(305 ILCS 5/10-26)
Sec. 10-26.
State Disbursement Unit.
(a) Effective October 1, 1999 the Illinois Department shall establish a
State Disbursement Unit in accordance with the requirements of Title IV-D of
the Social Security Act. The Illinois Department shall enter into an agreement
with a State or local governmental unit or private entity to perform the
functions of the State Disbursement Unit as set forth in this Section. The
State Disbursement Unit shall collect and disburse support payments made under
court and administrative support orders:
(1) being enforced in cases in which child and spouse |
| support services are being provided under this Article X; and
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(2) in all cases in which child and spouse support
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| services are not being provided under this Article X and in which support payments are made under the provisions of the Income Withholding for Support Act.
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(a-2) The contract entered into by the Illinois Department with a
public or
private entity or an individual for the operation of the State
Disbursement
Unit is subject to competitive bidding. In addition, the contract is subject
to Section
10-26.2 of this
Code. As used in this subsection (a-2), "contract" has the same meaning as in
the Illinois
Procurement Code.
(a-5) If the State Disbursement Unit receives a support payment that was
not appropriately made to the Unit under this Section, the Unit shall
immediately return the payment to the sender, including, if possible,
instructions detailing where to send the support payments.
(b) All payments received by the State Disbursement Unit:
(1) shall be deposited into an account obtained by
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| the Illinois Department, and
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(2) distributed and disbursed by the State
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| Disbursement Unit, in accordance with the directions of the Illinois Department, pursuant to Title IV-D of the Social Security Act and rules promulgated by the Department.
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(c) All support payments assigned to the Illinois Department under Article X
of this Code and rules promulgated by the Illinois Department that are
disbursed to the Illinois Department by the State Disbursement Unit shall be
paid into the Child Support Enforcement Trust Fund.
(d) If the agreement with the State or local governmental unit or private
entity provided for in this Section is not in effect for any reason, the
Department shall perform the functions of the State Disbursement Unit as set
forth in this Section for a maximum of 12 months before July 1, 2001, and for
a
maximum of 24 months after June 30, 2001. If the Illinois Department is
performing the functions of the State Disbursement Unit on July 1, 2001, then
the Illinois Department shall make an award on or before December 31, 2002, to
a State or local government unit or private entity to perform the functions of
the State Disbursement Unit.
Payments received by the Illinois Department in performance of the duties
of the State
Disbursement Unit shall be deposited into the State Disbursement Unit Revolving
Fund established under Section 12-8.1.
Nothing in this Section shall prohibit the Illinois Department from holding
the State Disbursement Unit Revolving Fund after June 30, 2003.
(e) By February 1, 2000, the Illinois Department shall conduct at least 4
regional training and educational seminars to educate the clerks of the circuit
court on the general operation of the State Disbursement Unit, the role of the
State Disbursement Unit, and the role of the clerks of the circuit court in the
collection and distribution of child support payments.
(f) By March 1, 2000, the Illinois Department shall conduct at least 4
regional educational and training seminars to educate payors, as defined
in the Income Withholding for Support Act, on the general operation of the
State Disbursement Unit, the role of the State Disbursement Unit, and the
distribution of income withholding payments pursuant to this Section and the
Income Withholding for Support Act.
(Source: P.A. 92-44, eff. 7-1-01; 93-20, eff. 6-20-03.)
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(305 ILCS 5/10-27)
Sec. 10-27. State Case Registry.
(a) The Illinois Department shall establish an automated State Case
Registry to
contain records concerning child support orders for parties receiving child
support enforcement services under this Article X, and for all child support
orders entered or modified on or after October 1, 1998. The State Case
Registry shall include (i) the information filed with the Illinois Department,
or filed with the clerk of the circuit court and provided to the Illinois
Department, under the provisions of Sections 10-10.5 and 10-11.2 of this Code,
Section 505.3 of the Illinois Marriage and Dissolution of Marriage Act, Section
30 of the Non-Support Punishment Act, Section 803 of the Illinois Parentage Act of 2015, and Section 14.1 of the Illinois
Parentage Act of 1984, and (ii) any other information required under Title IV,
Part D of the Social Security Act or by the federal Department of Health and
Human Services.
(b) (Blank).
(c) The Illinois Department shall maintain the following payment information
on child support orders for parties receiving child support
enforcement services
under
this Article X:
(1) the amount of monthly or other periodic support |
| owed under the order and other amounts, including arrearages, interest or late payment penalties, and fees, due or overdue under the order;
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(2) any amounts described in subdivision (1) of
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| subsection (d) that have been collected;
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(3) the distribution of the collected amounts; and
(4) the amount of any lien imposed with respect to
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| the order pursuant to Section 10-25 or Section 10-25.5 of this Code.
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(d) The Illinois Department shall establish, update, maintain, and monitor
case records in the Registry of parties receiving child support
enforcement services under this Article X, on the bases of:
(1) information on administrative actions and
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| administrative and judicial proceedings and orders relating to paternity and support;
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(2) information obtained from comparison with
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| federal, State, and local sources of information;
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(3) information on support collections and
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(4) any other relevant information.
(e) The Illinois Department shall use the automated State Case Registry to
share and compare information with, and receive information from, other data
bases and information comparison services in order to obtain (or provide)
information necessary to enable the Illinois Department (or the federal
Department of Health and Human Services or other State or federal agencies) to
carry out the requirements of the child support enforcement program established
under Title IV, Part D of the Social Security Act. Such information comparison
activities shall include the following:
(1) Furnishing to the Federal Case Registry of Child
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| Support Orders (and updating as necessary, with information including notice of expiration of orders) the information specified by the federal Department of Health and Human Services in regulations.
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(2) Exchanging information with the Federal Parent
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| Locator Service for the purposes specified in Section 453 of the Social Security Act.
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(3) Exchanging information with State agencies (of
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| this State and of other states) administering programs funded under Title IV, Part A and Title XIX of the Social Security Act and other programs designated by the federal Department of Health and Human Services, as necessary to perform responsibilities under Title IV, Part D of the Social Security Act and under such other programs.
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(4) Exchanging information with other agencies of
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| this State, agencies of other states, and interstate information networks, as necessary and appropriate to carry out (or assist other states to carry out) the purposes of Title IV, Part D of the Social Security Act.
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(5) Disclosing information to any other entities as
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| required under Title IV, Part D of the Social Security Act.
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(f) The Illinois Department shall adopt rules establishing safeguards,
applicable to all confidential information included in the State Case Registry,
that are designed to protect the privacy rights of persons concerning whom
information is on record in the State Case Registry. Such safeguards shall
include,
but not be limited to the following:
(1) Prohibitions against the release of information
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| on the whereabouts of one party or the child to another party against whom a protective order with respect to the former party or the child has been entered.
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(2) Prohibitions against the release of information
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| on the whereabouts of one party or the child to another party if the Illinois Department has reasonable evidence of domestic violence or child abuse (that is, allegations of domestic violence or child abuse, unless the Illinois Department has an independent, reasonable basis to find the person making the allegation not credible) to the former party or child by the party requesting information.
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(3) Prohibitions against the release of information
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| on the whereabouts of one party or the child to another person if the Illinois Department has reason to believe the release of information to that person may result in physical or emotional harm to the party or child.
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(Source: P.A. 99-85, eff. 1-1-16 .)
