Sen. Mike Simmons

Filed: 4/1/2021





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2    AMENDMENT NO. ______. Amend Senate Bill 966 by replacing
3everything after the enacting clause with the following:
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. Medical assistance
8under this Article shall be available to any of the following
9classes of persons in respect to whom a plan for coverage has
10been submitted to the Governor by the Illinois Department and
11approved by him. If changes made in this Section 5-2 require
12federal approval, they shall not take effect until such
13approval has been received:
14        1. Recipients of basic maintenance grants under
15    Articles III and IV.
16        2. Beginning January 1, 2014, persons otherwise



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1    eligible for basic maintenance under Article III,
2    excluding any eligibility requirements that are
3    inconsistent with any federal law or federal regulation,
4    as interpreted by the U.S. Department of Health and Human
5    Services, but who fail to qualify thereunder on the basis
6    of need, and who have insufficient income and resources to
7    meet the costs of necessary medical care, including, but
8    not limited to, the following:
9            (a) All persons otherwise eligible for basic
10        maintenance under Article III but who fail to qualify
11        under that Article on the basis of need and who meet
12        either of the following requirements:
13                (i) their income, as determined by the
14            Illinois Department in accordance with any federal
15            requirements, is equal to or less than 100% of the
16            federal poverty level; or
17                (ii) their income, after the deduction of
18            costs incurred for medical care and for other
19            types of remedial care, is equal to or less than
20            100% of the federal poverty level.
21            (b) (Blank).
22        3. (Blank).
23        4. Persons not eligible under any of the preceding
24    paragraphs who fall sick, are injured, or die, not having
25    sufficient money, property or other resources to meet the
26    costs of necessary medical care or funeral and burial



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1    expenses.
2        5.(a) Beginning January 1, 2020, women during
3    pregnancy and during the 12-month period beginning on the
4    last day of the pregnancy, together with their infants,
5    whose income is at or below 200% of the federal poverty
6    level. Until September 30, 2019, or sooner if the
7    maintenance of effort requirements under the Patient
8    Protection and Affordable Care Act are eliminated or may
9    be waived before then, women during pregnancy and during
10    the 12-month period beginning on the last day of the
11    pregnancy, whose countable monthly income, after the
12    deduction of costs incurred for medical care and for other
13    types of remedial care as specified in administrative
14    rule, is equal to or less than the Medical Assistance-No
15    Grant(C) (MANG(C)) Income Standard in effect on April 1,
16    2013 as set forth in administrative rule.
17        (b) The plan for coverage shall provide ambulatory
18    prenatal care to pregnant women during a presumptive
19    eligibility period and establish an income eligibility
20    standard that is equal to 200% of the federal poverty
21    level, provided that costs incurred for medical care are
22    not taken into account in determining such income
23    eligibility.
24        (c) The Illinois Department may conduct a
25    demonstration in at least one county that will provide
26    medical assistance to pregnant women, together with their



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1    infants and children up to one year of age, where the
2    income eligibility standard is set up to 185% of the
3    nonfarm income official poverty line, as defined by the
4    federal Office of Management and Budget. The Illinois
5    Department shall seek and obtain necessary authorization
6    provided under federal law to implement such a
7    demonstration. Such demonstration may establish resource
8    standards that are not more restrictive than those
9    established under Article IV of this Code.
10        6. (a) Children younger than age 19 when countable
11    income is at or below 133% of the federal poverty level.
12    Until September 30, 2019, or sooner if the maintenance of
13    effort requirements under the Patient Protection and
14    Affordable Care Act are eliminated or may be waived before
15    then, children younger than age 19 whose countable monthly
16    income, after the deduction of costs incurred for medical
17    care and for other types of remedial care as specified in
18    administrative rule, is equal to or less than the Medical
19    Assistance-No Grant(C) (MANG(C)) Income Standard in effect
20    on April 1, 2013 as set forth in administrative rule.
21        (b) Children and youth who are under temporary custody
22    or guardianship of the Department of Children and Family
23    Services or who receive financial assistance in support of
24    an adoption or guardianship placement from the Department
25    of Children and Family Services.
26        7. (Blank).



