Rep. Delia C. Ramirez

Filed: 3/26/2019

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 72

2    AMENDMENT NO. ______. Amend House Bill 72 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-2 and 5-3 as follows:
 
6    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
7    Sec. 5-2. Classes of Persons Eligible.
8    Medical assistance under this Article shall be available to
9any of the following classes of persons in respect to whom a
10plan for coverage has been submitted to the Governor by the
11Illinois Department and approved by him. If changes made in
12this Section 5-2 require federal approval, they shall not take
13effect until such approval has been received:
14        1. Recipients of basic maintenance grants under
15    Articles III and IV.
16        2. Beginning January 1, 2014, persons otherwise

 

 

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1    eligible for basic maintenance under Article III,
2    excluding any eligibility requirements that are
3    inconsistent with any federal law or federal regulation, as
4    interpreted by the U.S. Department of Health and Human
5    Services, but who fail to qualify thereunder on the basis
6    of need, and who have insufficient income and resources to
7    meet the costs of necessary medical care, including but not
8    limited to the following:
9            (a) All persons otherwise eligible for basic
10        maintenance under Article III but who fail to qualify
11        under that Article on the basis of need and who meet
12        either of the following requirements:
13                (i) their income, as determined by the
14            Illinois Department in accordance with any federal
15            requirements, is equal to or less than 100% of the
16            federal poverty level; or
17                (ii) their income, after the deduction of
18            costs incurred for medical care and for other types
19            of remedial care, is equal to or less than 100% of
20            the federal poverty level.
21            (b) (Blank).
22        3. (Blank).
23        4. Persons not eligible under any of the preceding
24    paragraphs who fall sick, are injured, or die, not having
25    sufficient money, property or other resources to meet the
26    costs of necessary medical care or funeral and burial

 

 

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1    expenses.
2        5.(a) Women during pregnancy and during the 60-day
3    period beginning on the last day of the pregnancy, together
4    with their infants, whose income is at or below 200% of the
5    federal poverty level. Until September 30, 2019, or sooner
6    if the maintenance of effort requirements under the Patient
7    Protection and Affordable Care Act are eliminated or may be
8    waived before then, women during pregnancy and during the
9    60-day period beginning on the last day of the pregnancy,
10    whose countable monthly income, after the deduction of
11    costs incurred for medical care and for other types of
12    remedial care as specified in administrative rule, is equal
13    to or less than the Medical Assistance-No Grant(C)
14    (MANG(C)) Income Standard in effect on April 1, 2013 as set
15    forth in administrative rule.
16        (b) The plan for coverage shall provide ambulatory
17    prenatal care to pregnant women during a presumptive
18    eligibility period and establish an income eligibility
19    standard that is equal to 200% of the federal poverty
20    level, provided that costs incurred for medical care are
21    not taken into account in determining such income
22    eligibility.
23        (c) The Illinois Department may conduct a
24    demonstration in at least one county that will provide
25    medical assistance to pregnant women, together with their
26    infants and children up to one year of age, where the

 

 

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1    income eligibility standard is set up to 185% of the
2    nonfarm income official poverty line, as defined by the
3    federal Office of Management and Budget. The Illinois
4    Department shall seek and obtain necessary authorization
5    provided under federal law to implement such a
6    demonstration. Such demonstration may establish resource
7    standards that are not more restrictive than those
8    established under Article IV of this Code.
9        6. (a) Children younger than age 19 when countable
10    income is at or below 133% of the federal poverty level.
11    Until September 30, 2019, or sooner if the maintenance of
12    effort requirements under the Patient Protection and
13    Affordable Care Act are eliminated or may be waived before
14    then, children younger than age 19 whose countable monthly
15    income, after the deduction of costs incurred for medical
16    care and for other types of remedial care as specified in
17    administrative rule, is equal to or less than the Medical
18    Assistance-No Grant(C) (MANG(C)) Income Standard in effect
19    on April 1, 2013 as set forth in administrative rule.
20        (b) Children and youth who are under temporary custody
21    or guardianship of the Department of Children and Family
22    Services or who receive financial assistance in support of
23    an adoption or guardianship placement from the Department
24    of Children and Family Services.
25        7. (Blank).
26        8. As required under federal law, persons who are

 

 