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(305 ILCS 5/11-5.1) Sec. 11-5.1. Eligibility verification. Notwithstanding any other provision of this Code, with respect to applications for medical assistance provided under Article V of this Code, eligibility shall be determined in a manner that ensures program integrity and complies with federal laws and regulations while minimizing unnecessary barriers to enrollment. To this end, as soon as practicable, and unless the Department receives written denial from the federal government, this Section shall be implemented: (a) The Department of Healthcare and Family Services or its designees shall: (1) By no later than July 1, 2011, require |
| verification of, at a minimum, one month's income from all sources required for determining the eligibility of applicants for medical assistance under this Code. Such verification shall take the form of pay stubs, business or income and expense records for self-employed persons, letters from employers, and any other valid documentation of income including data obtained electronically by the Department or its designees from other sources as described in subsection (b) of this Section. A month's income may be verified by a single pay stub with the monthly income extrapolated from the time period covered by the pay stub.
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(2) By no later than October 1, 2011, require
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| verification of, at a minimum, one month's income from all sources required for determining the continued eligibility of recipients at their annual review of eligibility for medical assistance under this Code. Information the Department receives prior to the annual review, including information available to the Department as a result of the recipient's application for other non-Medicaid benefits, that is sufficient to make a determination of continued Medicaid eligibility may be reviewed and verified, and subsequent action taken including client notification of continued Medicaid eligibility. The date of client notification establishes the date for subsequent annual Medicaid eligibility reviews. Such verification shall take the form of pay stubs, business or income and expense records for self-employed persons, letters from employers, and any other valid documentation of income including data obtained electronically by the Department or its designees from other sources as described in subsection (b) of this Section. A month's income may be verified by a single pay stub with the monthly income extrapolated from the time period covered by the pay stub. The Department shall send a notice to recipients at least 60 days prior to the end of their period of eligibility that informs them of the requirements for continued eligibility. If a recipient does not fulfill the requirements for continued eligibility by the deadline established in the notice a notice of cancellation shall be issued to the recipient and coverage shall end no later than the last day of the month following the last day of the eligibility period. A recipient's eligibility may be reinstated without requiring a new application if the recipient fulfills the requirements for continued eligibility prior to the end of the third month following the last date of coverage (or longer period if required by federal regulations). Nothing in this Section shall prevent an individual whose coverage has been cancelled from reapplying for health benefits at any time.
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(3) By no later than July 1, 2011, require
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| verification of Illinois residency.
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The Department, with federal approval, may choose to adopt continuous financial eligibility for a full 12 months for adults on Medicaid.
(b) The Department shall establish or continue cooperative
arrangements with the Social Security Administration, the
Illinois Secretary of State, the Department of Human Services,
the Department of Revenue, the Department of Employment
Security, and any other appropriate entity to gain electronic
access, to the extent allowed by law, to information available
to those entities that may be appropriate for electronically
verifying any factor of eligibility for benefits under the
Program. Data relevant to eligibility shall be provided for no
other purpose than to verify the eligibility of new applicants or current recipients of health benefits under the Program. Data shall be requested or provided for any new applicant or current recipient only insofar as that individual's circumstances are relevant to that individual's or another individual's eligibility.
(c) Within 90 days of the effective date of this amendatory Act of the 96th General Assembly, the Department of Healthcare and Family Services shall send notice to current recipients informing them of the changes regarding their eligibility verification.
(d) As soon as practical if the data is reasonably available, but no later than January 1, 2017, the Department shall compile on a monthly basis data on eligibility redeterminations of beneficiaries of medical assistance provided under Article V of this Code. In addition to the
other data required under this subsection, the Department
shall compile on a monthly basis data on the percentage of
beneficiaries whose eligibility is renewed through ex parte
redeterminations as described in subsection (b) of Section
5-1.6 of this Code, subject to federal approval of the changes
made in subsection (b) of Section 5-1.6 by this amendatory Act
of the 102nd General Assembly. This data shall be posted on the Department's website, and data from prior months shall be retained and available on the Department's website. The data compiled and reported shall include the following:
(1) The total number of redetermination decisions
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| made in a month and, of that total number, the number of decisions to continue or change benefits and the number of decisions to cancel benefits.
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(2) A breakdown of enrollee language preference for
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| the total number of redetermination decisions made in a month and, of that total number, a breakdown of enrollee language preference for the number of decisions to continue or change benefits, and a breakdown of enrollee language preference for the number of decisions to cancel benefits. The language breakdown shall include, at a minimum, English, Spanish, and the next 4 most commonly used languages.
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(3) The percentage of cancellation decisions made in
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| a month due to each of the following:
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(A) The beneficiary's ineligibility due to excess
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(B) The beneficiary's ineligibility due to not
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| being an Illinois resident.
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(C) The beneficiary's ineligibility due to being
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(D) The beneficiary's request to cancel benefits.
(E) The beneficiary's lack of response after
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| notices mailed to the beneficiary are returned to the Department as undeliverable by the United States Postal Service.
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(F) The beneficiary's lack of response to a
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| request for additional information when reliable information in the beneficiary's account, or other more current information, is unavailable to the Department to make a decision on whether to continue benefits.
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(G) Other reasons tracked by the Department for
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| the purpose of ensuring program integrity.
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(4) If a vendor is utilized to provide services in
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| support of the Department's redetermination decision process, the total number of redetermination decisions made in a month and, of that total number, the number of decisions to continue or change benefits, and the number of decisions to cancel benefits (i) with the involvement of the vendor and (ii) without the involvement of the vendor.
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(5) Of the total number of benefit cancellations in a
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| month, the number of beneficiaries who return from cancellation within one month, the number of beneficiaries who return from cancellation within 2 months, and the number of beneficiaries who return from cancellation within 3 months. Of the number of beneficiaries who return from cancellation within 3 months, the percentage of those cancellations due to each of the reasons listed under paragraph (3) of this subsection.
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(e) The Department shall conduct a complete review of the Medicaid redetermination process in order to identify changes that can increase the use of ex parte redetermination processing. This review shall be completed within 90 days after the effective date of this amendatory Act of the 101st General Assembly. Within 90 days of completion of the review, the Department shall seek written federal approval of policy changes the review recommended and implement once approved. The review shall specifically include, but not be limited to, use of ex parte redeterminations of the following populations:
(1) Recipients of developmental disabilities
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(2) Recipients of benefits under the State's Aid to
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| the Aged, Blind, or Disabled program.
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(3) Recipients of Medicaid long-term care services
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| and supports, including waiver services.
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(4) All Modified Adjusted Gross Income (MAGI)
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(5) Populations with no verifiable income.
(6) Self-employed people.
The report shall also outline populations and circumstances in which an ex parte redetermination is not a recommended option.
(f) The Department shall explore and implement, as practical and technologically possible, roles that stakeholders outside State agencies can play to assist in expediting eligibility determinations and redeterminations within 24 months after the effective date of this amendatory Act of the 101st General Assembly. Such practical roles to be explored to expedite the eligibility determination processes shall include the implementation of hospital presumptive eligibility, as authorized by the Patient Protection and Affordable Care Act.
(g) The Department or its designee shall seek federal approval to enhance the reasonable compatibility standard from 5% to 10%.
(h) Reporting. The Department of Healthcare and Family Services and the Department of Human Services shall publish quarterly reports on their progress in implementing policies and practices pursuant to this Section as modified by this amendatory Act of the 101st General Assembly.
