Illinois General Assembly - Full Text of HB3259
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Full Text of HB3259  97th General Assembly




State of Illinois
2011 and 2012


Introduced 2/24/2011, by Rep. Jil Tracy


215 ILCS 170/20

    Amends the Covering ALL KIDS Health Insurance Act. 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. Effective immediately.

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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7    (Section scheduled to be repealed on July 1, 2016)
8    Sec. 20. Eligibility.
9    (a) To be eligible for the Program, a person must be a
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, has not gained access to affordable
10employer-sponsored dependent health insurance coverage, and is
11not excluded under subsection (e).
12    (e) A child is not eligible for coverage under the Program
14        (1) the premium required under Section 40 has not been
15    timely paid; if the required premiums are not paid, the
16    liability of the Program shall be limited to benefits
17    incurred under the Program for the time period for which
18    premiums have been paid; re-enrollment shall be completed
19    before the next covered medical visit, and the first
20    month's required premium shall be paid in advance of the
21    next covered medical visit; or
22        (2) the child is an inmate of a public institution or
23    an institution for mental diseases.
24    (f) The Department may adopt rules, including, but not
25limited to: rules regarding annual renewals of eligibility for
26the Program in conformance with Section 7 of this Act; rules



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1providing for re-enrollment, grace periods, notice
2requirements, and hearing procedures under subdivision (e)(1)
3of this Section; and rules regarding what constitutes
4availability and affordability of private or
5employer-sponsored health insurance, with consideration of
6such factors as the percentage of income needed to purchase
7children or family health insurance, the availability of
8employer subsidies, and other relevant factors.
9    (g) Each child enrolled in the Program as of July 1, 2011
10whose family income, as established by the Department, exceeds
11300% of the federal poverty level may remain enrolled in the
12Program for 12 additional months commencing July 1, 2011.
13Continued enrollment pursuant to this subsection shall be
14available only if the child continues to meet all eligibility
15criteria established under the Program as of the effective date
16of this amendatory Act of the 96th General Assembly without a
17break in coverage. Nothing contained in this subsection shall
18prevent a child from qualifying for any other health benefits
19program operated by the Department.
20    (h) The parent, guardian, or legal custodian of an enrolled
21child shall report promptly those changes in income and other
22circumstances, including availability of affordable
23employer-sponsored dependent health insurance coverage, that
24affect eligibility within 30 days after the occurrence of the
25change. The eligibility of a child may be redetermined based on
26the information reported or may be terminated based on the



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1failure to report or failure to report accurately.
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.