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1    eligible for Transitional Medical Assistance as a result of
2    an increase in earnings or child or spousal support
3    received. The plan for coverage for this class of persons
4    shall:
5            (a) extend the medical assistance coverage to the
6        extent required by federal law; and
7            (b) offer persons who have initially received 6
8        months of the coverage provided in paragraph (a) above,
9        the option of receiving an additional 6 months of
10        coverage, subject to the following:
11                (i) such coverage shall be pursuant to
12            provisions of the federal Social Security Act;
13                (ii) such coverage shall include all services
14            covered under Illinois' State Medicaid Plan;
15                (iii) no premium shall be charged for such
16            coverage; and
17                (iv) such coverage shall be suspended in the
18            event of a person's failure without good cause to
19            file in a timely fashion reports required for this
20            coverage under the Social Security Act and
21            coverage shall be reinstated upon the filing of
22            such reports if the person remains otherwise
23            eligible.
24        9. Persons with acquired immunodeficiency syndrome
25    (AIDS) or with AIDS-related conditions with respect to whom
26    there has been a determination that but for home or

 

 

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

 

 

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1        and medical savings accounts established pursuant to
2        26 U.S.C. 220;
3            (c) allow non-exempt assets up to $25,000 as to
4        those assets accumulated during periods of eligibility
5        under this paragraph 11; and
6            (d) continue to apply subparagraphs (b) and (c) in
7        determining the eligibility of the person under this
8        Article even if the person loses eligibility under this
9        paragraph 11.
10        12. Subject to federal approval, persons who are
11    eligible for medical assistance coverage under applicable
12    provisions of the federal Social Security Act and the
13    federal Breast and Cervical Cancer Prevention and
14    Treatment Act of 2000. Those eligible persons are defined
15    to include, but not be limited to, the following persons:
16            (1) persons who have been screened for breast or
17        cervical cancer under the U.S. Centers for Disease
18        Control and Prevention Breast and Cervical Cancer
19        Program established under Title XV of the federal
20        Public Health Services Act in accordance with the
21        requirements of Section 1504 of that Act as
22        administered by the Illinois Department of Public
23        Health; and
24            (2) persons whose screenings under the above
25        program were funded in whole or in part by funds
26        appropriated to the Illinois Department of Public

 

 

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

 

 

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

 

 

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1    implementation of this paragraph 14.
2        15. Family Care Eligibility.
3            (a) On and after July 1, 2012, a parent or other
4        caretaker relative who is 19 years of age or older when
5        countable income is at or below 133% of the federal
6        poverty level. A person may not spend down to become
7        eligible under this paragraph 15.
8            (b) Eligibility shall be reviewed annually.
9            (c) (Blank).
10            (d) (Blank).
11            (e) (Blank).
12            (f) (Blank).
13            (g) (Blank).
14            (h) (Blank).
15            (i) Following termination of an individual's
16        coverage under this paragraph 15, the individual must
17        be determined eligible before the person can be
18        re-enrolled.
19        16. Subject to appropriation, uninsured persons who
20    are not otherwise eligible under this Section who have been
21    certified and referred by the Department of Public Health
22    as having been screened and found to need diagnostic
23    evaluation or treatment, or both diagnostic evaluation and
24    treatment, for prostate or testicular cancer. For the
25    purposes of this paragraph 16, uninsured persons are those
26    who do not have creditable coverage, as defined under the

 

 

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1    Health Insurance Portability and Accountability Act, or
2    have otherwise exhausted any insurance benefits they may
3    have had, for prostate or testicular cancer diagnostic
4    evaluation or treatment, or both diagnostic evaluation and
5    treatment. To be eligible, a person must furnish a Social
6    Security number. A person's assets are exempt from
7    consideration in determining eligibility under this
8    paragraph 16. Such persons shall be eligible for medical
9    assistance under this paragraph 16 for so long as they need
10    treatment for the cancer. A person shall be considered to
11    need treatment if, in the opinion of the person's treating
12    physician, the person requires therapy directed toward
13    cure or palliation of prostate or testicular cancer,
14    including recurrent metastatic cancer that is a known or
15    presumed complication of prostate or testicular cancer and
16    complications resulting from the treatment modalities
17    themselves. Persons who require only routine monitoring
18    services are not considered to need treatment. "Medical
19    assistance" under this paragraph 16 shall be identical to
20    the benefits provided under the State's approved plan under
21    Title XIX of the Social Security Act. Notwithstanding any
22    other provision of law, the Department (i) does not have a
23    claim against the estate of a deceased recipient of
24    services under this paragraph 16 and (ii) does not have a
25    lien against any homestead property or other legal or
26    equitable real property interest owned by a recipient of

 

 

