Illinois General Assembly - Full Text of SB3703
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Full Text of SB3703  101st General Assembly




State of Illinois
2019 and 2020


Introduced 2/14/2020, by Sen. Omar Aquino


305 ILCS 5/5-2  from Ch. 23, par. 5-2

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that beginning January 1, 2021, persons aged 19 and older who are eligible for medical assistance but for their immigration status, and who have income at or below 133% of the federal poverty level plus 5% for the applicable family size as determined under applicable federal law and regulations. Provides that persons eligible for medical assistance under the amendatory Act shall receive coverage identical to the coverage for the Health Benefits Service Package as that term is defined under the Code.

LRB101 19609 KTG 69089 b






SB3703LRB101 19609 KTG 69089 b

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 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.
8    Medical assistance under this Article shall be available to
9any of the following classes of persons in respect to whom a
10plan for coverage has been submitted to the Governor by the
11Illinois Department and approved by him. If changes made in
12this Section 5-2 require federal approval, they shall not take
13effect until such approval has been received:
14        1. Recipients of basic maintenance grants under
15    Articles III and IV.
16        2. Beginning January 1, 2014, persons otherwise
17    eligible for basic maintenance under Article III,
18    excluding any eligibility requirements that are
19    inconsistent with any federal law or federal regulation, as
20    interpreted by the U.S. Department of Health and Human
21    Services, but who fail to qualify thereunder on the basis
22    of need, and who have insufficient income and resources to
23    meet the costs of necessary medical care, including but not



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1    limited to the following:
2            (a) All persons otherwise eligible for basic
3        maintenance under Article III but who fail to qualify
4        under that Article on the basis of need and who meet
5        either of the following requirements:
6                (i) their income, as determined by the
7            Illinois Department in accordance with any federal
8            requirements, is equal to or less than 100% of the
9            federal poverty level; or
10                (ii) their income, after the deduction of
11            costs incurred for medical care and for other types
12            of remedial care, is equal to or less than 100% of
13            the federal poverty level.
14            (b) (Blank).
15        3. (Blank).
16        4. Persons not eligible under any of the preceding
17    paragraphs who fall sick, are injured, or die, not having
18    sufficient money, property or other resources to meet the
19    costs of necessary medical care or funeral and burial
20    expenses.
21        5.(a) Beginning January 1, 2020, women during
22    pregnancy and during the 12-month period beginning on the
23    last day of the pregnancy, together with their infants,
24    whose income is at or below 200% of the federal poverty
25    level. Until September 30, 2019, or sooner if the
26    maintenance of effort requirements under the Patient



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1    Protection and Affordable Care Act are eliminated or may be
2    waived before then, women during pregnancy and during the
3    12-month period beginning on the last day of the pregnancy,
4    whose countable monthly income, after the deduction of
5    costs incurred for medical care and for other types of
6    remedial care as specified in administrative rule, is equal
7    to or less than the Medical Assistance-No Grant(C)
8    (MANG(C)) Income Standard in effect on April 1, 2013 as set
9    forth in administrative rule.
10        (b) The plan for coverage shall provide ambulatory
11    prenatal care to pregnant women during a presumptive
12    eligibility period and establish an income eligibility
13    standard that is equal to 200% of the federal poverty
14    level, provided that costs incurred for medical care are
15    not taken into account in determining such income
16    eligibility.
17        (c) The Illinois Department may conduct a
18    demonstration in at least one county that will provide
19    medical assistance to pregnant women, together with their
20    infants and children up to one year of age, where the
21    income eligibility standard is set up to 185% of the
22    nonfarm income official poverty line, as defined by the
23    federal Office of Management and Budget. The Illinois
24    Department shall seek and obtain necessary authorization
25    provided under federal law to implement such a
26    demonstration. Such demonstration may establish resource



