97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB3093

 

Introduced 2/23/2011, by Rep. Michael W. Tryon

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 170/20

    Amends the Covering ALL KIDS Health Insurance Act. In the provision concerning eligibility, provides that the Department of Healthcare and Family Services, in cooperation with the Department of Human Services, shall develop and implement procedures in administration of the Covering ALL KIDS Health Insurance Program to require certain proofs of eligibility from applicants; cross reference income reported by applicants; and require the termination of coverage if certain premiums have not been paid pursuant to a grace period. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

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 Section 20 as follows:
 
6    (215 ILCS 170/20)
7    (Section scheduled to be repealed on July 1, 2016)
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;
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;
15        (3) either (i) who has been without health insurance
16    coverage for 12 months, (ii) whose parent has lost
17    employment that made available affordable dependent health
18    insurance coverage, until such time as affordable
19    employer-sponsored dependent health insurance coverage is
20    again available for the child as set forth by the
21    Department in rules, (iii) who is a newborn whose
22    responsible relative does not have available affordable
23    private or employer-sponsored health insurance, or (iv)

 

 

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1    who, within one year of applying for coverage under this
2    Act, lost medical benefits under the Illinois Public Aid
3    Code or the Children's Health Insurance Program Act; and
4        (3.5) whose household income, as determined by the
5    Department, is at or below 300% of the federal poverty
6    level. This item (3.5) is effective July 1, 2011.
7    An entity that provides health insurance coverage (as
8defined in Section 2 of the Comprehensive Health Insurance Plan
9Act) to Illinois residents shall provide health insurance data
10match to the Department of Healthcare and Family Services as
11provided by and subject to Section 5.5 of the Illinois
12Insurance Code.
13    The Department of Healthcare and Family Services, in
14collaboration with the Department of Insurance, shall adopt
15rules governing the exchange of information under this Section.
16The rules shall be consistent with all laws relating to the
17confidentiality or privacy of personal information or medical
18records, including provisions under the Federal Health
19Insurance Portability and Accountability Act (HIPAA).
20    (b) The Department shall monitor the availability and
21retention of employer-sponsored dependent health insurance
22coverage and shall modify the period described in subdivision
23(a)(3) if necessary to promote retention of private or
24employer-sponsored health insurance and timely access to
25healthcare services, but at no time shall the period described
26in subdivision (a)(3) be less than 6 months.

 

 

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1    (c) The Department, at its discretion, may take into
2account the affordability of dependent health insurance when
3determining whether employer-sponsored dependent health
4insurance coverage is available upon reemployment of a child's
5parent as provided in subdivision (a)(3).
6    (d) A child who is determined to be eligible for the
7Program shall remain eligible for 12 months, provided that the
8child maintains his or her residence in this State, has not yet
9attained 19 years of age, and is not excluded under subsection
10(e).
11    (e) A child is not eligible for coverage under the Program
12if:
13        (1) the premium required under Section 40 has not been
14    timely paid; if the required premiums are not paid, the
15    liability of the Program shall be limited to benefits
16    incurred under the Program for the time period for which
17    premiums have been paid; re-enrollment shall be completed
18    before the next covered medical visit, and the first
19    month's required premium shall be paid in advance of the
20    next covered medical visit; or
21        (2) the child is an inmate of a public institution or
22    an institution for mental diseases.
23    (f) The Department may adopt rules, including, but not
24limited to: rules regarding annual renewals of eligibility for
25the Program in conformance with Section 7 of this Act; rules
26providing for re-enrollment, grace periods, notice

 

 

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1requirements, and hearing procedures under subdivision (e)(1)
2of this Section; and rules regarding what constitutes
3availability and affordability of private or
4employer-sponsored health insurance, with consideration of
5such factors as the percentage of income needed to purchase
6children or family health insurance, the availability of
7employer subsidies, and other relevant factors.
8    (f-5) Within 90 days after the effective date of this
9amendatory Act of the 97th General Assembly, the Department, in
10cooperation with the Department of Human Services, shall
11develop and implement procedures in administration of the
12Program to do all of the following:
13        (1) Require applicants to provide proof of the
14    applicant's date of birth, including, but not limited to,
15    by providing a birth certificate to prove the age of the
16    applicant.
17        (2) Require applicants to provide documentation to
18    prove the identity of the applicant.
19        (3) Require applicants to provide documentation to
20    prove that the applicant is a resident of Illinois.
21        (4) Address or other contact information of the
22    applicant's parent or guardian.
23        (5) For documented immigrants, provide for applicants
24    to supply information to prove the documented status of the
25    applicant.
26        (6) Cross reference income reported by applicants, at

 

 

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1    the time of original application or renewal, to other State
2    records, including the Department of Employment Security
3    data or tax records.
4        (7) Require all enrollees to return an annual
5    redetermination to verify that there were no changes to
6    their eligibility information.
7        (8) Require the termination of coverage if the premium
8    for an enrollee in All Kids Premium Level 2 through Premium
9    Level 8 has not been paid pursuant to a grace period
10    through the end of the month of coverage. When termination
11    of coverage is recorded by the 15th day of the month, the
12    termination is effective the first day of the following
13    month. When termination of coverage is recorded after the
14    15th day of the month, the termination is effective no
15    later than the first day of the second month following that
16    determination.
17    (g) Each child enrolled in the Program as of July 1, 2011
18whose family income, as established by the Department, exceeds
19300% of the federal poverty level may remain enrolled in the
20Program for 12 additional months commencing July 1, 2011.
21Continued enrollment pursuant to this subsection shall be
22available only if the child continues to meet all eligibility
23criteria established under the Program as of the effective date
24of this amendatory Act of the 96th General Assembly without a
25break in coverage. Nothing contained in this subsection shall
26prevent a child from qualifying for any other health benefits

 

 

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1program operated by the Department.
2(Source: P.A. 96-1272, eff. 1-1-11; 96-1501, eff. 1-25-11.)
 
3    Section 99. Effective date. This Act takes effect upon
4becoming law.