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1    services under this paragraph 16.
2        17. Persons who, pursuant to a waiver approved by the
3    Secretary of the U.S. Department of Health and Human
4    Services, are eligible for medical assistance under Title
5    XIX or XXI of the federal Social Security Act.
6    Notwithstanding any other provision of this Code and
7    consistent with the terms of the approved waiver, the
8    Illinois Department, may by rule:
9            (a) Limit the geographic areas in which the waiver
10        program operates.
11            (b) Determine the scope, quantity, duration, and
12        quality, and the rate and method of reimbursement, of
13        the medical services to be provided, which may differ
14        from those for other classes of persons eligible for
15        assistance under this Article.
16            (c) Restrict the persons' freedom in choice of
17        providers.
18        18. Beginning January 1, 2014, persons aged 19 or
19    older, but younger than 65, who are not otherwise eligible
20    for medical assistance under this Section 5-2, who qualify
21    for medical assistance pursuant to 42 U.S.C.
22    1396a(a)(10)(A)(i)(VIII) and applicable federal
23    regulations, and who have income at or below 133% of the
24    federal poverty level plus 5% for the applicable family
25    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
26    applicable federal regulations. Persons eligible for

 

 

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1    medical assistance under this paragraph 18 shall receive
2    coverage for the Health Benefits Service Package as that
3    term is defined in subsection (m) of Section 5-1.1 of this
4    Code. If Illinois' federal medical assistance percentage
5    (FMAP) is reduced below 90% for persons eligible for
6    medical assistance under this paragraph 18, eligibility
7    under this paragraph 18 shall cease no later than the end
8    of the third month following the month in which the
9    reduction in FMAP takes effect.
10        19. Beginning January 1, 2014, as required under 42
11    U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
12    and younger than age 26 who are not otherwise eligible for
13    medical assistance under paragraphs (1) through (17) of
14    this Section who (i) were in foster care under the
15    responsibility of the State on the date of attaining age 18
16    or on the date of attaining age 21 when a court has
17    continued wardship for good cause as provided in Section
18    2-31 of the Juvenile Court Act of 1987 and (ii) received
19    medical assistance under the Illinois Title XIX State Plan
20    or waiver of such plan while in foster care.
21        20. Beginning January 1, 2018, persons who are
22    foreign-born victims of human trafficking, torture, or
23    other serious crimes as defined in Section 2-19 of this
24    Code and their derivative family members if such persons:
25    (i) reside in Illinois; (ii) are not eligible under any of
26    the preceding paragraphs; (iii) meet the income guidelines

 

 

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1    of subparagraph (a) of paragraph 2; and (iv) meet the
2    nonfinancial eligibility requirements of Sections 16-2,
3    16-3, and 16-5 of this Code. The Department may extend
4    medical assistance for persons who are foreign-born
5    victims of human trafficking, torture, or other serious
6    crimes whose medical assistance would be terminated
7    pursuant to subsection (b) of Section 16-5 if the
8    Department determines that the person, during the year of
9    initial eligibility (1) experienced a health crisis, (2)
10    has been unable, after reasonable attempts, to obtain
11    necessary information from a third party, or (3) has other
12    extenuating circumstances that prevented the person from
13    completing his or her application for status. The
14    Department may adopt any rules necessary to implement the
15    provisions of this paragraph.
16        21. Beginning January 1, 2020, persons who are
17    foreign-born and who: (i) reside in Illinois; (ii) are not
18    eligible under any of the preceding paragraphs; (iii) meet
19    the income guidelines of subparagraph (a) of paragraph 2;
20    (iv) meet the nonfinancial eligibility requirements of
21    Sections 16-2, 16-3, and 16-5 of this Code; and (v) have a
22    valid I-766 Employment Authorization Document pursuant to
23    Section 274a.13 of Title 8 of the Code of Federal
24    Regulations or a valid social security number issued by the
25    Social Security Administration. The Department may adopt
26    any rules necessary to implement the provisions of this

 

 

