97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB6253

 

Introduced , by Rep. Sara Feigenholtz - Lisa M. Dugan - Elizabeth Hernandez - William Davis

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-1.1  from Ch. 23, par. 5-1.1
305 ILCS 5/5-1.4
305 ILCS 5/5-2  from Ch. 23, par. 5-2

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Beginning January 1, 2014, extends benefits under the State's medical assistance program to persons aged 19 or older, but younger than 65, who are not otherwise eligible for medical assistance under the Code, who qualify for medical assistance under specified provisions of the Social Security Act, and who have income at or below 133% of the federal poverty level plus 5% for the applicable family size. Provides that the 4-year moratorium on the expansion of medical assistance eligibility through increasing financial eligibility standards shall not apply to this new class of persons. Provides that such persons shall receive coverage for the Health Benefits Service Package. Defines "Health Benefits Service Package". Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-1.1, 5-1.4, and 5-2 as follows:
 
6    (305 ILCS 5/5-1.1)  (from Ch. 23, par. 5-1.1)
7    Sec. 5-1.1. Definitions. The terms defined in this Section
8shall have the meanings ascribed to them, except when the
9context otherwise requires.
10    (a) "Nursing facility" means a facility, licensed by the
11Department of Public Health under the Nursing Home Care Act,
12that provides nursing facility services within the meaning of
13Title XIX of the federal Social Security Act.
14    (b) "Intermediate care facility for the developmentally
15disabled" or "ICF/DD" means a facility, licensed by the
16Department of Public Health under the ID/DD Community Care Act,
17that is an intermediate care facility for the mentally retarded
18within the meaning of Title XIX of the federal Social Security
19Act.
20    (c) "Standard services" means those services required for
21the care of all patients in the facility and shall, as a
22minimum, include the following: (1) administration; (2)
23dietary (standard); (3) housekeeping; (4) laundry and linen;

 

 

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1(5) maintenance of property and equipment, including
2utilities; (6) medical records; (7) training of employees; (8)
3utilization review; (9) activities services; (10) social
4services; (11) disability services; and all other similar
5services required by either the laws of the State of Illinois
6or one of its political subdivisions or municipalities or by
7Title XIX of the Social Security Act.
8    (d) "Patient services" means those which vary with the
9number of personnel; professional and para-professional skills
10of the personnel; specialized equipment, and reflect the
11intensity of the medical and psycho-social needs of the
12patients. Patient services shall as a minimum include: (1)
13physical services; (2) nursing services, including restorative
14nursing; (3) medical direction and patient care planning; (4)
15health related supportive and habilitative services and all
16similar services required by either the laws of the State of
17Illinois or one of its political subdivisions or municipalities
18or by Title XIX of the Social Security Act.
19    (e) "Ancillary services" means those services which
20require a specific physician's order and defined as under the
21medical assistance program as not being routine in nature for
22skilled nursing facilities and ICF/DDs. Such services
23generally must be authorized prior to delivery and payment as
24provided for under the rules of the Department of Healthcare
25and Family Services.
26    (f) "Capital" means the investment in a facility's assets

 

 

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1for both debt and non-debt funds. Non-debt capital is the
2difference between an adjusted replacement value of the assets
3and the actual amount of debt capital.
4    (g) "Profit" means the amount which shall accrue to a
5facility as a result of its revenues exceeding its expenses as
6determined in accordance with generally accepted accounting
7principles.
8    (h) "Non-institutional services" means those services
9provided under paragraph (f) of Section 3 of the Disabled
10Persons Rehabilitation Act and those services provided under
11Section 4.02 of the Illinois Act on the Aging.
12    (i) (Blank).
13    (j) "Institutionalized person" means an individual who is
14an inpatient in an ICF/DD or nursing facility, or who is an
15inpatient in a medical institution receiving a level of care
16equivalent to that of an ICF/DD or nursing facility, or who is
17receiving services under Section 1915(c) of the Social Security
18Act.
19    (k) "Institutionalized spouse" means an institutionalized
20person who is expected to receive services at the same level of
21care for at least 30 days and is married to a spouse who is not
22an institutionalized person.
23    (l) "Community spouse" is the spouse of an
24institutionalized spouse.
25    (m) "Health Benefits Service Package" means, subject to
26federal approval, benefits covered by the medical assistance

 

 

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1program as determined by the Department by rule for individuals
2eligible for medical assistance under paragraph 18 of Section
35-2 of this Code.
4(Source: P.A. 96-1530, eff. 2-16-11; 97-227, eff. 1-1-12;
597-820, eff. 7-17-12.)
 
