HB5969 Engrossed LRB095 18231 DRJ 44315 b

1     AN ACT concerning public aid.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Illinois Public Aid Code is amended by
5 changing 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
8 under this Article shall be available to any of the following
9 classes of persons in respect to whom a plan for coverage has
10 been submitted to the Governor by the Illinois Department and
11 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 but who fail to qualify
16     thereunder on the basis of need, and who have insufficient
17     income and resources to meet the costs of necessary medical
18     care, including but not limited to the following:
19             (a) All persons otherwise eligible for basic
20         maintenance under Article III but who fail to qualify
21         under that Article on the basis of need and who meet
22         either of the following requirements:
23                 (i) their income, as determined by the

 

 

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

 

 

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1         3. Persons who would otherwise qualify for Aid to the
2     Medically Indigent under Article VII.
3         4. Persons not eligible under any of the preceding
4     paragraphs who fall sick, are injured, or die, not having
5     sufficient money, property or other resources to meet the
6     costs of necessary medical care or funeral and burial
7     expenses.
8         5.(a) Women during pregnancy, after the fact of
9     pregnancy has been determined by medical diagnosis, and
10     during the 60-day period beginning on the last day of the
11     pregnancy, together with their infants and children born
12     after September 30, 1983, whose income and resources are
13     insufficient to meet the costs of necessary medical care to
14     the maximum extent possible under Title XIX of the Federal
15     Social Security Act.
16         (b) The Illinois Department and the Governor shall
17     provide a plan for coverage of the persons eligible under
18     paragraph 5(a) by April 1, 1990. Such plan shall provide
19     ambulatory prenatal care to pregnant women during a
20     presumptive eligibility period and establish an income
21     eligibility standard that is equal to 133% of the nonfarm
22     income official poverty line, as defined by the federal
23     Office of Management and Budget and revised annually in
24     accordance with Section 673(2) of the Omnibus Budget
25     Reconciliation Act of 1981, applicable to families of the
26     same size, provided that costs incurred for medical care

 

 

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1     are not taken into account in determining such income
2     eligibility.
3         (c) The Illinois Department may conduct a
4     demonstration in at least one county that will provide
5     medical assistance to pregnant women, together with their
6     infants and children up to one year of age, where the
7     income eligibility standard is set up to 185% of the
8     nonfarm income official poverty line, as defined by the
9     federal Office of Management and Budget. The Illinois
10     Department shall seek and obtain necessary authorization
11     provided under federal law to implement such a
12     demonstration. Such demonstration may establish resource
13     standards that are not more restrictive than those
14     established under Article IV of this Code.
15         6. Persons under the age of 18 who fail to qualify as
16     dependent under Article IV and who have insufficient income
17     and resources to meet the costs of necessary medical care
18     to the maximum extent permitted under Title XIX of the
19     Federal Social Security Act.
20         7. Persons who are under 21 years of age and would
21     qualify as disabled as defined under the Federal
22     Supplemental Security Income Program, provided medical
23     service for such persons would be eligible for Federal
24     Financial Participation, and provided the Illinois
25     Department determines that:
26             (a) the person requires a level of care provided by

 

 

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1         a hospital, skilled nursing facility, or intermediate
2         care facility, as determined by a physician licensed to
3         practice medicine in all its branches;
4             (b) it is appropriate to provide such care outside
5         of an institution, as determined by a physician
6         licensed to practice medicine in all its branches;
7             (c) the estimated amount which would be expended
8         for care outside the institution is not greater than
9         the estimated amount which would be expended in an
10         institution.
11         8. Persons who become ineligible for basic maintenance
12     assistance under Article IV of this Code in programs
13     administered by the Illinois Department due to employment
14     earnings and persons in assistance units comprised of
15     adults and children who become ineligible for basic
16     maintenance assistance under Article VI of this Code due to
17     employment earnings. The plan for coverage for this class
18     of persons shall:
19             (a) extend the medical assistance coverage for up
20         to 12 months following termination of basic
21         maintenance assistance; and
22             (b) offer persons who have initially received 6
23         months of the coverage provided in paragraph (a) above,
24         the option of receiving an additional 6 months of
25         coverage, subject to the following:
26                 (i) such coverage shall be pursuant to

 

 

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1             provisions of the federal Social Security Act;
2                 (ii) such coverage shall include all services
3             covered while the person was eligible for basic
4             maintenance assistance;
5                 (iii) no premium shall be charged for such
6             coverage; and
7                 (iv) such coverage shall be suspended in the
8             event of a person's failure without good cause to
9             file in a timely fashion reports required for this
10             coverage under the Social Security Act and
11             coverage shall be reinstated upon the filing of
12             such reports if the person remains otherwise
13             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
18     the level of care provided in an inpatient hospital,
19     skilled nursing facility or intermediate care facility the
20     cost of which is reimbursed under this Article. Assistance
21     shall be provided to such persons to the maximum extent
22     permitted under Title XIX of the Federal Social Security
23     Act.
24         10. Participants in the long-term care insurance
25     partnership program established under the Partnership for
26     Long-Term Care Act who meet the qualifications for

 

 

