97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB0018

 

Introduced 1/12/2011, by Rep. Jil Tracy

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 170/20

    Amends the Covering ALL KIDS Health Insurance Act. In the provision concerning eligibility, adds the requirement that a person must be a child who has a household income equal to or less than 300% of the federal poverty guidelines. Provides that a child who is determined to be eligible shall remain eligible for 12 months, provided that the child has not gained access to affordable employer-sponsored dependent health insurance. Provides that the parent, guardian, or legal custodian of an enrolled child shall report promptly those changes in income and other circumstances that affect eligibility within 30 days after the occurrence of the change. Provides that the eligibility of a child may be redetermined based on the information reported or may be terminated based on the failure to report or failure to report accurately.


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A BILL FOR

 

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1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Covering ALL KIDS Health Insurance Act is
5amended by changing Sections 20 and 25 as follows:
 
6    (215 ILCS 170/20)
7    (Section scheduled to be repealed on July 1, 2011)
8    Sec. 20. Eligibility.
9    (a) To be eligible for the Program, a person must be a
10child:
11        (1) who is a resident of the State of Illinois; and
12        (2) who is ineligible for medical assistance under the
13    Illinois Public Aid Code or benefits under the Children's
14    Health Insurance Program Act; and
15        (3) either (i) who has been without health insurance
16    coverage for a period set forth by the Department in rules,
17    but not less than 6 months during the first month of
18    operation of the Program, 7 months during the second month
19    of operation, 8 months during the third month of operation,
20    9 months during the fourth month of operation, 10 months
21    during the fifth month of operation, 11 months during the
22    sixth month of operation, and 12 months thereafter, (ii)
23    whose parent has lost employment that made available

 

 

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1    affordable dependent health insurance coverage, until such
2    time as affordable employer-sponsored dependent health
3    insurance coverage is again available for the child as set
4    forth by the Department in rules, (iii) who is a newborn
5    whose responsible relative does not have available
6    affordable private or employer-sponsored health insurance,
7    or (iv) who, within one year of applying for coverage under
8    this Act, lost medical benefits under the Illinois Public
9    Aid Code or the Children's Health Insurance Program Act;
10    and .
11        (4) who has a household income equal to or less than
12    300% of the federal poverty guidelines as determined
13    annually by the U.S. Department of Health and Human
14    Services.
15    An entity that provides health insurance coverage (as
16defined in Section 2 of the Comprehensive Health Insurance Plan
17Act) to Illinois residents shall provide health insurance data
18match to the Department of Healthcare and Family Services for
19the purpose of determining eligibility for the Program under
20this Act.
21    The Department of Healthcare and Family Services, in
22collaboration with the Department of Financial and
23Professional Regulation, Division of Insurance, shall adopt
24rules governing the exchange of information under this Section.
25The rules shall be consistent with all laws relating to the
26confidentiality or privacy of personal information or medical

 

 

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1records, including provisions under the Federal Health
2Insurance Portability and Accountability Act (HIPAA).
3    (b) The Department shall monitor the availability and
4retention of employer-sponsored dependent health insurance
5coverage and shall modify the period described in subdivision
6(a)(3) if necessary to promote retention of private or
7employer-sponsored health insurance and timely access to
8healthcare services, but at no time shall the period described
9in subdivision (a)(3) be less than 6 months.
10    (c) The Department, at its discretion, may take into
11account the affordability of dependent health insurance when
12determining whether employer-sponsored dependent health
13insurance coverage is available upon reemployment of a child's
14parent as provided in subdivision (a)(3).
15    (d) A child who is determined to be eligible for the
16Program shall remain eligible for 12 months, provided that the
17child maintains his or her residence in this State, has not yet
18attained 19 years of age, has not gained access to affordable
19employer-sponsored dependent health insurance coverage, and is
20not excluded under subsection (e).
21    (e) A child is not eligible for coverage under the Program
22if:
23        (1) the premium required under Section 40 has not been
24    timely paid; if the required premiums are not paid, the
25    liability of the Program shall be limited to benefits
26    incurred under the Program for the time period for which

 

 

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1    premiums have been paid; re-enrollment shall be completed
2    before the next covered medical visit, and the first
3    month's required premium shall be paid in advance of the
4    next covered medical visit; or
5        (2) the child is an inmate of a public institution or
6    an institution for mental diseases.
7    (f) The Department shall adopt eligibility rules,
8including, but not limited to: rules regarding annual renewals
9of eligibility for the Program; rules providing for
10re-enrollment, grace periods, notice requirements, and hearing
11procedures under subdivision (e)(1) of this Section; and rules
12regarding what constitutes availability and affordability of
13private or employer-sponsored health insurance, with
14consideration of such factors as the percentage of income
15needed to purchase children or family health insurance, the
16availability of employer subsidies, and other relevant
17factors.
18    (g) The parent, guardian, or legal custodian of an enrolled
19child shall report promptly those changes in income and other
20circumstances, including availability of affordable
21employer-sponsored dependent health insurance coverage, that
22affect eligibility within 30 days after the occurrence of the
23change. The eligibility of a child may be redetermined based on
24the information reported or may be terminated based on the
25failure to report or failure to report accurately.
26(Source: P.A. 96-1272, eff. 1-1-11.)