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1    standards that are not more restrictive than those
2    established under Article IV of this Code.
3        6. (a) Children younger than age 19 when countable
4    income is at or below 133% of the federal poverty level.
5    Until September 30, 2019, or sooner if the maintenance of
6    effort requirements under the Patient Protection and
7    Affordable Care Act are eliminated or may be waived before
8    then, children younger than age 19 whose countable monthly
9    income, after the deduction of costs incurred for medical
10    care and for other types of remedial care as specified in
11    administrative rule, is equal to or less than the Medical
12    Assistance-No Grant(C) (MANG(C)) Income Standard in effect
13    on April 1, 2013 as set forth in administrative rule.
14        (b) Children and youth who are under temporary custody
15    or guardianship of the Department of Children and Family
16    Services or who receive financial assistance in support of
17    an adoption or guardianship placement from the Department
18    of Children and Family Services.
19        7. (Blank).
20        8. As required under federal law, persons who are
21    eligible for Transitional Medical Assistance as a result of
22    an increase in earnings or child or spousal support
23    received. The plan for coverage for this class of persons
24    shall:
25            (a) extend the medical assistance coverage to the
26        extent required by federal law; and



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



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



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



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1    effective date of this amendatory Act of the 92nd General
2    Assembly.
3        In addition to the persons who are eligible for medical
4    assistance pursuant to subparagraphs (1) and (2) of this
5    paragraph 12, and to be paid from funds appropriated to the
6    Department for its medical programs, any uninsured person
7    as defined by the Department in rules residing in Illinois
8    who is younger than 65 years of age, who has been screened
9    for breast and cervical cancer in accordance with standards
10    and procedures adopted by the Department of Public Health
11    for screening, and who is referred to the Department by the
12    Department of Public Health as being in need of treatment
13    for breast or cervical cancer is eligible for medical
14    assistance benefits that are consistent with the benefits
15    provided to those persons described in subparagraphs (1)
16    and (2). Medical assistance coverage for the persons who
17    are eligible under the preceding sentence is not dependent
18    on federal approval, but federal moneys may be used to pay
19    for services provided under that coverage upon federal
20    approval.
21        13. Subject to appropriation and to federal approval,
22    persons living with HIV/AIDS who are not otherwise eligible
23    under this Article and who qualify for services covered
24    under Section 5-5.04 as provided by the Illinois Department
25    by rule.
26        14. Subject to the availability of funds for this



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



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



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



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1    consistent with the terms of the approved waiver, the
2    Illinois Department, may by rule:
3            (a) Limit the geographic areas in which the waiver
4        program operates.
5            (b) Determine the scope, quantity, duration, and
6        quality, and the rate and method of reimbursement, of
7        the medical services to be provided, which may differ
8        from those for other classes of persons eligible for
9        assistance under this Article.
10            (c) Restrict the persons' freedom in choice of
11        providers.
12        18. Beginning January 1, 2014, persons aged 19 or
13    older, but younger than 65, who are not otherwise eligible
14    for medical assistance under this Section 5-2, who qualify
15    for medical assistance pursuant to 42 U.S.C.
16    1396a(a)(10)(A)(i)(VIII) and applicable federal
17    regulations, and who have income at or below 133% of the
18    federal poverty level plus 5% for the applicable family
19    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
20    applicable federal regulations. Persons eligible for
21    medical assistance under this paragraph 18 shall receive
22    coverage for the Health Benefits Service Package as that
23    term is defined in subsection (m) of Section 5-1.1 of this
24    Code. If Illinois' federal medical assistance percentage
25    (FMAP) is reduced below 90% for persons eligible for
26    medical assistance under this paragraph 18, eligibility