6    (305 ILCS 5/5-1.4)
7    Sec. 5-1.4. Moratorium on eligibility expansions.
8Beginning on January 25, 2011 (the effective date of Public Act
996-1501), there shall be a 4-year moratorium on the expansion
10of eligibility through increasing financial eligibility
11standards, or through increasing income disregards, or through
12the creation of new programs which would add new categories of
13eligible individuals under the medical assistance program in
14addition to those categories covered on January 1, 2011 or
15above the level of any subsequent reduction in eligibility.
16This moratorium shall not apply to expansions required as a
17federal condition of State participation in the medical
18assistance program or to expansions approved by the federal
19government that are financed entirely by units of local
20government and federal matching funds. If the State of Illinois
21finds that the State has borne a cost related to such an
22expansion, the unit of local government shall reimburse the
23State. All federal funds associated with an expansion funded by
24a unit of local government shall be returned to the local
25government entity funding the expansion, pursuant to an

 

 

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1intergovernmental agreement between the Department of
2Healthcare and Family Services and the local government entity.
3Within 10 calendar days of the effective date of this
4amendatory Act of the 97th General Assembly, the Department of
5Healthcare and Family Services shall formally advise the
6Centers for Medicare and Medicaid Services of the passage of
7this amendatory Act of the 97th General Assembly. The State is
8prohibited from submitting additional waiver requests that
9expand or allow for an increase in the classes of persons
10eligible for medical assistance under this Article to the
11federal government for its consideration beginning on the 20th
12calendar day following the effective date of this amendatory
13Act of the 97th General Assembly until January 25, 2015. This
14moratorium shall not apply to those persons eligible for
15medical assistance pursuant to 42 U.S.C.
161396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
17Section 5-2 of this Code.
18(Source: P.A. 96-1501, eff. 1-25-11; 97-687, eff. 6-14-12.)
 
19    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
20    Sec. 5-2. Classes of Persons Eligible. Medical assistance
21under this Article shall be available to any of the following
22classes of persons in respect to whom a plan for coverage has
23been submitted to the Governor by the Illinois Department and
24approved by him:
25        1. Recipients of basic maintenance grants under

 

 

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1    Articles III and IV.
2        2. Persons otherwise eligible for basic maintenance
3    under Articles III and IV, excluding any eligibility
4    requirements that are inconsistent with any federal law or
5    federal regulation, as interpreted by the U.S. Department
6    of Health and Human Services, but who fail to qualify
7    thereunder on the basis of need or who qualify but are not
8    receiving basic maintenance under Article IV, and who have
9    insufficient income and resources to meet the costs of
10    necessary medical care, including but not limited to the
11    following:
12            (a) All persons otherwise eligible for basic
13        maintenance under Article III but who fail to qualify
14        under that Article on the basis of need and who meet
15        either of the following requirements:
16                (i) their income, as determined by the
17            Illinois Department in accordance with any federal
18            requirements, is equal to or less than 70% in
19            fiscal year 2001, equal to or less than 85% in
20            fiscal year 2002 and until a date to be determined
21            by the Department by rule, and equal to or less
22            than 100% beginning on the date determined by the
23            Department by rule, of the nonfarm income official
24            poverty line, as defined by the federal Office of
25            Management and Budget and revised annually in
26            accordance with Section 673(2) of the Omnibus

 

 

