State of Illinois
91st General Assembly

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 1        AN  ACT to amend the Illinois Public Aid Code by changing
 2    Section 5-2.

 3        Be it enacted by the People of  the  State  of  Illinois,
 4    represented in the General Assembly:

 5        Section  5.  The  Illinois  Public Aid Code is amended by
 6    changing Section 5-2 as follows:

 7        (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
 8        Sec.  5-2.  Classes   of   Persons   Eligible.    Medical
 9    assistance  under  this  Article shall be available to any of
10    the following classes of persons in respect to  whom  a  plan
11    for  coverage  has  been  submitted  to  the  Governor by the
12    Illinois Department and approved by him:
13        1.  Recipients of basic maintenance grants under Articles
14    III and IV.
15        2.  Persons  otherwise  eligible  for  basic  maintenance
16    under Articles III and IV but who fail to qualify  thereunder
17    on  the  basis  of need, and who have insufficient income and
18    resources to  meet  the  costs  of  necessary  medical  care,
19    including  but  not  limited  to,  all  persons  who would be
20    determined eligible for such basic maintenance under  Article
21    IV  by  disregarding  the  maximum earned income permitted by
22    federal law.
23        3.  Persons who would otherwise qualify for  Aid  to  the
24    Medically Indigent under Article VII.
25        4.  Persons  not  eligible  under  any  of  the preceding
26    paragraphs who fall sick, are injured,  or  die,  not  having
27    sufficient  money,  property  or  other resources to meet the
28    costs  of  necessary  medical  care  or  funeral  and  burial
29    expenses.
30        5. (a)  Women  during  pregnancy,  after  the   fact   of
31        pregnancy  has  been determined by medical diagnosis, and
                            -2-                LRB9112082DJcs
 1        during the 60-day period beginning on the last day of the
 2        pregnancy, together with their infants and children  born
 3        after  September 30, 1983, whose income and resources are
 4        insufficient to meet the costs of necessary medical  care
 5        to  the  maximum  extent  possible under Title XIX of the
 6        Federal Social Security Act.
 7             (b)  The Illinois Department and the Governor  shall
 8        provide a plan for coverage of the persons eligible under
 9        paragraph 5(a) by April 1, 1990.  Such plan shall provide
10        ambulatory  prenatal  care  to  pregnant  women  during a
11        presumptive eligibility period and  establish  an  income
12        eligibility standard that is equal to 133% of the nonfarm
13        income  official  poverty line, as defined by the federal
14        Office of Management and Budget and revised  annually  in
15        accordance  with  Section  673(2)  of  the Omnibus Budget
16        Reconciliation Act of 1981, applicable to families of the
17        same size, provided that costs incurred for medical  care
18        are  not  taken  into  account in determining such income
19        eligibility.
20             (c)  The   Illinois   Department   may   conduct   a
21        demonstration in at least one county  that  will  provide
22        medical assistance to pregnant women, together with their
23        infants  and  children  up  to one year of age, where the
24        income eligibility standard is set  up  to  185%  of  the
25        nonfarm  income  official poverty line, as defined by the
26        federal Office of Management and Budget.    The  Illinois
27        Department  shall seek and obtain necessary authorization
28        provided  under  federal  law   to   implement   such   a
29        demonstration.  Such demonstration may establish resource
30        standards  that  are  not  more  restrictive  than  those
31        established under Article IV of this Code.
32        6.  Persons  under  the  age of 18 who fail to qualify as
33    dependent under Article IV and who have  insufficient  income
34    and  resources to meet the costs of necessary medical care to
                            -3-                LRB9112082DJcs
 1    the maximum extent permitted under Title XIX of  the  Federal
 2    Social Security Act.
 3        7.  Persons  who are 18 years of age or younger and would
 4    qualify as disabled as defined under the Federal Supplemental
 5    Security Income Program, provided medical  service  for  such
 6    persons    would    be   eligible   for   Federal   Financial
 7    Participation,   and   provided   the   Illinois   Department
 8    determines that:
 9             (a)  the person requires a level of care provided by
10        a hospital, skilled  nursing  facility,  or  intermediate
11        care  facility,  as determined by a physician licensed to
12        practice medicine in all its branches;
13             (b)  it is appropriate to provide such care  outside
14        of  an institution, as determined by a physician licensed