(1) The reports shall include, but not be limited to,
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(A) Medical application processing, including a
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| breakdown of the number of MAGI, non-MAGI, long-term care, and other medical cases pending for various incremental time frames between 0 to 181 or more days.
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(B) Medical redeterminations completed,
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| including: (i) a breakdown of the number of households that were redetermined ex parte and those that were not; (ii) the reasons households were not redetermined ex parte; and (iii) the relative percentages of these reasons.
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(C) A narrative discussion on issues identified
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| in the functioning of the State's Integrated Eligibility System and progress on addressing those issues, as well as progress on implementing strategies to address eligibility backlogs, including expanding ex parte determinations to ensure timely eligibility determinations and renewals.
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(2) Initial reports shall be issued within 90 days
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| after the effective date of this amendatory Act of the 101st General Assembly.
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(3) All reports shall be published on the
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(i) It is the determination of the General Assembly that the Department must include seniors and persons with disabilities in ex parte renewals. It is the determination of the General Assembly that the Department must use its asset verification system to assist in the determination of whether an individual's coverage can be renewed using the ex parte process. If a State Plan amendment is required, the Department shall pursue such State Plan amendment by July 1, 2022. Within 60 days after receiving federal approval or guidance, the Department of Healthcare and Family Services and the Department of Human Services shall make necessary technical and rule changes to implement these changes to the redetermination process.
(Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20; 102-1037, eff. 6-2-22.)
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(305 ILCS 5/11-5.2) Sec. 11-5.2. Income, Residency, and Identity Verification System. (a) The Department shall ensure that its proposed integrated eligibility system shall include the computerized functions of income, residency, and identity eligibility verification to verify eligibility, eliminate duplication of medical assistance, and deter fraud. Until the integrated eligibility system is operational, the Department may enter into a contract with the vendor selected pursuant to Section 11-5.3 as necessary to obtain the electronic data matching described in this Section. This contract shall be exempt from the Illinois Procurement Code pursuant to subsection (h) of Section 1-10 of that Code. (b) Prior to awarding medical assistance at application under Article V of this Code, the Department shall, to the extent such databases are available to the Department, conduct data matches using the name, date of birth, address, and Social Security Number of each applicant or recipient or responsible relative of an applicant or recipient against the following: (1) Income tax information. (2) Employer reports of income and unemployment |
| insurance payment information maintained by the Department of Employment Security.
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(3) Earned and unearned income, citizenship and
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| death, and other relevant information maintained by the Social Security Administration.
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(4) Immigration status information maintained by the
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| United States Citizenship and Immigration Services.
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(5) Wage reporting and similar information maintained
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| by states contiguous to this State.
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(6) Employment information maintained by the
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| Department of Employment Security in its New Hire Directory database.
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(7) Employment information maintained by the United
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| States Department of Health and Human Services in its National Directory of New Hires database.
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(8) Veterans' benefits information maintained by the
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| United States Department of Health and Human Services, in coordination with the Department of Health and Human Services and the Department of Veterans' Affairs, in the federal Public Assistance Reporting Information System (PARIS) database.
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(9) Residency information maintained by the Illinois
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(10) A database which is substantially similar to or
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| a successor of a database described in this Section that contains information relevant for verifying eligibility for medical assistance.
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(c) (Blank).
(d) If a discrepancy results between information provided by an applicant, recipient, or responsible relative and information contained in one or more of the databases or information tools listed under subsection (b) of this Section or subsection (c) of Section 11-5.3 and that discrepancy calls into question the accuracy of information relevant to a condition of eligibility provided by the applicant, recipient, or responsible relative, the Department or its contractor shall review the applicant's or recipient's case using the following procedures:
(1) If the information discovered under subsection
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| (b) of this Section or subsection (c) of Section 11-5.3 does not result in the Department finding the applicant or recipient ineligible for assistance under Article V of this Code, the Department shall finalize the determination or redetermination of eligibility.
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(2) If the information discovered results in the
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| Department finding the applicant or recipient ineligible for assistance, the Department shall provide notice as set forth in Section 11-7 of this Article.
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(3) If the information discovered is insufficient to
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| determine that the applicant or recipient is eligible or ineligible, the Department shall provide written notice to the applicant or recipient which shall describe in sufficient detail the circumstances of the discrepancy, the information or documentation required, the manner in which the applicant or recipient may respond, and the consequences of failing to take action. The applicant or recipient shall have 10 business days to respond.
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(4) If the applicant or recipient does not respond to
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| the notice, the Department shall deny assistance for failure to cooperate, in which case the Department shall provide notice as set forth in Section 11-7. Eligibility for assistance shall not be established until the discrepancy has been resolved.
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(5) If an applicant or recipient responds to the
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| notice, the Department shall determine the effect of the information or documentation provided on the applicant's or recipient's case and shall take appropriate action. Written notice of the Department's action shall be provided as set forth in Section 11-7 of this Article.
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(6) Suspected cases of fraud shall be referred to the
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| Department's Inspector General.
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(e) The Department shall adopt any rules necessary to implement this Section.
(Source: P.A. 97-689, eff. 6-14-12; 98-756, eff. 7-16-14.)
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(305 ILCS 5/11-5.4) Sec. 11-5.4. Expedited long-term care eligibility determination and enrollment. (a) Establishment of the expedited long-term care eligibility determination and enrollment system shall be a joint venture of the Departments of Human Services and Healthcare and Family Services and the Department on Aging. (b) Streamlined application enrollment process; expedited eligibility process. The streamlined application and enrollment process must include, but need not be limited to, the following: (1) On or before July 1, 2019, a streamlined |
| application and enrollment process shall be put in place which must include, but need not be limited to, the following:
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(A) Minimize the burden on applicants by
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| collecting only the data necessary to determine eligibility for medical services, long-term care services, and spousal impoverishment offset.
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(B) Integrate online data sources to simplify the
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| application process by reducing the amount of information needed to be entered and to expedite eligibility verification.
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(C) Provide online prompts to alert the applicant
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| that information is missing or not complete.
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(D) Provide training and step-by-step written
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| instructions for caseworkers, applicants, and providers.
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(2) The State must expedite the eligibility process
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| for applicants meeting specified guidelines, regardless of the age of the application. The guidelines, subject to federal approval, must include, but need not be limited to, the following individually or collectively:
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(A) Full Medicaid benefits in the community for a
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| specified period of time.
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(B) No transfer of assets or resources during the
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| federally prescribed look-back period, as specified in federal law.
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(C) Receives Supplemental Security Income
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| payments or was receiving such payments at the time of admission to a nursing facility.
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(D) For applicants or recipients with verified
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| income at or below 100% of the federal poverty level when the declared value of their countable resources is no greater than the allowable amounts pursuant to Section 5-2 of this Code for classes of eligible persons for whom a resource limit applies. Such simplified verification policies shall apply to community cases as well as long-term care cases.
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(3) Subject to federal approval, the Department of
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| Healthcare and Family Services must implement an ex parte renewal process for Medicaid-eligible individuals residing in long-term care facilities. "Renewal" has the same meaning as "redetermination" in State policies, administrative rule, and federal Medicaid law. The ex parte renewal process must be fully operational on or before January 1, 2019. If an individual has transferred to another long-term care facility, any annual notice concerning redetermination of eligibility must be sent to the long-term care facility where the individual resides as well as to the individual.
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(4) The Department of Human Services must use the
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| standards and distribution requirements described in this subsection and in Section 11-6 for notification of missing supporting documents and information during all phases of the application process: initial, renewal, and appeal.