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1            Budget Reconciliation Act of 1981, applicable to
2            families of the same size; or
3                (ii) their income, after the deduction of
4            costs incurred for medical care and for other types
5            of remedial care, is equal to or less than 70% in
6            fiscal year 2001, equal to or less than 85% in
7            fiscal year 2002 and until a date to be determined
8            by the Department by rule, and equal to or less
9            than 100% beginning on the date determined by the
10            Department by rule, of the nonfarm income official
11            poverty line, as defined in item (i) of this
12            subparagraph (a).
13            (b) All persons who, excluding any eligibility
14        requirements that are inconsistent with any federal
15        law or federal regulation, as interpreted by the U.S.
16        Department of Health and Human Services, would be
17        determined eligible for such basic maintenance under
18        Article IV by disregarding the maximum earned income
19        permitted by federal law.
20        3. Persons who would otherwise qualify for Aid to the
21    Medically Indigent under Article VII.
22        4. Persons not eligible under any of the preceding
23    paragraphs who fall sick, are injured, or die, not having
24    sufficient money, property or other resources to meet the
25    costs of necessary medical care or funeral and burial
26    expenses.

 

 

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1        5.(a) Women during pregnancy, after the fact of
2    pregnancy has been determined by medical diagnosis, and
3    during the 60-day period beginning on the last day of the
4    pregnancy, together with their infants and children born
5    after September 30, 1983, whose income and resources are
6    insufficient to meet the costs of necessary medical care to
7    the maximum extent possible under Title XIX of the Federal
8    Social Security Act.
9        (b) The Illinois Department and the Governor shall
10    provide a plan for coverage of the persons eligible under
11    paragraph 5(a) by April 1, 1990. Such plan shall provide
12    ambulatory prenatal care to pregnant women during a
13    presumptive eligibility period and establish an income
14    eligibility standard that is equal to 133% of the nonfarm
15    income official poverty line, as defined by the federal
16    Office of Management and Budget and revised annually in
17    accordance with Section 673(2) of the Omnibus Budget
18    Reconciliation Act of 1981, applicable to families of the
19    same size, provided that costs incurred for medical care
20    are not taken into account in determining such income
21    eligibility.
22        (c) The Illinois Department may conduct a
23    demonstration in at least one county that will provide
24    medical assistance to pregnant women, together with their
25    infants and children up to one year of age, where the
26    income eligibility standard is set up to 185% of the

 

 

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1    nonfarm income official poverty line, as defined by the
2    federal Office of Management and Budget. The Illinois
3    Department shall seek and obtain necessary authorization
4    provided under federal law to implement such a
5    demonstration. Such demonstration may establish resource
6    standards that are not more restrictive than those
7    established under Article IV of this Code.
8        6. Persons under the age of 18 who fail to qualify as
9    dependent under Article IV and who have insufficient income
10    and resources to meet the costs of necessary medical care
11    to the maximum extent permitted under Title XIX of the
12    Federal Social Security Act.
13        7. (Blank).
14        8. Persons who become ineligible for basic maintenance
15    assistance under Article IV of this Code in programs
16    administered by the Illinois Department due to employment
17    earnings and persons in assistance units comprised of
18    adults and children who become ineligible for basic
19    maintenance assistance under Article VI of this Code due to
20    employment earnings. The plan for coverage for this class
21    of persons shall:
22            (a) extend the medical assistance coverage for up
23        to 12 months following termination of basic
24        maintenance assistance; and
25            (b) offer persons who have initially received 6
26        months of the coverage provided in paragraph (a) above,

 

 

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1        the option of receiving an additional 6 months of
2        coverage, subject to the following:
3                (i) such coverage shall be pursuant to
4            provisions of the federal Social Security Act;
5                (ii) such coverage shall include all services
6            covered while the person was eligible for basic
7            maintenance assistance;
8                (iii) no premium shall be charged for such
9            coverage; and
10                (iv) such coverage shall be suspended in the
11            event of a person's failure without good cause to
12            file in a timely fashion reports required for this
13            coverage under the Social Security Act and
14            coverage shall be reinstated upon the filing of
15            such reports if the person remains otherwise
16            eligible.
17        9. Persons with acquired immunodeficiency syndrome
18    (AIDS) or with AIDS-related conditions with respect to whom
19    there has been a determination that but for home or
20    community-based services such individuals would require
21    the level of care provided in an inpatient hospital,
22    skilled nursing facility or intermediate care facility the
23    cost of which is reimbursed under this Article. Assistance
24    shall be provided to such persons to the maximum extent
25    permitted under Title XIX of the Federal Social Security
26    Act.