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1        8. As required under federal law, persons who are
2    eligible for Transitional Medical Assistance as a result
3    of an increase in earnings or child or spousal support
4    received. The plan for coverage for this class of persons
5    shall:
6            (a) extend the medical assistance coverage to the
7        extent required by federal law; and
8            (b) offer persons who have initially received 6
9        months of the coverage provided in paragraph (a)
10        above, the option of receiving an additional 6 months
11        of coverage, subject to the following:
12                (i) such coverage shall be pursuant to
13            provisions of the federal Social Security Act;
14                (ii) such coverage shall include all services
15            covered under Illinois' State Medicaid Plan;
16                (iii) no premium shall be charged for such
17            coverage; and
18                (iv) such coverage shall be suspended in the
19            event of a person's failure without good cause to
20            file in a timely fashion reports required for this
21            coverage under the Social Security Act and
22            coverage shall be reinstated upon the filing of
23            such reports if the person remains otherwise
24            eligible.
25        9. Persons with acquired immunodeficiency syndrome
26    (AIDS) or with AIDS-related conditions with respect to



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1    whom there has been a determination that but for home or
2    community-based services such individuals would require
3    the level of care provided in an inpatient hospital,
4    skilled nursing facility or intermediate care facility the
5    cost of which is reimbursed under this Article. Assistance
6    shall be provided to such persons to the maximum extent
7    permitted under Title XIX of the Federal Social Security
8    Act.
9        10. Participants in the long-term care insurance
10    partnership program established under the Illinois
11    Long-Term Care Partnership Program Act who meet the
12    qualifications for protection of resources described in
13    Section 15 of that Act.
14        11. Persons with disabilities who are employed and
15    eligible for Medicaid, pursuant to Section
16    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
17    subject to federal approval, persons with a medically
18    improved disability who are employed and eligible for
19    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
20    the Social Security Act, as provided by the Illinois
21    Department by rule. In establishing eligibility standards
22    under this paragraph 11, the Department shall, subject to
23    federal approval:
24            (a) set the income eligibility standard at not
25        lower than 350% of the federal poverty level;
26            (b) exempt retirement accounts that the person



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1        cannot access without penalty before the age of 59
2        1/2, and medical savings accounts established pursuant
3        to 26 U.S.C. 220;
4            (c) allow non-exempt assets up to $25,000 as to
5        those assets accumulated during periods of eligibility
6        under this paragraph 11; and
7            (d) continue to apply subparagraphs (b) and (c) in
8        determining the eligibility of the person under this
9        Article even if the person loses eligibility under
10        this paragraph 11.
11        12. Subject to federal approval, persons who are
12    eligible for medical assistance coverage under applicable
13    provisions of the federal Social Security Act and the
14    federal Breast and Cervical Cancer Prevention and
15    Treatment Act of 2000. Those eligible persons are defined
16    to include, but not be limited to, the following persons:
17            (1) persons who have been screened for breast or
18        cervical cancer under the U.S. Centers for Disease
19        Control and Prevention Breast and Cervical Cancer
20        Program established under Title XV of the federal
21        Public Health Service Services Act in accordance with
22        the requirements of Section 1504 of that Act as
23        administered by the Illinois Department of Public
24        Health; and
25            (2) persons whose screenings under the above
26        program were funded in whole or in part by funds