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(c) The Department of Human Services must adopt policies and procedures to improve communication between long-term care benefits central office personnel, applicants and their representatives, and facilities in which the applicants reside. Such policies and procedures must at a minimum permit applicants and their representatives and the facility in which the applicants reside to speak directly to an individual trained to take telephone inquiries and provide appropriate responses.
(d) Effective 30 days after the completion of 3 regionally based trainings, nursing facilities shall submit all applications for medical assistance online via the Application for Benefits Eligibility (ABE) website. This requirement shall extend to scanning and uploading with the online application any required additional forms such as the Long Term Care Facility Notification and the Additional Financial Information for Long Term Care Applicants as well as scanned copies of any supporting documentation. Long-term care facility admission documents must be submitted as required in Section 5-5 of this Code. No local Department of Human Services office shall refuse to accept an electronically filed application. No Department of Human Services office shall request submission of any document in hard copy.
(e) Notwithstanding any other provision of this Code, the Department of Human Services and the Department of Healthcare and Family Services' Office of the Inspector General shall, upon request, allow an applicant additional time to submit information and documents needed as part of a review of available resources or resources transferred during the look-back period. The initial extension shall not exceed 30 days. A second extension of 30 days may be granted upon request. Any request for information issued by the State to an applicant shall include the following: an explanation of the information required and the date by which the information must be submitted; a statement that failure to respond in a timely manner can result in denial of the application; a statement that the applicant or the facility in the name of the applicant may seek an extension; and the name and contact information of a caseworker in case of questions. Any such request for information shall also be sent to the facility. In deciding whether to grant an extension, the Department of Human Services or the Department of Healthcare and Family Services' Office of the Inspector General shall take into account what is in the best interest of the applicant. The time limits for processing an application shall be tolled during the period of any extension granted under this subsection.
(f) The Department of Human Services and the Department of Healthcare and Family Services must jointly compile data on pending applications, denials, appeals, and redeterminations into a monthly report, which shall be posted on each Department's website for the purposes of monitoring long-term care eligibility processing. The report must specify the number of applications and redeterminations pending long-term care eligibility determination and admission and the number of appeals of denials in the following categories:
(A) Length of time applications, redeterminations,
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| and appeals are pending - 0 to 45 days, 46 days to 90 days, 91 days to 180 days, 181 days to 12 months, over 12 months to 18 months, over 18 months to 24 months, and over 24 months.
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(B) Percentage of applications and redeterminations
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| pending in the Department of Human Services' Family Community Resource Centers, in the Department of Human Services' long-term care hubs, with the Department of Healthcare and Family Services' Office of Inspector General, and those applications which are being tolled due to requests for extension of time for additional information.
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(C) Status of pending applications, denials, appeals,
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(g) Beginning on July 1, 2017, the Auditor General shall report every 3 years to the General Assembly on the performance and compliance of the Department of Healthcare and Family Services, the Department of Human Services, and the Department on Aging in meeting the requirements of this Section and the federal requirements concerning eligibility determinations for Medicaid long-term care services and supports, and shall report any issues or deficiencies and make recommendations. The Auditor General shall, at a minimum, review, consider, and evaluate the following:
(1) compliance with federal regulations on furnishing
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| services as related to Medicaid long-term care services and supports as provided under 42 CFR 435.930;
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(2) compliance with federal regulations on the timely
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| determination of eligibility as provided under 42 CFR 435.912;
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(3) the accuracy and completeness of the report
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| required under paragraph (9) of subsection (e);
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(4) the efficacy and efficiency of the task-based
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| process used for making eligibility determinations in the centralized offices of the Department of Human Services for long-term care services, including the role of the State's integrated eligibility system, as opposed to the traditional caseworker-specific process from which these central offices have converted; and
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(5) any issues affecting eligibility determinations
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| related to the Department of Human Services' staff completing Medicaid eligibility determinations instead of the designated single-state Medicaid agency in Illinois, the Department of Healthcare and Family Services.
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The Auditor General's report shall include any and all other areas or issues which are identified through an annual review. Paragraphs (1) through (5) of this subsection shall not be construed to limit the scope of the annual review and the Auditor General's authority to thoroughly and completely evaluate any and all processes, policies, and procedures concerning compliance with federal and State law requirements on eligibility determinations for Medicaid long-term care services and supports.
(h) The Department of Healthcare and Family Services shall adopt any rules necessary to administer and enforce any provision of this Section. Rulemaking shall not delay the full implementation of this Section.
(i) Beginning on June 29, 2018, provisional eligibility for medical assistance under Article V of this Code, in
the form of a recipient identification number and any other necessary credentials to permit an applicant to receive covered services under Article V, must be issued to any applicant who has not received a determination on his or her application for Medicaid and Medicaid long-term care services filed simultaneously or, if already Medicaid enrolled, application for Medicaid long-term care services under Article V of this Code within the federally prescribed timeliness requirements for determinations on such applications. The Department of Healthcare and Family Services must maintain the applicant's provisional eligibility status until a determination is made on the individual's application for long-term care services. The Department of Healthcare and Family Services or the managed care organization, if applicable, must reimburse providers for services rendered during an applicant's provisional eligibility period.
(1) Claims for services rendered to an applicant with
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| provisional eligibility status must be submitted and processed in the same manner as those submitted on behalf of beneficiaries determined to qualify for benefits.
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(2) An applicant with provisional eligibility status
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| must have his or her long-term care benefits paid for under the State's fee-for-service system during the period of provisional eligibility. If an individual otherwise eligible for medical assistance under Article V of this Code is enrolled with a managed care organization for community benefits at the time the individual's provisional eligibility for long-term care services is issued, the managed care organization is only responsible for paying benefits covered under the capitation payment received by the managed care organization for the individual.
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(3) The Department of Healthcare and Family Services,
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| within 10 business days of issuing provisional eligibility to an applicant, must submit to the Office of the Comptroller for payment a voucher for all retroactive reimbursement due. The Department of Healthcare and Family Services must clearly identify such vouchers as provisional eligibility vouchers.
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(Source: P.A. 101-101, eff. 1-1-20; 101-209, eff. 8-5-19; 101-265, eff. 8-9-19; 101-559, eff. 8-23-19; 102-558, eff. 8-20-21.)
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(305 ILCS 5/11-8) (from Ch. 23, par. 11-8)
Sec. 11-8. Appeals - to whom taken. Applicants or recipients of aid
may, at any time within 60 days after the decision of the County
Department or local governmental unit, as the case may be, appeal a
decision denying or terminating aid, or granting aid in an amount which
is deemed inadequate, or changing, cancelling, revoking or suspending
grants as provided in Section 11-16, or determining to make a protective
payment under the provisions of Sections 3-5a or 4-9, or a decision by an
administrative review board to impose administrative safeguards as provided
in Section 8A-8. An appeal shall also lie when an application is not acted
upon within the time period after filing of the application as provided by rule
of the Illinois Department.
If an appeal is not made, the action of the County Department or
local governmental unit shall be final.
Appeals by applicants or recipients under Articles III, IV, or V
shall be taken to the Illinois Department.
Appeals by applicants or recipients under Article VI shall be taken
as follows:
(1) In counties under township organization (except |
| such counties in which the governing authority is a Board of Commissioners) appeals shall be to a Public Aid Committee consisting of the Chairman of the County Board, and 4 members who are township supervisors of general assistance, appointed by the Chairman, with the advice and consent of the county board.