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1     protection of resources described in Section 25 of that
2     Act.
3         11. Persons with disabilities who are employed and
4     eligible for Medicaid, pursuant to Section
5     1902(a)(10)(A)(ii)(xv) of the Social Security Act, as
6     provided by the Illinois Department by rule. In
7     establishing eligibility standards under this paragraph
8     11, the Department shall, subject to federal approval:
9             (a) set the income eligibility standard at not
10         lower than 350% of the federal poverty level;
11             (b) exempt retirement accounts that the person
12         cannot access without penalty before the age of 59 1/2,
13         and medical savings accounts established pursuant to
14         26 U.S.C. 220;
15             (c) allow non-exempt assets up to $25,000 as to
16         those assets accumulated during periods of eligibility
17         under this paragraph 11; and
18             (d) continue to apply subparagraphs (b) and (c) in
19         determining the eligibility of the person under this
20         Article even if the person loses eligibility under this
21         paragraph 11.
22         12. Subject to federal approval, persons who are
23     eligible for medical assistance coverage under applicable
24     provisions of the federal Social Security Act and the
25     federal Breast and Cervical Cancer Prevention and
26     Treatment Act of 2000. Those eligible persons are defined

 

 

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1     to include, but not be limited to, the following persons:
2             (1) persons who have been screened for breast or
3         cervical cancer under the U.S. Centers for Disease
4         Control and Prevention Breast and Cervical Cancer
5         Program established under Title XV of the federal
6         Public Health Services Act in accordance with the
7         requirements of Section 1504 of that Act as
8         administered by the Illinois Department of Public
9         Health; and
10             (2) persons whose screenings under the above
11         program were funded in whole or in part by funds
12         appropriated to the Illinois Department of Public
13         Health for breast or cervical cancer screening.
14         "Medical assistance" under this paragraph 12 shall be
15     identical to the benefits provided under the State's
16     approved plan under Title XIX of the Social Security Act.
17     The Department must request federal approval of the
18     coverage under this paragraph 12 within 30 days after the
19     effective date of this amendatory Act of the 92nd General
20     Assembly.
21         In addition to the women who are eligible for medical
22     assistance pursuant to subparagraphs (1) and (2) of this
23     paragraph 12, all uninsured women residing in Illinois who
24     are at least 35 years of age but less than 65 years of age
25     are eligible for medical assistance benefits that are
26     consistent with the benefits provided to those women

 

 

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

 

 

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1     this paragraph 14. If an individual has an appeal pending
2     regarding an application for asylum before the Department
3     of Homeland Security, eligibility under this paragraph 14
4     may be extended until a final decision is rendered on the
5     appeal. The Department may adopt rules governing the
6     implementation of this paragraph 14.
7     The Illinois Department and the Governor shall provide a
8 plan for coverage of the persons eligible under paragraph 7 as
9 soon as possible after July 1, 1984.
10     The eligibility of any such person for medical assistance
11 under this Article is not affected by the payment of any grant
12 under the Senior Citizens and Disabled Persons Property Tax
13 Relief and Pharmaceutical Assistance Act or any distributions
14 or items of income described under subparagraph (X) of
15 paragraph (2) of subsection (a) of Section 203 of the Illinois
16 Income Tax Act. The Department shall by rule establish the
17 amounts of assets to be disregarded in determining eligibility
18 for medical assistance, which shall at a minimum equal the
19 amounts to be disregarded under the Federal Supplemental
20 Security Income Program. The amount of assets of a single
21 person to be disregarded shall not be less than $2,000, and the
22 amount of assets of a married couple to be disregarded shall
23 not be less than $3,000.
24     To the extent permitted under federal law, any person found
25 guilty of a second violation of Article VIIIA shall be
26 ineligible for medical assistance under this Article, as

 

 

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1 provided in Section 8A-8.
2     The eligibility of any person for medical assistance under
3 this Article shall not be affected by the receipt by the person
4 of donations or benefits from fundraisers held for the person
5 in cases of serious illness, as long as neither the person nor
6 members of the person's family have actual control over the
7 donations or benefits or the disbursement of the donations or
8 benefits.
9     Notwithstanding any other rulemaking authority that may
10 exist, neither the Governor nor any agency or agency head under
11 the jurisdiction of the Governor has any authority to make or
12 promulgate rules to implement or enforce the provisions of this
13 amendatory Act of the 95th General Assembly. If, however, the
14 Governor believes that rules are necessary to implement or
15 enforce the provisions of this amendatory Act of the 95th
16 General Assembly, the Governor may suggest rules to the General
17 Assembly by filing them with the Clerk of the House and
18 Secretary of the Senate and by requesting that the General
19 Assembly authorize such rulemaking by law, enact those
20 suggested rules into law, or take any other appropriate action
21 in the General Assembly's discretion. Nothing contained in this
22 amendatory Act of the 95th General Assembly shall be
23 interpreted to grant rulemaking authority under any other
24 Illinois statute where such authority is not otherwise
25 explicitly given. For the purposes of this amendatory Act of
26 the 95th General Assembly, "rules" is given the meaning

 

 

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1 contained in Section 1-70 of the Illinois Administrative
2 Procedure Act, and "agency" and "agency head" are given the
3 meanings contained in Sections 1-20 and 1-25 of the Illinois
4 Administrative Procedure Act to the extent that such
5 definitions apply to agencies or agency heads under the
6 jurisdiction of the Governor.
7 (Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06;
8 95-546, eff. 8-29-07.)
 
9     Section 99. Effective date. This Act takes effect upon
10 becoming law.