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1        appropriated to the Illinois Department of Public
2        Health for breast or cervical cancer screening.
3        "Medical assistance" under this paragraph 12 shall be
4    identical to the benefits provided under the State's
5    approved plan under Title XIX of the Social Security Act.
6    The Department must request federal approval of the
7    coverage under this paragraph 12 within 30 days after July
8    3, 2001 (the effective date of Public Act 92-47) this
9    amendatory Act of the 92nd General Assembly.
10        In addition to the persons who are eligible for
11    medical assistance pursuant to subparagraphs (1) and (2)
12    of this paragraph 12, and to be paid from funds
13    appropriated to the Department for its medical programs,
14    any uninsured person as defined by the Department in rules
15    residing in Illinois who is younger than 65 years of age,
16    who has been screened for breast and cervical cancer in
17    accordance with standards and procedures adopted by the
18    Department of Public Health for screening, and who is
19    referred to the Department by the Department of Public
20    Health as being in need of treatment for breast or
21    cervical cancer is eligible for medical assistance
22    benefits that are consistent with the benefits provided to
23    those persons described in subparagraphs (1) and (2).
24    Medical assistance coverage for the persons who are
25    eligible under the preceding sentence is not dependent on
26    federal approval, but federal moneys may be used to pay



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1    for services provided under that coverage upon federal
2    approval.
3        13. Subject to appropriation and to federal approval,
4    persons living with HIV/AIDS who are not otherwise
5    eligible under this Article and who qualify for services
6    covered under Section 5-5.04 as provided by the Illinois
7    Department by rule.
8        14. Subject to the availability of funds for this
9    purpose, the Department may provide coverage under this
10    Article to persons who reside in Illinois who are not
11    eligible under any of the preceding paragraphs and who
12    meet the income guidelines of paragraph 2(a) of this
13    Section and (i) have an application for asylum pending
14    before the federal Department of Homeland Security or on
15    appeal before a court of competent jurisdiction and are
16    represented either by counsel or by an advocate accredited
17    by the federal Department of Homeland Security and
18    employed by a not-for-profit organization in regard to
19    that application or appeal, or (ii) are receiving services
20    through a federally funded torture treatment center.
21    Medical coverage under this paragraph 14 may be provided
22    for up to 24 continuous months from the initial
23    eligibility date so long as an individual continues to
24    satisfy the criteria of this paragraph 14. If an
25    individual has an appeal pending regarding an application
26    for asylum before the Department of Homeland Security,



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1    eligibility under this paragraph 14 may be extended until
2    a final decision is rendered on the appeal. The Department
3    may adopt rules governing the implementation of this
4    paragraph 14.
5        15. Family Care Eligibility.
6            (a) On and after July 1, 2012, a parent or other
7        caretaker relative who is 19 years of age or older when
8        countable income is at or below 133% of the federal
9        poverty level. A person may not spend down to become
10        eligible under this paragraph 15.
11            (b) Eligibility shall be reviewed annually.
12            (c) (Blank).
13            (d) (Blank).
14            (e) (Blank).
15            (f) (Blank).
16            (g) (Blank).
17            (h) (Blank).
18            (i) Following termination of an individual's
19        coverage under this paragraph 15, the individual must
20        be determined eligible before the person can be
21        re-enrolled.
22        16. Subject to appropriation, uninsured persons who
23    are not otherwise eligible under this Section who have
24    been certified and referred by the Department of Public
25    Health as having been screened and found to need
26    diagnostic evaluation or treatment, or both diagnostic



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1    evaluation and treatment, for prostate or testicular
2    cancer. For the purposes of this paragraph 16, uninsured
3    persons are those who do not have creditable coverage, as
4    defined under the Health Insurance Portability and
5    Accountability Act, or have otherwise exhausted any
6    insurance benefits they may have had, for prostate or
7    testicular cancer diagnostic evaluation or treatment, or
8    both diagnostic evaluation and treatment. To be eligible,
9    a person must furnish a Social Security number. A person's
10    assets are exempt from consideration in determining
11    eligibility under this paragraph 16. Such persons shall be
12    eligible for medical assistance under this paragraph 16
13    for so long as they need treatment for the cancer. A person
14    shall be considered to need treatment if, in the opinion
15    of the person's treating physician, the person requires
16    therapy directed toward cure or palliation of prostate or
17    testicular cancer, including recurrent metastatic cancer
18    that is a known or presumed complication of prostate or
19    testicular cancer and complications resulting from the
20    treatment modalities themselves. Persons who require only
21    routine monitoring services are not considered to need
22    treatment. "Medical assistance" under this paragraph 16
23    shall be identical to the benefits provided under the
24    State's approved plan under Title XIX of the Social
25    Security Act. Notwithstanding any other provision of law,
26    the Department (i) does not have a claim against the