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(2) In counties in excess of 3,000,000 population and
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| under township organization in which the governing authority is a Board of Commissioners, appeals of persons from government units outside the corporate limits of a city, village or incorporated town of more than 500,000 population, and of persons from incorporated towns which have superseded civil townships in respect to aid under Article VI, shall be to the Cook County Townships Public Aid Committee consisting of 2 township supervisors and 3 persons knowledgeable in the area of General Assistance and the regulations of the Illinois Department pertaining thereto and who are not officers, agents or employees of any township, except that township supervisors may serve as members of the Cook County Township Public Aid and Committee. The 5 member committee shall be appointed by the township supervisors. The first appointments shall be made with one person serving a one year term, 2 persons serving a 2 year term, and 2 persons serving a 3 year term. Committee members shall thereafter serve 3 year terms. In any appeal involving a local governmental unit whose supervisor of general assistance is a member of the Committee, such supervisor shall not act as a member of the Committee for the purposes of such appeal, and the Committee shall select another township supervisor to serve as an alternate member for that appeal. The township whose action, inaction, or decision is being appealed shall bear the expenses related to the appeal as determined by the Cook County Townships Public Aid Committee. A township supervisor's compensation for general assistance or township related duties shall not be considered an expense related to the appeal except for expenses related to service on the Committee.
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(3) In counties described in paragraph (2) appeals of
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| persons from a city, village or incorporated town of more than 500,000 population shall be to the Illinois Department.
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(4) In counties not under township organization,
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| appeals shall be to the County Board of Commissioners which shall for this purpose be the Public Aid Committee of the County.
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In counties designated in paragraph (1) the Chairman or President of
the County Board shall appoint, with the advice and consent of the
county board, one or more alternate members of the Public Aid Committee.
All regular and alternate members shall be Supervisors of General
Assistance. In any appeal involving a local governmental unit whose
Supervisor of General Assistance is a member of the Committee, he shall
be replaced for that appeal by an alternate member designated by the
Chairman or President of the County Board, with the advice and consent
of the county board. In these counties not more than 3 of the 5 regular
appointees shall be members of the same political party unless the
political composition of the Supervisors of the General Assistance
precludes such a limitation. In these counties at least one member of the
Public Aid Committee shall be a person knowledgeable in the area of general
assistance and the regulations of the Illinois Department pertaining
thereto. If no member of the Committee possesses such knowledge, the
Illinois Department shall designate an employee of the Illinois Department
having such knowledge to be present at the Committee hearings to advise
the Committee.
In every county the County Board shall provide facilities for the
conduct of hearings on appeals under Article VI. All expenses incident
to such hearings shall be borne by the county except that in counties
under township organization in which the governing authority is a Board
of Commissioners (1) the salary and other expenses of the Commissioner
of Appeals shall be paid from General Assistance funds available for
administrative purposes, and (2) all expenses incident to such hearings
shall be borne by the township and the per diem and traveling expenses
of the township supervisors serving on the Public Aid Committee shall be
fixed and paid by their respective townships. In all other counties the
members of the Public Aid Committee shall receive the compensation and
expenses provided by law for attendance at meetings of the County Board.
In appeals under Article VI involving a governmental unit receiving
State funds, the Public Aid Committee and the Commissioner of Appeals
shall be bound by the rules and regulations of the Illinois Department
which are relevant to the issues on appeal, and shall file such reports
concerning appeals as the Illinois Department requests.
The members of each Public Aid Committee and the members of the Cook
County Townships Public Aid Committee are immune from personal liability in connection with their service on the committee to the same extent as an elected or appointed judge in this State is immune from personal liability in connection with the performance of his or her duties as judge. This immunity applies only to causes of action accruing on or after the effective date of this amendatory Act of the 94th General Assembly.
An appeal shall be without cost to the appellant and shall be made, at
the option of the appellant, either upon forms provided and prescribed by
the Illinois Department or, for appeals to a Public Aid Committee, upon
forms prescribed by the County Board; or an appeal may be made by calling a
toll-free number provided for that purpose by the Illinois Department and
providing the necessary information. The Illinois Department may assist
County Boards or a Commissioner of Appeals in the preparation of appeal
forms, or upon request of a County Board or Commissioner of Appeals may
furnish such forms. County Departments and local governmental units shall
render all possible aid to persons desiring to make an appeal. The
provisions of Sections 11-8.1 to 11-8.7, inclusive, shall apply to all
such appeals.
(Source: P.A. 93-295, eff. 7-22-03; 94-524, eff. 8-10-05.)
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(305 ILCS 5/11-9) (from Ch. 23, par. 11-9)
Sec. 11-9. Protection of records; exceptions. For the protection of applicants and recipients, the Illinois Department,
the county departments and local governmental units and their respective
officers and employees are prohibited, except as hereinafter provided, from
disclosing the contents of any records, files, papers and communications,
except for purposes directly connected with the administration of public
aid under this Code.
In any judicial proceeding, except a proceeding directly concerned with
the administration of programs provided for in this Code, such records,
files, papers and communications, and their contents shall be deemed
privileged communications and shall be disclosed only upon the order of the
court, where the court finds such to be necessary in the interest of justice.
The Illinois Department shall establish and enforce reasonable rules and
regulations governing the custody, use and preservation of the records,
papers, files, and communications of the Illinois Department, the county
departments and local governmental units receiving State or Federal funds
or aid. The governing body of other local governmental units shall in like
manner establish and enforce rules and regulations governing the same matters.
The contents of case files pertaining to recipients under Articles IV, V,
and VI shall be made available without subpoena or formal notice to the
officers of any court, to all law enforcement agencies, and to such other persons
or
agencies as from time to time may be authorized by any court.
In particular, the contents of those case files shall be made available upon
request to a law enforcement agency for the purpose of determining the current
address of a recipient with respect to whom an arrest warrant is outstanding,
and
the current address of a recipient who was a victim of a felony or a
witness to a felony shall be made available upon
request to a State's Attorney of this State or a State's Attorney's
investigator. Information shall also be disclosed to
the Illinois State Scholarship
Commission pursuant to an investigation or audit by the Illinois State
Scholarship Commission of a delinquent student loan or monetary award.
This Section does not prevent the Illinois Department and local governmental
units from reporting to appropriate law enforcement officials the desertion
or abandonment by a parent of a child, as a result of which financial aid
has been necessitated under Articles IV, V, or VI, or reporting
to
appropriate law enforcement officials instances in which a mother under
age 18 has a child out of wedlock and is an applicant for or recipient of
aid under any Article of this Code. The Illinois Department may provide
by rule for the county departments and local governmental units to initiate
proceedings under the Juvenile Court Act of 1987 to have children declared
to be neglected when they deem
such action necessary to protect the children from immoral influences
present in their home or surroundings.
This Section does not preclude the full exercise of the powers of the Board
of Public Aid Commissioners to inspect records and documents, as provided
for all advisory boards pursuant to Section 5-505 of the
Departments of State Government Law (20 ILCS 5/5-505).
This Section does not preclude exchanges of information among the Department of Healthcare and Family Services (formerly Illinois
Department of Public Aid), the Department of Human Services (as successor to the
Department of Public Aid), and the Illinois Department of Revenue for the
purpose of verifying sources and amounts of income and for other purposes
directly connected with the administration of this Code and of the Illinois
Income Tax Act.
