons with disabilities who are eligible for medical assistance from annual redeterminations of eligibility, except that a full redetermination shall be conducted at least once every 5 years, regardless of whether a material change in financial circumstances has occurred. Effective immediately.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by changing Section 5-2.03 and by adding Section 5-2.03a as follows:

(305 ILCS 5/5-2.03)

Sec. 5-2.03. Presumptive eligibility. Except as provided in Section 5-2.03a Beginning on the effective date of this amendatory Act of the 96th General Assembly and except where federal law requires presumptive eligibility, no adult may be presumed eligible for medical assistance under this Code and the Department may not cover any service rendered to an adult unless the adult has completed an application for benefits, all required verifications have been received, and the Department or its designee has found the adult eligible for the date on which that service was provided. Nothing in this Section shall apply to pregnant women or to persons enrolled under the medical assistance program due to expansions approved by the federal government that are financed entirely by units of local government and federal matching funds.

(Source: P.A. 96-1501, eff. 1-25-11; 97-687, eff. 6-14-12.)

(305 ILCS 5/5-2.03a new)

Sec. 5-2.03a. Redeterminations of eligibility for certain persons.

(a) Any person who was initially determined to be eligible for medical assistance and is receiving institutional services or home and community-based services as authorized under this Article shall be presumed eligible for a continuation of coverage for such services during any redetermination process. The Department shall continue to make payments for such services unless the person experiences a material change in financial circumstances that results in the loss of eligibility.

(b) If the person experiences a material change in financial circumstances that results in the loss of eligibility, the person, or the person's designated caregiver or responsible party, shall notify the Department. The Department may conduct a redetermination of eligibility. If a redetermination is conducted, the Department must provide written notice to the person or to the person's designated caregiver or responsible party:

(1) before the commencement of the redetermination; and

(2) upon conclusion of the redetermination, including the results and the effective date of any eligibility change.

(c) No later than October 1, 2026, the Department shall seek federal authorization to exempt persons with disabilities who are eligible for medical assistance from annual redeterminations of eligibility, except that a full redetermination shall be conducted at least once every 5 years, regardless of whether a material change in financial circumstances has occurred.

(d) The Department shall develop a process to facilitate the notifications required under subsection (b).

Section 99. Effective date. This Act takes effect upon becoming law.