HB5113 Engrossed LRB096 18588 KTG 33970 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, 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             At no time shall the Department of Healthcare and
3         Family Services, the Department of Human Services, the
4         Department on Aging, or any other State agency utilize
5         a third-party managed care organization, a health
6         maintenance organization, or any similar provider to
7         administer or pay for any and all benefits made
8         available to those persons eligible under Article III,
9         unless the third party has an existing contractual
10         relationship with the State to provide benefits to
11         those persons eligible under Article III on or before
12         December 31, 2009. Nothing in this subparagraph (a)
13         shall prohibit the Department from contracting with
14         vendors to continue the operation of care or disease
15         management programs that existed prior to December 31,
16         2009. This provision does not apply to programs
17         administered by the Department on Aging if federal law
18         or regulations require that any willing and qualified
19         providers be granted access to the program.
20             (b) All persons who, excluding any eligibility
21         requirements that are inconsistent with any federal
22         law or federal regulation, as interpreted by the U.S.
23         Department of Health and Human Services, would be
24         determined eligible for such basic maintenance under
25         Article IV by disregarding the maximum earned income
26         permitted by 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 Illinois
26     Long-Term Care Partnership Program Act who meet the

 

 

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

 

 

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1     eligible for medical assistance coverage under applicable
2     provisions of the federal Social Security Act and the
3     federal Breast and Cervical Cancer Prevention and
4     Treatment Act of 2000. Those eligible persons are defined
5     to include, but not be limited to, the following persons:
6             (1) persons who have been screened for breast or
7         cervical cancer under the U.S. Centers for Disease
8         Control and Prevention Breast and Cervical Cancer
9         Program established under Title XV of the federal
10         Public Health Services Act in accordance with the
11         requirements of Section 1504 of that Act as
12         administered by the Illinois Department of Public
13         Health; and
14             (2) persons whose screenings under the above
15         program were funded in whole or in part by funds
16         appropriated to the Illinois Department of Public
17         Health for breast or cervical cancer screening.
18         "Medical assistance" under this paragraph 12 shall be
19     identical to the benefits provided under the State's
20     approved plan under Title XIX of the Social Security Act.
21     The Department must request federal approval of the
22     coverage under this paragraph 12 within 30 days after the
23     effective date of this amendatory Act of the 92nd General
24     Assembly.
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         the month 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. 15. Subject to appropriation, uninsured persons
5     who are not otherwise eligible under this Section who have
6     been certified and referred by the Department of Public
7     Health 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 15, uninsured persons are
11     those who do not have creditable coverage, as defined under
12     the Health Insurance Portability and Accountability Act,
13     or 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 15. Such persons shall be eligible for medical
20     assistance under this paragraph 16 15 for so long as they
21     need treatment for the cancer. A person shall be considered
22     to need treatment if, in the opinion of the person's
23     treating physician, the person requires therapy directed
24     toward 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 15 shall be identical
5     to the benefits provided under the State's approved plan
6     under Title XIX of the Social Security Act. Notwithstanding
7     any other provision of law, the Department (i) does not
8     have a claim against the estate of a deceased recipient of
9     services under this paragraph 16 15 and (ii) does not have
10     a 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 15.
13     In implementing the provisions of Public Act 96-20 this
14 amendatory Act of the 96th General Assembly, the Department is
15 authorized to adopt only those rules necessary, including
16 emergency rules. Nothing in Public Act 96-20 this amendatory
17 Act of the 96th General Assembly permits the Department to
18 adopt rules or issue a decision that expands eligibility for
19 the FamilyCare Program to a person whose income exceeds 185% of
20 the Federal Poverty Level as determined from time to time by
21 the U.S. Department of Health and Human Services, unless the
22 Department is provided with express statutory authority.
23     The Illinois Department and the Governor shall provide a
24 plan for coverage of the persons eligible under paragraph 7 as
25 soon as possible after July 1, 1984.
26     The eligibility of any such person for medical assistance

 

 

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1 under this Article is not affected by the payment of any grant
2 under the Senior Citizens and Disabled Persons Property Tax
3 Relief and Pharmaceutical Assistance Act or any distributions
4 or items of income described under subparagraph (X) of
5 paragraph (2) of subsection (a) of Section 203 of the Illinois
6 Income Tax Act. The Department shall by rule establish the
7 amounts of assets to be disregarded in determining eligibility
8 for medical assistance, which shall at a minimum equal the
9 amounts to be disregarded under the Federal Supplemental
10 Security Income Program. The amount of assets of a single
11 person to be disregarded shall not be less than $2,000, and the
12 amount of assets of a married couple to be disregarded shall
13 not be less than $3,000.
14     To the extent permitted under federal law, any person found
15 guilty of a second violation of Article VIIIA shall be
16 ineligible for medical assistance under this Article, as
17 provided in Section 8A-8.
18     The eligibility of any person for medical assistance under
19 this Article shall not be affected by the receipt by the person
20 of donations or benefits from fundraisers held for the person
21 in cases of serious illness, as long as neither the person nor
22 members of the person's family have actual control over the
23 donations or benefits or the disbursement of the donations or
24 benefits.
25 (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09;
26 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff.

 

 

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1 8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
 
2     Section 99. Effective date. This Act takes effect upon
3 becoming law.