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1    estate of a deceased recipient of services under this
2    paragraph 16 and (ii) does not have a lien against any
3    homestead property or other legal or equitable real
4    property interest owned by a recipient of services under
5    this paragraph 16.
6        17. Persons who, pursuant to a waiver approved by the
7    Secretary of the U.S. Department of Health and Human
8    Services, are eligible for medical assistance under Title
9    XIX or XXI of the federal Social Security Act.
10    Notwithstanding any other provision of this Code and
11    consistent with the terms of the approved waiver, the
12    Illinois Department, may by rule:
13            (a) Limit the geographic areas in which the waiver
14        program operates.
15            (b) Determine the scope, quantity, duration, and
16        quality, and the rate and method of reimbursement, of
17        the medical services to be provided, which may differ
18        from those for other classes of persons eligible for
19        assistance under this Article.
20            (c) Restrict the persons' freedom in choice of
21        providers.
22        18. Beginning January 1, 2014, persons aged 19 or
23    older, but younger than 65, who are not otherwise eligible
24    for medical assistance under this Section 5-2, who qualify
25    for medical assistance pursuant to 42 U.S.C.
26    1396a(a)(10)(A)(i)(VIII) and applicable federal



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1    regulations, and who have income at or below 133% of the
2    federal poverty level plus 5% for the applicable family
3    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
4    applicable federal regulations. Persons eligible for
5    medical assistance under this paragraph 18 shall receive
6    coverage for the Health Benefits Service Package as that
7    term is defined in subsection (m) of Section 5-1.1 of this
8    Code. If Illinois' federal medical assistance percentage
9    (FMAP) is reduced below 90% for persons eligible for
10    medical assistance under this paragraph 18, eligibility
11    under this paragraph 18 shall cease no later than the end
12    of the third month following the month in which the
13    reduction in FMAP takes effect.
14        19. Beginning January 1, 2014, as required under 42
15    U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
16    and younger than age 26 who are not otherwise eligible for
17    medical assistance under paragraphs (1) through (17) of
18    this Section who (i) were in foster care under the
19    responsibility of the State on the date of attaining age
20    18 or on the date of attaining age 21 when a court has
21    continued wardship for good cause as provided in Section
22    2-31 of the Juvenile Court Act of 1987 and (ii) received
23    medical assistance under the Illinois Title XIX State Plan
24    or waiver of such plan while in foster care.
25        20. Beginning January 1, 2018, persons who are
26    foreign-born victims of human trafficking, torture, or



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1    other serious crimes as defined in Section 2-19 of this
2    Code and their derivative family members if such persons:
3    (i) reside in Illinois; (ii) are not eligible under any of
4    the preceding paragraphs; (iii) meet the income guidelines
5    of subparagraph (a) of paragraph 2; and (iv) meet the
6    nonfinancial eligibility requirements of Sections 16-2,
7    16-3, and 16-5 of this Code. The Department may extend
8    medical assistance for persons who are foreign-born
9    victims of human trafficking, torture, or other serious
10    crimes whose medical assistance would be terminated
11    pursuant to subsection (b) of Section 16-5 if the
12    Department determines that the person, during the year of
13    initial eligibility (1) experienced a health crisis, (2)
14    has been unable, after reasonable attempts, to obtain
15    necessary information from a third party, or (3) has other
16    extenuating circumstances that prevented the person from
17    completing his or her application for status. The
18    Department may adopt any rules necessary to implement the
19    provisions of this paragraph.
20        21. Persons who are not otherwise eligible for medical
21    assistance under this Section who may qualify for medical
22    assistance pursuant to 42 U.S.C.
23    1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the
24    duration of any federal or State declared emergency due to
25    COVID-19. Medical assistance to persons eligible for
26    medical assistance solely pursuant to this paragraph 21