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1    paragraph.
2    In implementing the provisions of Public Act 96-20, the
3Department is authorized to adopt only those rules necessary,
4including emergency rules. Nothing in Public Act 96-20 permits
5the Department to adopt rules or issue a decision that expands
6eligibility for the FamilyCare Program to a person whose income
7exceeds 185% of the Federal Poverty Level as determined from
8time to time by the U.S. Department of Health and Human
9Services, unless the Department is provided with express
10statutory authority.
11    The eligibility of any such person for medical assistance
12under this Article is not affected by the payment of any grant
13under the Senior Citizens and Persons with Disabilities
14Property Tax Relief Act or any distributions or items of income
15described under subparagraph (X) of paragraph (2) of subsection
16(a) of Section 203 of the Illinois Income Tax Act.
17    The Department shall by rule establish the amounts of
18assets to be disregarded in determining eligibility for medical
19assistance, which shall at a minimum equal the amounts to be
20disregarded under the Federal Supplemental Security Income
21Program. The amount of assets of a single person to be
22disregarded shall not be less than $2,000, and the amount of
23assets of a married couple to be disregarded shall not be less
24than $3,000.
25    To the extent permitted under federal law, any person found
26guilty of a second violation of Article VIIIA shall be

 

 

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1ineligible for medical assistance under this Article, as
2provided in Section 8A-8.
3    The eligibility of any person for medical assistance under
4this Article shall not be affected by the receipt by the person
5of donations or benefits from fundraisers held for the person
6in cases of serious illness, as long as neither the person nor
7members of the person's family have actual control over the
8donations or benefits or the disbursement of the donations or
9benefits.
10    Notwithstanding any other provision of this Code, if the
11United States Supreme Court holds Title II, Subtitle A, Section
122001(a) of Public Law 111-148 to be unconstitutional, or if a
13holding of Public Law 111-148 makes Medicaid eligibility
14allowed under Section 2001(a) inoperable, the State or a unit
15of local government shall be prohibited from enrolling
16individuals in the Medical Assistance Program as the result of
17federal approval of a State Medicaid waiver on or after the
18effective date of this amendatory Act of the 97th General
19Assembly, and any individuals enrolled in the Medical
20Assistance Program pursuant to eligibility permitted as a
21result of such a State Medicaid waiver shall become immediately
22ineligible.
23    Notwithstanding any other provision of this Code, if an Act
24of Congress that becomes a Public Law eliminates Section
252001(a) of Public Law 111-148, the State or a unit of local
26government shall be prohibited from enrolling individuals in

 

 

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1the Medical Assistance Program as the result of federal
2approval of a State Medicaid waiver on or after the effective
3date of this amendatory Act of the 97th General Assembly, and
4any individuals enrolled in the Medical Assistance Program
5pursuant to eligibility permitted as a result of such a State
6Medicaid waiver shall become immediately ineligible.
7    Effective October 1, 2013, the determination of
8eligibility of persons who qualify under paragraphs 5, 6, 8,
915, 17, and 18 of this Section shall comply with the
10requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
11regulations.
12    The Department of Healthcare and Family Services, the
13Department of Human Services, and the Illinois health insurance
14marketplace shall work cooperatively to assist persons who
15would otherwise lose health benefits as a result of changes
16made under this amendatory Act of the 98th General Assembly to
17transition to other health insurance coverage.
18(Source: P.A. 98-104, eff. 7-22-13; 98-463, eff. 8-16-13;
1999-143, eff. 7-27-15; 99-870, eff. 8-22-16.)
 
20    (305 ILCS 5/5-3)  (from Ch. 23, par. 5-3)
21    Sec. 5-3. Residence.) Any person who has established his
22residence in this State and lives therein, including any person
23who is a migrant worker, any person who has a valid I-766
24Employment Authorization Document pursuant to Section 274a.13
25of Title 8 of the Code of Federal Regulations, or any person

 

 

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1with a valid social security number issued by the Social
2Security Administration, may qualify for medical assistance. A
3person who, while temporarily in this State, suffers injury or
4illness endangering his life and health and necessitating
5emergency care, may also qualify.
6    Temporary absence from the State shall not disqualify a
7person from maintaining his eligibility under this Article.
8    As used in this Section, "migrant worker" means any person
9residing temporarily and employed in Illinois who moves
10seasonally from one place to another for the purpose of
11employment in agricultural activities, including the planting,
12raising or harvesting of any agricultural or horticultural
13commodities and the handling, packing or processing of such
14commodities on the farm where produced or at the point of first
15processing, in animal husbandry, or in other activities
16connected with the care of animals. Dependents of such person
17shall be considered eligible if they are living with the person
18during his or her temporary residence and employment in
19Illinois.
20    In order to be eligible for medical assistance under this
21Section section, each person migrant worker shall show proof of
22citizenship or legal alien status, or a valid I-766 Employment
23Authorization Document pursuant to Section 274a.13 of Title 8
24of the Code of Federal Regulations, or a valid social security
25number issued by the Social Security Administration.
26(Source: P.A. 81-746.)".