 

 

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

 

 

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1        Article even if the person loses eligibility under this
2        paragraph 11.
3        12. Subject to federal approval, persons who are
4    eligible for medical assistance coverage under applicable
5    provisions of the federal Social Security Act and the
6    federal Breast and Cervical Cancer Prevention and
7    Treatment Act of 2000. Those eligible persons are defined
8    to include, but not be limited to, the following persons:
9            (1) persons who have been screened for breast or
10        cervical cancer under the U.S. Centers for Disease
11        Control and Prevention Breast and Cervical Cancer
12        Program established under Title XV of the federal
13        Public Health Services Act in accordance with the
14        requirements of Section 1504 of that Act as
15        administered by the Illinois Department of Public
16        Health; and
17            (2) persons whose screenings under the above
18        program were funded in whole or in part by funds
19        appropriated to the Illinois Department of Public
20        Health for breast or cervical cancer screening.
21        "Medical assistance" under this paragraph 12 shall be
22    identical to the benefits provided under the State's
23    approved plan under Title XIX of the Social Security Act.
24    The Department must request federal approval of the
25    coverage under this paragraph 12 within 30 days after the
26    effective date of this amendatory Act of the 92nd General

 

 

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1    Assembly.
2        In addition to the persons who are eligible for medical
3    assistance pursuant to subparagraphs (1) and (2) of this
4    paragraph 12, and to be paid from funds appropriated to the
5    Department for its medical programs, any uninsured person
6    as defined by the Department in rules residing in Illinois
7    who is younger than 65 years of age, who has been screened
8    for breast and cervical cancer in accordance with standards
9    and procedures adopted by the Department of Public Health
10    for screening, and who is referred to the Department by the
11    Department of Public Health as being in need of treatment
12    for breast or cervical cancer is eligible for medical
13    assistance benefits that are consistent with the benefits
14    provided to those persons described in subparagraphs (1)
15    and (2). Medical assistance coverage for the persons who
16    are eligible under the preceding sentence is not dependent
17    on federal approval, but federal moneys may be used to pay
18    for services provided under that coverage upon federal
19    approval.
20        13. Subject to appropriation and to federal approval,
21    persons living with HIV/AIDS who are not otherwise eligible
22    under this Article and who qualify for services covered
23    under Section 5-5.04 as provided by the Illinois Department
24    by rule.
25        14. Subject to the availability of funds for this
26    purpose, the Department may provide coverage under this

 

 

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1    Article to persons who reside in Illinois who are not
2    eligible under any of the preceding paragraphs and who meet
3    the income guidelines of paragraph 2(a) of this Section and
4    (i) have an application for asylum pending before the
5    federal Department of Homeland Security or on appeal before
6    a court of competent jurisdiction and are represented
7    either by counsel or by an advocate accredited by the
8    federal Department of Homeland Security and employed by a
9    not-for-profit organization in regard to that application
10    or appeal, or (ii) are receiving services through a
11    federally funded torture treatment center. Medical
12    coverage under this paragraph 14 may be provided for up to
13    24 continuous months from the initial eligibility date so
14    long as an individual continues to satisfy the criteria of
15    this paragraph 14. If an individual has an appeal pending
16    regarding an application for asylum before the Department
17    of Homeland Security, eligibility under this paragraph 14
18    may be extended until a final decision is rendered on the
19    appeal. The Department may adopt rules governing the
20    implementation of this paragraph 14.
21        15. Family Care Eligibility.
22            (a) On and after July 1, 2012, a caretaker relative
23        who is 19 years of age or older when countable income
24        is at or below 133% of the Federal Poverty Level
25        Guidelines, as published annually in the Federal
26        Register, for the appropriate family size. A person may

