97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB3416

 

Introduced 2/7/2012, by Sen. Carole Pankau

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 106/20
215 ILCS 106/40
215 ILCS 170/20

    Amends the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act. In the provisions concerning eligibility for the KidCare and Covering ALL KIDS programs, sets an asset limit of $10,000, excluding the value of the child's residence and the value of a vehicle (other than a recreational vehicle) used by the household. Makes changes concerning the reporting of changes in income and other circumstances that affect eligibility. Requires the Department of Healthcare and Family Services to seek a waiver of federal requirements under the Patient Protection and Affordable Care Act in order to allow the Department to immediately implement the changes made by the amendatory Act. 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 10. The Children's Health Insurance Program Act is
5amended by changing Sections 20 and 40 as follows:
 
6    (215 ILCS 106/20)
7    Sec. 20. Eligibility.
8    (a) To be eligible for this Program, a person must be a
9person who has a child eligible under this Act and who is
10eligible under a waiver of federal requirements pursuant to an
11application made pursuant to subdivision (a)(1) of Section 40
12of this Act or who is a child who:
13        (1) is a child who is not eligible for medical
14    assistance;
15        (2) is a child whose annual household income, as
16    determined by the Department, is above 133% of the federal
17    poverty level and at or below 200% of the federal poverty
18    level;
19        (2.5) is a child whose household assets do not exceed
20    $10,000, excluding (i) the value of the residence in which
21    the child lives and (ii) the value of a vehicle used by the
22    household for transportation purposes; for purposes of
23    this paragraph (2.5), "vehicle" does not include a

 

 

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1    recreational vehicle as defined in the Campground
2    Licensing and Recreational Area Act;
3        (3) is a resident of the State of Illinois; and
4        (4) is a child who is either a United States citizen or
5    included in one of the following categories of
6    non-citizens:
7            (A) unmarried dependent children of either a
8        United States Veteran honorably discharged or a person
9        on active military duty;
10            (B) refugees under Section 207 of the Immigration
11        and Nationality Act;
12            (C) asylees under Section 208 of the Immigration
13        and Nationality Act;
14            (D) persons for whom deportation has been withheld
15        under Section 243(h) of the Immigration and
16        Nationality Act;
17            (E) persons granted conditional entry under
18        Section 203(a)(7) of the Immigration and Nationality
19        Act as in effect prior to April 1, 1980;
20            (F) persons lawfully admitted for permanent
21        residence under the Immigration and Nationality Act;
22        and
23            (G) parolees, for at least one year, under Section
24        212(d)(5) of the Immigration and Nationality Act.
25    Those children who are in the categories set forth in
26subdivisions (4)(F) and (4)(G) of this subsection, who enter

 

 

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1the United States on or after August 22, 1996, shall not be
2eligible for 5 years beginning on the date the child entered
3the United States.
4    (b) A child who is determined to be eligible for assistance
5may remain eligible for 12 months, provided the child maintains
6his or her residence in the State, has not yet attained 19
7years of age, and is not excluded pursuant to subsection (c). A
8child who has been determined to be eligible for assistance
9must reapply or otherwise establish eligibility at least
10annually. An eligible child shall be required, as determined by
11the Department by rule, to report promptly those changes in
12income and other circumstances that affect eligibility within
1330 days after the occurrence of the change. The eligibility of
14a child may be redetermined based on the information reported
15or may be terminated based on the failure to report or failure
16to report accurately. A child's responsible relative or
17caretaker may also be held liable to the Department for any
18payments made by the Department on such child's behalf that
19were inappropriate. An applicant shall be provided with notice
20of these obligations.
21    (c) A child shall not be eligible for coverage under this
22Program if:
23        (1) the premium required pursuant to Section 30 of this
24    Act has not been paid. If the required premiums are not
25    paid the liability of the Program shall be limited to
26    benefits incurred under the Program for the time period for

 

 

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1    which premiums had been paid. Re-enrollment shall be
2    completed prior to the next covered medical visit and the
3    first month's required premium shall be paid in advance of
4    the next covered medical visit. The Department shall
5    promulgate rules regarding grace periods, notice
6    requirements, and hearing procedures pursuant to this
7    subsection;
8        (2) the child is an inmate of a public institution or a
9    patient in an institution for mental diseases; or
10        (3) the child is a member of a family that is eligible
11    for health benefits covered under the State of Illinois
12    health benefits plan on the basis of a member's employment
13    with a public agency.
14    (d) The Department shall seek a waiver of federal
15requirements under the Patient Protection and Affordable Care
16Act in order to allow the Department to immediately implement
17the changes made to this Section by this amendatory Act of the
1897th General Assembly. Upon federal waiver approval, the
19Department shall adopt rules necessary to implement the changes
20made to this Section by this amendatory Act of the 97th General
21Assembly.
22(Source: P.A. 96-1272, eff. 1-1-11.)
 