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1    under this paragraph 18 shall cease no later than the end
2    of the third month following the month in which the
3    reduction in FMAP takes effect.
4        19. Beginning January 1, 2014, as required under 42
5    U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
6    and younger than age 26 who are not otherwise eligible for
7    medical assistance under paragraphs (1) through (17) of
8    this Section who (i) were in foster care under the
9    responsibility of the State on the date of attaining age 18
10    or on the date of attaining age 21 when a court has
11    continued wardship for good cause as provided in Section
12    2-31 of the Juvenile Court Act of 1987 and (ii) received
13    medical assistance under the Illinois Title XIX State Plan
14    or waiver of such plan while in foster care.
15        20. Beginning January 1, 2018, persons who are
16    foreign-born victims of human trafficking, torture, or
17    other serious crimes as defined in Section 2-19 of this
18    Code and their derivative family members if such persons:
19    (i) reside in Illinois; (ii) are not eligible under any of
20    the preceding paragraphs; (iii) meet the income guidelines
21    of subparagraph (a) of paragraph 2; and (iv) meet the
22    nonfinancial eligibility requirements of Sections 16-2,
23    16-3, and 16-5 of this Code. The Department may extend
24    medical assistance for persons who are foreign-born
25    victims of human trafficking, torture, or other serious
26    crimes whose medical assistance would be terminated



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1    pursuant to subsection (b) of Section 16-5 if the
2    Department determines that the person, during the year of
3    initial eligibility (1) experienced a health crisis, (2)
4    has been unable, after reasonable attempts, to obtain
5    necessary information from a third party, or (3) has other
6    extenuating circumstances that prevented the person from
7    completing his or her application for status. The
8    Department may adopt any rules necessary to implement the
9    provisions of this paragraph.
10        21. Beginning January 1, 2021, persons aged 19 and
11    older who are eligible for medical assistance under this
12    Section but for their immigration status, and who have
13    income at or below 133% of the federal poverty level plus
14    5% for the applicable family size as determined under 42
15    U.S.C. 1396a(e)(14) and applicable federal regulations.
16    Persons eligible for medical assistance under this
17    paragraph 21 shall receive coverage identical to the
18    coverage for the Health Benefits Service Package as that
19    term is defined in subsection (m) of Section 5-1.1 of this
20    Code.
21    In implementing the provisions of Public Act 96-20, the
22Department is authorized to adopt only those rules necessary,
23including emergency rules. Nothing in Public Act 96-20 permits
24the Department to adopt rules or issue a decision that expands
25eligibility for the FamilyCare Program to a person whose income
26exceeds 185% of the Federal Poverty Level as determined from



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



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1donations or benefits or the disbursement of the donations or
3    Notwithstanding any other provision of this Code, if the
4United States Supreme Court holds Title II, Subtitle A, Section
52001(a) of Public Law 111-148 to be unconstitutional, or if a
6holding of Public Law 111-148 makes Medicaid eligibility
7allowed under Section 2001(a) inoperable, the State or a unit
8of local government shall be prohibited from enrolling
9individuals in the Medical Assistance Program as the result of
10federal approval of a State Medicaid waiver on or after the
11effective date of this amendatory Act of the 97th General
12Assembly, and any individuals enrolled in the Medical
13Assistance Program pursuant to eligibility permitted as a
14result of such a State Medicaid waiver shall become immediately
16    Notwithstanding any other provision of this Code, if an Act
17of Congress that becomes a Public Law eliminates Section
182001(a) of Public Law 111-148, the State or a unit of local
19government shall be prohibited from enrolling individuals in
20the Medical Assistance Program as the result of federal
21approval of a State Medicaid waiver on or after the effective
22date of this amendatory Act of the 97th General Assembly, and
23any individuals enrolled in the Medical Assistance Program
24pursuant to eligibility permitted as a result of such a State
25Medicaid waiver shall become immediately ineligible.
26    Effective October 1, 2013, the determination of



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1eligibility of persons who qualify under paragraphs 5, 6, 8,
215, 17, and 18 of this Section shall comply with the
3requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
5    The Department of Healthcare and Family Services, the
6Department of Human Services, and the Illinois health insurance
7marketplace shall work cooperatively to assist persons who
8would otherwise lose health benefits as a result of changes
9made under this amendatory Act of the 98th General Assembly to
10transition to other health insurance coverage.
11(Source: P.A. 101-10, eff. 6-5-19.)