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1    shall be limited to any in vitro diagnostic product (and
2    the administration of such product) described in 42 U.S.C.
3    1396d(a)(3)(B) on or after March 18, 2020, any visit
4    described in 42 U.S.C. 1396o(a)(2)(G), or any other
5    medical assistance that may be federally authorized for
6    this class of persons. The Department may also cover
7    treatment of COVID-19 for this class of persons, or any
8    similar category of uninsured individuals, to the extent
9    authorized under a federally approved 1115 Waiver or other
10    federal authority. Notwithstanding the provisions of
11    Section 1-11 of this Code, due to the nature of the
12    COVID-19 public health emergency, the Department may cover
13    and provide the medical assistance described in this
14    paragraph 21 to noncitizens who would otherwise meet the
15    eligibility requirements for the class of persons
16    described in this paragraph 21 for the duration of the
17    State emergency period.
18    In implementing the provisions of Public Act 96-20, the
19Department is authorized to adopt only those rules necessary,
20including emergency rules. Nothing in Public Act 96-20 permits
21the Department to adopt rules or issue a decision that expands
22eligibility for the FamilyCare Program to a person whose
23income exceeds 185% of the Federal Poverty Level as determined
24from time to time by the U.S. Department of Health and Human
25Services, unless the Department is provided with express
26statutory authority.



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



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1United States Supreme Court holds Title II, Subtitle A,
2Section 2001(a) of Public Law 111-148 to be unconstitutional,
3or if a holding of Public Law 111-148 makes Medicaid
4eligibility allowed under Section 2001(a) inoperable, the
5State or a unit of local government shall be prohibited from
6enrolling individuals in the Medical Assistance Program as the
7result of federal approval of a State Medicaid waiver on or
8after June 14, 2012 (the effective date of Public Act 97-687)
9this amendatory Act of the 97th General Assembly, and any
10individuals enrolled in the Medical Assistance Program
11pursuant to eligibility permitted as a result of such a State
12Medicaid waiver shall become immediately ineligible.
13    Notwithstanding any other provision of this Code, if an
14Act of Congress that becomes a Public Law eliminates Section
152001(a) of Public Law 111-148, the State or a unit of local
16government shall be prohibited from enrolling individuals in
17the Medical Assistance Program as the result of federal
18approval of a State Medicaid waiver on or after June 14, 2012
19(the effective date of Public Act 97-687) this amendatory Act
20of the 97th General Assembly, and any individuals enrolled in
21the Medical Assistance Program pursuant to eligibility
22permitted as a result of such a State Medicaid waiver shall
23become immediately ineligible.
24    Effective October 1, 2013, the determination of
25eligibility of persons who qualify under paragraphs 5, 6, 8,
2615, 17, and 18 of this Section shall comply with the



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1requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
3    The Department of Healthcare and Family Services, the
4Department of Human Services, and the Illinois health
5insurance marketplace shall work cooperatively to assist
6persons who would otherwise lose health benefits as a result
7of changes made under Public Act 98-104 this amendatory Act of
8the 98th General Assembly to transition to other health
9insurance coverage.
10    Notwithstanding any provision of this Section, beginning
11on January 1, 2023, the Department shall raise the income
12eligibility standard for all of its medical assistance
13programs to include persons whose income is equal to or less
14than 276% of the federal poverty level (or any higher
15percentage determined by the Department) plus 5% for the
16applicable family size as determined under 42 U.S.C.
171396a(e)(14) and applicable federal regulations. Persons
18eligible for medical assistance under this amendatory Act of
19the 102nd General Assembly shall receive coverage identical to
20the coverage provided to persons eligible for each medical
21assistance program under the income eligibility requirements
22in effect on December 31, 2022. The Department may adopt rules
23for the implementation of this amendatory Act of the 102nd
24General Assembly. This amendatory Act of the 102nd General
25Assembly does not apply to programs in which the income
26eligibility standard is higher than the standard created by



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1this amendatory Act of the 102nd General Assembly.
2(Source: P.A. 101-10, eff. 6-5-19; 101-649, eff. 7-7-20;
3revised 8-24-20.)".