The provisions of this Section and of Section 11-11 as they apply to
applicants and recipients of public aid under Article V shall
be operative only to the extent that they do not conflict with any Federal
law or regulation governing Federal grants to this State for such programs.
The Department of Healthcare and Family Services and the Department of Human Services
(as successor to the Illinois Department of Public Aid) shall enter into an
inter-agency agreement with the
Department of Children and Family Services to establish a procedure by which
employees of the Department of Children and Family Services may have immediate
access to records,
files, papers, and communications (except medical, alcohol or drug assessment
or treatment, mental health, or any other medical records) of the Illinois
Department, county
departments, and local governmental units receiving State or federal funds or
aid, if the Department of Children and Family Services determines the
information is necessary to perform its duties under the Abused and Neglected
Child Reporting Act, the Child Care Act of 1969, and the Children and Family
Services Act.
(Source: P.A. 100-201, eff. 8-18-17.)
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(305 ILCS 5/11-15) (from Ch. 23, par. 11-15)
Sec. 11-15. Application requirements.
(1) An application for financial
aid shall be filed in writing by the person requesting aid and, in the case
of a request for family aid, by the head of that family, except as
otherwise permitted in paragraph (2). Applications for aid under Articles
III, IV, and V shall be filed in writing with any local office of the Department of Human Services in the manner prescribed by the
Department. Applications for aid under Article VI shall be filed
in writing with the local governmental unit upon forms approved by the
Department.
Each applicant shall provide information as to the amount of
property, real and personal, owned by him or her within the period of time
preceding
the application as required under Sections 3-1.3, 4-1.11, and 5-2.1 of this
Code. The
applicant shall also furnish information concerning
all income, money contributions, and other support from any source, and
the beneficiary and the amount or cash surrender or loan value of all
insurance policies held by himself or herself or any member of his family
for whom aid is requested.
(2) An application, in all instances to be in writing, may be filed
in behalf of a person considered to be in need of financial aid under
Articles III, IV, V, or VI only if the person
(a) has been adjudged to be under legal disability; or
(b) is unable because of minority or physical or |
| mental disability, to execute the application; or
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(c) in the case of need for funeral and burial, died
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| before an application was filed and the application is filed not more than 30 days after the person's death, excluding the day on which the death occurred.
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Applications in behalf of persons specified in (a) and (b) shall be
filed by the applicant's legal guardian or, if a
guardian has not been appointed or the applicant has no legal
guardian or the guardian is not available, by a relative or other
person, acceptable under the rules of the Illinois Department, who is
able to furnish the required information. Applications in behalf of
persons specified in (c) shall be filed by any next of kin of the deceased
who is not under legal disability or, if there are no such next of kin or
they are unknown or unavailable, by a person, acceptable under the rules of
the Illinois Department, who is able to furnish the required information.
(3) The application shall contain a written declaration to be signed
by the applicant, or in behalf of the applicant by a person qualified
under paragraph (2), in substantially the following form, the
parenthetical references being applicable to an application filed by a
person in behalf of the applicant:
"I declare under penalties of perjury that I have examined this form
and all accompanying statements or documents pertaining to the income
and resources of myself (the applicant) or any member of my family (the
applicant's family) included in this application for aid, or pertaining
to any other matter having bearing upon my (the applicant's) eligibility
for aid, and to the best of my knowledge and belief the information
supplied is true, correct, and complete".
(4) If an application for financial aid is filed for a family, and any
person in that family is under 18 years of age, the application shall be
accompanied by the following for each such person under 18 years of age:
(i) a copy of the person's birth certificate, or
(ii) other reliable proof, as determined by the
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| Department, of the person's identity and age.
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The Illinois Department shall provide information to all families, orally
by an intake
worker and in writing when the application is filed, about the availability and
location of immunization services.
(5) Once an applicant is determined eligible for aid, he or she has the right to request to have the case transferred to another local office of the Department of Human Services for his or her convenience based on one of the following factors: the location of his or her employer; the location of his or her child care provider; access to reliable transportation; or the location of a social service provider that he or she sees on a regular basis. Within 5 business days after the request for transfer, the Department shall transfer the case, assign a caseworker, make appropriate entries in the computer system, and issue a written notice to the recipient that includes the name of and contact information for the caseworker. The location of the recipient's case may be reconsidered on the recipient's request or at the time of redetermination of eligibility.
(Source: P.A. 96-867, eff. 1-1-11 .)
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(305 ILCS 5/11-20.1) (from Ch. 23, par. 11-20.1)
Sec. 11-20.1. Employment; Rights of recipient and obligations of
Illinois Department when recipients become employed; Assistance when
a recipient has employment or earned income or both. (a) When a recipient reports employment or earned income, or both, or
the Illinois Department otherwise learns of a recipient's employment or
earned income, or both, the Illinois Department shall provide the recipient
with:
(1) An explanation of how the earned income will |
| affect the recipient's eligibility for a grant, and whether the recipient must engage in additional work activities to meet the recipient's monthly work activities requirement and what types of activities may be approved for that purpose, and whether the employment is sufficient to cause months of continued receipt of a grant not to be counted against the recipient's lifetime eligibility limit.
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(2) An explanation of the Work Pays budgeting
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| process, and an explanation of how the first month's income on a new job will be projected, and how the recipient should report the new job to avoid the Department overestimating the first month's income.
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(3) An explanation of how the earned income will
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| affect the recipient's eligibility for food stamps, whether the recipient will continue to receive food stamps, and, if so, the amount of food stamps.
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(4) The names and telephone numbers of all
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| caseworkers to whom the recipient's case or cases are assigned or will be transferred, an explanation of which type of case each worker will be handling, and the effective date of the transfer.
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(5) An explanation of the recipient's
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| responsibilities to report income and household circumstances, the process by which quarterly reporting forms are sent to recipients, where and to whom the reports should be returned, the deadline by which reports must be returned, instructions on how to fill out the reports, an explanation of what the recipient should do if he or she does not receive the form, advice on how to prove the report was returned by the recipient such as by keeping a copy, and an explanation of the effects of failure to file reports.
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(6) If the recipient will continue to receive a
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| grant, an explanation of the recipient's new fiscal month and a statement as to when the recipient will receive his or her grant.
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(7) An explanation of Kidcare, Family Assist, Family
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| Care, and the 12 month extension of medical assistance that is available when a grant is cancelled due to earned income.
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(8) An explanation of the medical assistance the
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| person may be eligible for when the 12 month extension expires and how to request or apply for it.
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(9) An explanation of the availability of a child
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| care subsidy to all families below the child care assistance program's income limit, how to apply for the benefit through the Child Care Resource and Referral or site-administered child care program or both, the nature of the child care program's sliding scale co-payments, the availability of the 10% earned income disregard in determining eligibility for child care assistance and the amount of the parent co-payment, the right to use the subsidy for either licensed or license exempt legal care, and the availability of benefits when the parent is engaged in an education and training program.
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(10) (Blank).
(11) (Blank).
(11a) (Blank).
(12) (Blank).
(13) An explanation of the availability of payment
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| for initial expenses of employment and how to request or apply for it.
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(14) An explanation of the job retention component
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| and how to participate in it, and an explanation of the recipient's eligibility to receive supportive services to participate in education and training programs while working.
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(15) A statement of the types of assistance that will
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| be provided to the person automatically or continued and a statement of the types of assistance for which the person must apply or reapply.