23    (215 ILCS 106/40)
24    Sec. 40. Waivers.
25    (a) The Department shall request any necessary waivers of

 

 

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1federal requirements in order to allow receipt of federal
2funding for:
3        (1) the coverage of families with eligible children
4    under this Act; and
5        (2) the coverage of children who would otherwise be
6    eligible under this Act, but who have health insurance.
7    (b) The failure of the responsible federal agency to
8approve a waiver for children who would otherwise be eligible
9under this Act but who have health insurance shall not prevent
10the implementation of any Section of this Act provided that
11there are sufficient appropriated funds.
12    (c) Eligibility of a person under an approved waiver due to
13the relationship with a child pursuant to Article V of the
14Illinois Public Aid Code or this Act shall be limited to such a
15person whose countable income is determined by the Department
16to be at or below such income eligibility standard as the
17Department by rule shall establish. The income level
18established by the Department shall not be below 90% of the
19federal poverty level. Such persons who are determined to be
20eligible must reapply, or otherwise establish eligibility, at
21least annually. An eligible person shall be required, as
22determined by the Department by rule, to report promptly those
23changes in income and other circumstances that affect
24eligibility to the Department within 30 days after the
25occurrence of the change. The eligibility of a person may be
26redetermined based on the information reported or may be

 

 

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1terminated based on the failure to report or failure to report
2accurately. A person may also be held liable to the Department
3for any payments made by the Department on such person's behalf
4that were inappropriate. An applicant shall be provided with
5notice of these obligations.
6    (d) The Department shall adopt rules necessary to implement
7the changes made to this Section by this amendatory Act of the
897th General Assembly.
9(Source: P.A. 96-328, eff. 8-11-09.)
 
10    Section 15. The Covering ALL KIDS Health Insurance Act is
11amended by changing Section 20 as follows:
 
12    (215 ILCS 170/20)
13    (Section scheduled to be repealed on July 1, 2016)
14    Sec. 20. Eligibility.
15    (a) To be eligible for the Program, a person must be a
16child:
17        (1) who is a resident of the State of Illinois;
18        (2) who is ineligible for medical assistance under the
19    Illinois Public Aid Code or benefits under the Children's
20    Health Insurance Program Act;
21        (3) either (i) who has been without health insurance
22    coverage for 12 months, (ii) whose parent has lost
23    employment that made available affordable dependent health
24    insurance coverage, until such time as affordable

 

 

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1    employer-sponsored dependent health insurance coverage is
2    again available for the child as set forth by the
3    Department in rules, (iii) who is a newborn whose
4    responsible relative does not have available affordable
5    private or employer-sponsored health insurance, or (iv)
6    who, within one year of applying for coverage under this
7    Act, lost medical benefits under the Illinois Public Aid
8    Code or the Children's Health Insurance Program Act; and
9        (3.5) whose household income, as determined by the
10    Department, is at or below 300% of the federal poverty
11    level. This item (3.5) is effective July 1, 2011; and .
12        (4) whose household assets do not exceed $10,000,
13    excluding (i) the value of the residence in which the child
14    lives and (ii) the value of a vehicle used by the household
15    for transportation purposes; for purposes of this
16    paragraph (4), "vehicle" does not include a recreational
17    vehicle as defined in the Campground Licensing and
18    Recreational Area Act.
19    An entity that provides health insurance coverage (as
20defined in Section 2 of the Comprehensive Health Insurance Plan
21Act) to Illinois residents shall provide health insurance data
22match to the Department of Healthcare and Family Services as
23provided by and subject to Section 5.5 of the Illinois
24Insurance Code.
25    The Department of Healthcare and Family Services, in
26collaboration with the Department of Insurance, shall adopt

 

 

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

 

 

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1    liability of the Program shall be limited to benefits
2    incurred under the Program for the time period for which
3    premiums have been paid; re-enrollment shall be completed
4    before the next covered medical visit, and the first
5    month's required premium shall be paid in advance of the
6    next covered medical visit; or
7        (2) the child is an inmate of a public institution or
8    an institution for mental diseases.
9    (f) The Department may adopt rules, including, but not
10limited to: rules regarding annual renewals of eligibility for
11the Program in conformance with Section 7 of this Act; rules
12providing for re-enrollment, grace periods, notice
13requirements, and hearing procedures under subdivision (e)(1)
14of this Section; and rules regarding what constitutes
15availability and affordability of private or
16employer-sponsored health insurance, with consideration of
17such factors as the percentage of income needed to purchase
18children or family health insurance, the availability of
19employer subsidies, and other relevant factors.
20    (g) Each child enrolled in the Program as of July 1, 2011
21whose family income, as established by the Department, exceeds
22300% of the federal poverty level may remain enrolled in the
23Program for 12 additional months commencing July 1, 2011.
24Continued enrollment pursuant to this subsection shall be
25available only if the child continues to meet all eligibility
26criteria established under the Program as of the effective date

 

 

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1of this amendatory Act of the 96th General Assembly without a
2break in coverage. Nothing contained in this subsection shall
3prevent a child from qualifying for any other health benefits
4program operated by the Department.
5    (d) The Department shall seek a waiver of federal
6requirements under the Patient Protection and Affordable Care
7Act in order to allow the Department to immediately implement
8the changes made to this Section by this amendatory Act of the
997th General Assembly. Upon federal waiver approval, the
10Department shall adopt rules necessary to implement the changes
11made to this Section by this amendatory Act of the 97th General
12Assembly.
13(Source: P.A. 96-1272, eff. 1-1-11; 96-1501, eff. 1-25-11.)
 
14    Section 99. Effective date. This Act takes effect upon
15becoming law.