 

 

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1        not spend down to become eligible under this paragraph
2        15.
3            (b) Eligibility shall be reviewed annually.
4            (c) (Blank).
5            (d) (Blank).
6            (e) (Blank).
7            (f) (Blank).
8            (g) (Blank).
9            (h) (Blank).
10            (i) Following termination of an individual's
11        coverage under this paragraph 15, the individual must
12        be determined eligible before the person can be
13        re-enrolled.
14        16. Subject to appropriation, uninsured persons who
15    are not otherwise eligible under this Section who have been
16    certified and referred by the Department of Public Health
17    as having been screened and found to need diagnostic
18    evaluation or treatment, or both diagnostic evaluation and
19    treatment, for prostate or testicular cancer. For the
20    purposes of this paragraph 16, uninsured persons are those
21    who do not have creditable coverage, as defined under the
22    Health Insurance Portability and Accountability Act, or
23    have otherwise exhausted any insurance benefits they may
24    have had, for prostate or testicular cancer diagnostic
25    evaluation or treatment, or both diagnostic evaluation and
26    treatment. To be eligible, a person must furnish a Social

 

 

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

 

 

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1    Notwithstanding any other provision of this Code and
2    consistent with the terms of the approved waiver, the
3    Illinois Department, may by rule:
4            (a) Limit the geographic areas in which the waiver
5        program operates.
6            (b) Determine the scope, quantity, duration, and
7        quality, and the rate and method of reimbursement, of
8        the medical services to be provided, which may differ
9        from those for other classes of persons eligible for
10        assistance under this Article.
11            (c) Restrict the persons' freedom in choice of
12        providers.
13        18. Beginning January 1, 2014, persons aged 19 or
14    older, but younger than 65, who are not otherwise eligible
15    for medical assistance under this Section 5-2, who qualify
16    for medical assistance pursuant to 42 U.S.C.
17    1396a(a)(10)(A)(i)(VIII) and as set forth in 42 CFR
18    435.119, and who have income at or below 133% of the
19    federal poverty level plus 5% for the applicable family
20    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
21    as set forth in 42 CFR 435.603. Persons eligible for
22    medical assistance under this paragraph 18 shall receive
23    coverage for the Health Benefits Service Package as that
24    term is defined in subsection (m) of Section 5-1.1 of this
25    Code.
26    In implementing the provisions of Public Act 96-20, the

 

 

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1Department is authorized to adopt only those rules necessary,
2including emergency rules. Nothing in Public Act 96-20 permits
3the Department to adopt rules or issue a decision that expands
4eligibility for the FamilyCare Program to a person whose income
5exceeds 185% of the Federal Poverty Level as determined from
6time to time by the U.S. Department of Health and Human
7Services, unless the Department is provided with express
8statutory authority.
9    The Illinois Department and the Governor shall provide a
10plan for coverage of the persons eligible under paragraph 7 as
11soon as possible after July 1, 1984.
12    The eligibility of any such person for medical assistance
13under this Article is not affected by the payment of any grant
14under the Senior Citizens and Disabled Persons Property Tax
15Relief Act or any distributions or items of income described
16under subparagraph (X) of paragraph (2) of subsection (a) of
17Section 203 of the Illinois Income Tax Act. The Department
18shall by rule establish the amounts of assets to be disregarded
19in determining eligibility for medical assistance, which shall
20at a minimum equal the amounts to be disregarded under the
21Federal Supplemental Security Income Program. The amount of
22assets of a single person to be disregarded shall not be less
23than $2,000, and the amount of assets of a married couple to be
24disregarded shall not be less than $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(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;
896-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
97-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
10eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
1197-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff.
127-13-12; revised 7-23-12.)
 
13    Section 99. Effective date. This Act takes effect upon
14becoming law.