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(16) If the recipient will not continue to receive a
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| cash grant and the recipient has assigned his or her right to child support to the Illinois Department, an explanation of the recipient's right to continue to receive child support enforcement services, the recipient's right to have all current support paid after grant cancellation forwarded promptly to the recipient, the procedures by which child support will be forwarded, and the procedures by which the recipient will be informed of the collection and distribution of child support.
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(17) An explanation of the availability of payments
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| if the recipient experiences a decrease in or loss of earned income during a calendar quarter as to which the monthly grant was previously budgeted based upon the higher income.
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(18) If the recipient will not continue to receive a
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| cash grant, an explanation of the procedures for reapplying for cash assistance if the person experiences a decrease in or loss of earned income.
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(19) An explanation of the earned income tax credit
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| and the procedures by which it may be obtained and the rules for disregarding it in determining eligibility for and the amount of assistance.
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(20) An explanation of the education and training
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| opportunities available to recipients.
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(b) The information listed in subsection (a) shall be provided to the
recipient on an individual basis during an in-person meeting with a
representative of the Illinois Department. The individual in-person
meeting shall be held at a time which does not conflict with the
recipient's work schedule within 30 days of the date the recipient begins
working. If the recipient informs the Illinois Department that an
in-person meeting would be inconvenient, the Illinois Department may
provide the information during a home visit, by telephone, or by mail
within 30 days of the date the recipient begins working, whichever the
client prefers.
(c) At the conclusion of the meeting described in subsection (b), the
Illinois Department shall ensure that all case transfers and calculations
of benefits necessitated by the recipient's employment or receipt of earned
income have been performed, that applications have been made or provided
for all benefits for which the person must apply or reapply, and that the
person has received payment for initial expenses of employment.
(d) In food stamp cases in which an applicant or recipient reports earned income, the applicant's or recipient's employment shall be presumed to be a hardship for purposes of scheduling an in-person meeting with a
representative of the Illinois Department and an in-person meeting shall be waived.
(Source: P.A. 96-867, eff. 1-1-11 .)
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(305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
Sec. 11-22. Charge upon claims and causes of action for injuries. The Illinois Department shall have a charge upon all claims, demands and
causes of action for injuries to an applicant for or recipient of (i)
financial aid under Articles III, IV, and V, (ii) health care benefits provided under the Covering ALL KIDS Health Insurance Act, or (iii) health care benefits provided under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008 for the total
amount of
medical assistance provided the recipient from the time of injury to the
date of recovery upon such claim, demand or cause of action. In addition, if
the applicant or recipient was employable, as defined by the Department, at
the time of the injury, the Department shall also have a charge upon any
such claims, demands and causes of action for the total amount of aid
provided to the recipient and his
dependents, including all cash assistance and medical assistance
only to the extent includable in the claimant's action, from the
time of injury to the date of recovery upon such
claim, demand or cause of action. Any definition of "employable"
adopted by the Department shall apply only to persons above the age of
compulsory school attendance.
If the injured person was employable at the time of the injury and is
provided aid under Articles III, IV, or V and any dependent or
member of his family is provided aid under Article VI, or vice versa,
both the Illinois Department and the local governmental unit shall have
a charge upon such claims, demands and causes of action for the aid
provided to the injured person and any
dependent member of his family, including all cash assistance, medical
assistance and food stamps, from the time of the injury to the date
of recovery.
"Recipient", as used herein, means (i) in the case of financial aid provided under this Code, the grantee of record and any
persons whose needs are included in the financial aid provided to the
grantee of record or otherwise met by grants under the appropriate
Article of this Code for which such person is eligible, (ii) in the case of health care benefits provided under the Covering ALL KIDS Health Insurance Act, the child to whom those benefits are provided, and (iii) in the case of health care benefits provided under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, the veteran to whom benefits are provided.
In each case, the notice shall be served by certified mail or
registered mail, or by facsimile or electronic messaging when requested by the party or parties against whom the applicant or recipient has a claim, demand, or cause of action, upon the party or parties against whom the applicant or
recipient has a claim, demand or cause of action. The notice shall
claim the charge and describe the interest the Illinois Department, the
local governmental unit, or the county, has in the claim, demand, or
cause of action. The charge shall attach to any verdict or judgment
entered and to any money or property which may be recovered on account
of such claim, demand, cause of action or suit from and after the time
of the service of the notice.
On petition filed by the Illinois Department, or by the local
governmental unit or county if either is claiming a charge, or by the
recipient, or by the defendant, the court, on written notice to all
interested parties, may adjudicate the rights of the parties and enforce
the charge. The court may approve the settlement of any claim, demand
or cause of action either before or after a verdict, and nothing in this
Section shall be construed as requiring the actual trial or final
adjudication of any claim, demand or cause of action upon which the
Illinois Department, the local governmental unit or county has charge.
The court may determine what portion of the recovery shall be paid to
the injured person and what portion shall be paid to the Illinois
Department, the local governmental unit or county having a charge
against the recovery.
In making this determination, the court shall conduct an evidentiary hearing
and shall consider competent evidence pertaining
to the following matters:
(1) the amount of the charge sought to be enforced |
| against the recovery when expressed as a percentage of the gross amount of the recovery; the amount of the charge sought to be enforced against the recovery when expressed as a percentage of the amount obtained by subtracting from the gross amount of the recovery the total attorney's fees and other costs incurred by the recipient incident to the recovery; and whether the Department, unit of local government or county seeking to enforce the charge against the recovery should as a matter of fairness and equity bear its proportionate share of the fees and costs incurred to generate the recovery from which the charge is sought to be satisfied;
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(2) the amount, if any, of the attorney's fees and
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| other costs incurred by the recipient incident to the recovery and paid by the recipient up to the time of recovery, and the amount of such fees and costs remaining unpaid at the time of recovery;
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(3) the total hospital, doctor and other medical
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| expenses incurred for care and treatment of the injury to the date of recovery therefor, the portion of such expenses theretofore paid by the recipient, by insurance provided by the recipient, and by the Department, unit of local government and county seeking to enforce a charge against the recovery, and the amount of such previously incurred expenses which remain unpaid at the time of recovery and by whom such incurred, unpaid expenses are to be paid;
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(4) whether the recovery represents less than
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| substantially full recompense for the injury and the hospital, doctor and other medical expenses incurred to the date of recovery for the care and treatment of the injury, so that reduction of the charge sought to be enforced against the recovery would not likely result in a double recovery or unjust enrichment to the recipient;
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(5) the age of the recipient and of persons dependent
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| for support upon the recipient, the nature and permanency of the recipient's injuries as they affect not only the future employability and education of the recipient but also the reasonably necessary and foreseeable future material, maintenance, medical, rehabilitative and training needs of the recipient, the cost of such reasonably necessary and foreseeable future needs, and the resources available to meet such needs and pay such costs;
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(6) the realistic ability of the recipient to repay
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| in whole or in part the charge sought to be enforced against the recovery when judged in light of the factors enumerated above.
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The burden of producing evidence sufficient to support the exercise by
the court of its discretion to reduce the amount of a proven charge sought
to be enforced against the recovery shall rest with the party seeking such reduction.
The court may reduce and apportion the Illinois
Department's lien proportionate to the recovery of the claimant. The court may
consider the nature and extent of the injury, economic and noneconomic
loss, settlement offers, comparative negligence as it applies to the case
at hand, hospital costs, physician costs, and all other appropriate costs.
The Illinois Department shall pay its pro rata share of the attorney fees
based on the Illinois Department's lien as it compares to the total
settlement agreed upon. This Section shall not affect the priority of an
attorney's lien under the Attorneys Lien Act. The charges of
the Illinois Department described in this Section, however, shall take
priority over all other liens and charges existing under the laws of the
State of Illinois with the exception of the attorney's lien under said statute.
Whenever the Department or any unit of local government
has a statutory charge under this Section against a recovery for damages
incurred by a recipient because of its advancement of any assistance, such
charge shall not be satisfied out of any recovery until the attorney's claim
for fees is satisfied, irrespective of whether or not an action based on
recipient's claim has been filed in court.
This Section shall be inapplicable to any claim, demand or cause of
action arising under (a) the Workers' Compensation Act or the predecessor
Workers' Compensation Act
of
June 28, 1913, (b) the Workers' Occupational Diseases Act or the predecessor
Workers' Occupational
Diseases Act of March 16, 1936; and (c) the Wrongful Death Act.
(Source: P.A. 98-73, eff. 7-15-13.)
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(305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
Sec. 11-22b. Recoveries.
(a) As used in this Section:
(1) "Carrier" means any insurer, including any |
| private company, corporation, mutual association, trust fund, reciprocal or interinsurance exchange authorized under the laws of this State to insure persons against liability or injuries caused to another and any insurer providing benefits under a policy of bodily injury liability insurance covering liability arising out of the ownership, maintenance or use of a motor vehicle which provides uninsured motorist endorsement or coverage.
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(2) "Beneficiary" means any person or their
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| dependents who has received benefits or will be provided benefits under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008 because of an injury for which another person may be liable. It includes such beneficiary's guardian, conservator or other personal representative, his estate or survivors.
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(b)(1) When benefits are provided or will be provided to a beneficiary
under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008 because of an injury for which another person is liable, or
for which a carrier is liable in accordance with the provisions of any
policy of insurance issued pursuant to the Illinois Insurance Code, the
Illinois Department shall have a right to recover from such person or carrier
the reasonable value of benefits so provided. The Attorney General may, to
enforce such right, institute and prosecute legal proceedings against the
third person or carrier who may be liable for the injury in an appropriate
court, either in the name of the Illinois Department or in the name of the
injured person, his guardian, personal representative, estate, or survivors.
(2) The Department may:
(A) compromise or settle and release any such claim
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(B) waive any such claims for benefits provided under
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| this Code, in whole or in part, for the convenience of the Department or if the Department determines that collection would result in undue hardship upon the person who suffered the injury or, in a wrongful death action, upon the heirs of the deceased.
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(3) No action taken on behalf of the Department pursuant to this Section
or any judgment rendered in such action shall be a bar to any action upon
the claim or cause of action of the beneficiary, his guardian, conservator,
personal representative, estate, dependents or survivors against the third
person who may be liable for the injury, or shall operate to deny to the
beneficiary the recovery for that portion of any damages not covered hereunder.
(c)(1) When an action is brought by the Department pursuant to
subsection (b), it shall be commenced within the period prescribed by
Article XIII of the Code of Civil Procedure.
However, the Department may not commence the action prior to 5 months
before the end of the applicable period prescribed by Article XIII of the
Code of Civil Procedure. Thirty days prior to commencing an action, the
Department shall notify the beneficiary of the Department's intent to
commence such an action.
(2) The death of the beneficiary does not abate any right of action
established by subsection (b).
(3) When an action or claim is brought by persons entitled to bring such
actions or assert such claims against a third person who may be liable for
causing the death of a beneficiary, any settlement, judgment or award
obtained is subject to the Department's claim for reimbursement of the
benefits provided to the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008.
(4) When the action or claim is brought by the beneficiary alone and
the beneficiary incurs a personal liability to pay attorney's fees and
costs of litigation, the Department's claim for reimbursement of the
benefits provided to the beneficiary shall be the full amount of benefits
paid on behalf of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008 less a pro rata
share which represents the Department's reasonable share of attorney's fees
paid by the beneficiary and that portion of the cost of litigation expenses
determined by multiplying by the ratio of the full amount of the
expenditures of the full amount of the judgment, award or settlement.
(d)(1) If either the beneficiary or the Department brings an action or
claim against such third party or carrier, the beneficiary or the
Department shall within 30 days of filing the action give to the other
written notice by personal service or registered mail of the action or
claim and of the name of the court in which the
action or claim is brought. Proof of such notice shall be filed in such
action or claim. If an action or claim is brought by either the Department
or the beneficiary, the other may, at any time before trial on the facts,
become a party to such action or claim or shall consolidate his action or
claim with the other if brought independently.
(2) If an action or claim is brought by the Department pursuant to
subsection (b)(1), written notice to the beneficiary, guardian, personal
representative, estate or survivor given pursuant to this Section shall
advise him of his right to intervene in the proceeding, his right to obtain
a private attorney of his choice and the Department's right to recover the
reasonable value of the benefits provided.
(e) In the event of judgment or award in a suit or claim against such
third person or carrier:
(1) If the action or claim is prosecuted by the
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| beneficiary alone, the court shall first order paid from any judgment or award the reasonable litigation expenses incurred in preparation and prosecution of such action or claim, together with reasonable attorney's fees, when an attorney has been retained. After payment of such expenses and attorney's fees the court shall, on the application of the Department, allow as a first lien against the amount of such judgment or award the amount of the Department's expenditures for the benefit of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, as provided in subsection (c)(4).
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(2) If the action or claim is prosecuted both by the
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| beneficiary and the Department, the court shall first order paid from any judgment or award the reasonable litigation expenses incurred in preparation and prosecution of such action or claim, together with reasonable attorney's fees for plaintiffs attorneys based solely on the services rendered for the benefit of the beneficiary. After payment of such expenses and attorney's fees, the court shall apply out of the balance of such judgment or award an amount sufficient to reimburse the Department the full amount of benefits paid on behalf of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008.
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(f) The court shall, upon further application at any time
before the judgment or award is satisfied, allow as a further lien the
amount of any expenditures of the Department in payment of additional
benefits arising out of the same cause of action or claim provided on
behalf of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, when such benefits were
provided or became payable subsequent to the original order.
(g) No judgment, award, or settlement in any action or claim by a
beneficiary to recover damages for injuries, when the Department has an
interest, shall be satisfied without first giving the Department notice and
a reasonable opportunity to perfect and satisfy its lien.
(h) When the Department has perfected a lien upon a judgment or award in
favor of a beneficiary against any third party for an injury for which the
beneficiary has received benefits under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act or the Veterans' Health Insurance Program Act of 2008, the Department shall be
entitled to a writ of execution as lien claimant to enforce payment of said
lien against such third party with interest and other accruing costs as in
the case of other executions. In the event the amount of such judgment or
award so recovered has been paid to the beneficiary, the Department shall
be entitled to a writ of execution against such beneficiary to the extent of
the Department's lien, with interest and other accruing costs as in the case
of other executions.
(i) Except as otherwise provided in this Section, notwithstanding any
other provision of law, the entire amount of any settlement of the injured
beneficiary's action or claim, with or without suit, is subject to the
Department's claim for reimbursement of the benefits provided and any lien
filed pursuant thereto to the same extent and subject to the same
limitations as in Section 11-22 of this Code.
(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06; 95-755, eff. 7-25-08.)
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