15        to practice medicine in all its branches;
16             (c)  the estimated amount which  would  be  expended
17        for  care outside the institution is not greater than the
18        estimated  amount  which  would   be   expended   in   an
19        institution.
20        8.  Persons  who  become ineligible for basic maintenance
21    assistance  under  Article  IV  of  this  Code  in   programs
22    administered  by  the  Illinois  Department due to employment
23    earnings and persons in assistance units comprised of  adults
24    and  children  who  become  ineligible  for basic maintenance
25    assistance under Article VI of this Code  due  to  employment
26    earnings.   The  plan  for coverage for this class of persons
27    shall:
28             (a)  extend the medical assistance coverage  for  up
29        to  12  months following termination of basic maintenance
30        assistance; and
31             (b)  offer persons who  have  initially  received  6
32        months  of  the coverage provided in paragraph (a) above,
33        the  option  of  receiving  an  additional  6  months  of
34        coverage, subject to the following:
                            -4-                LRB9112082DJcs
 1                  (i)  such  coverage  shall   be   pursuant   to
 2             provisions of the federal Social Security Act;
 3                  (ii)  such  coverage shall include all services
 4             covered while the  person  was  eligible  for  basic
 5             maintenance assistance;
 6                  (iii)  no  premium  shall  be  charged for such
 7             coverage; and
 8                  (iv)  such coverage shall be suspended  in  the
 9             event  of  a  person's failure without good cause to
10             file in a timely fashion reports required  for  this
11             coverage  under the Social Security Act and coverage
12             shall be reinstated upon the filing of such  reports
13             if the person remains otherwise eligible.
14        9.  Persons   with   acquired  immunodeficiency  syndrome
15    (AIDS) or with AIDS-related conditions with respect  to  whom
16    there   has  been  a  determination  that  but  for  home  or
17    community-based services such individuals would  require  the
18    level  of  care  provided  in  an inpatient hospital, skilled
19    nursing facility or intermediate care facility  the  cost  of
20    which  is reimbursed under this Article.  Assistance shall be
21    provided to such persons  to  the  maximum  extent  permitted
22    under Title XIX of the Federal Social Security Act.
23        10.  Participants   in   the   long-term  care  insurance
24    partnership program established  under  the  Partnership  for
25    Long-Term Care Act who meet the qualifications for protection
26    of resources described in Section 25 of that Act.
27        11.  Employed  persons  with  disabilities  who  meet the
28    following criteria:
29             (A)  The person is at least 16  years  of  age,  but
30        less than 65 years of age.
31             (B)  The  person  is employed.  For purposes of this
32        item (B), a person is considered to be  employed  if  the
33        person:
34                  (i)  is earning at least the applicable minimum
                            -5-                LRB9112082DJcs
 1             wage  requirement  under section 6 of the Fair Labor
 2             Standards Act (29 U.S.C. 206) and working  at  least
 3             40 hours per month; or
 4                  (ii)  is  engaged  in  a work effort that meets
 5             substantial and reasonable  threshold  criteria  for
 6             hours  of work, or other measures, as defined by the
 7             Illinois Department by rule.
 8             (C)  The person either:
 9                  (i)  meets the definition of "disabled" as  set
10             forth in the Social Security Act at 42 U.S.C. 423(d)
11             and  42  U.S.C. 1382c(a)(3) without consideration of
12             the person's employment earnings; or
13                  (ii)  ceases  to  be   eligible   for   medical
14             assistance under this Article because the person, by
15             reason  of medical improvement, is determined by the
16             Social Security Administration  at  the  time  of  a
17             regularly  scheduled continuing disability review to
18             no longer be eligible for benefits under  42  U.S.C.
19             423(d)  or  42  U.S.C.  1382c(a)(3)  and  the person
20             continues to have a  severe  medically  determinable
21             impairment or combination of impairments.
22             (D)  The  person's  earned  and  unearned income and
23        assets  do  not  exceed  limits  as  established  by  the
24        Illinois Department.
25             (E)  The person pays premiums or other  cost-sharing
26        charges  set  on  a  sliding  scale  based  on  income as
27        established  by  the  Illinois  Department  by  rule   in
28        accordance with 42 U.S.C. 1396o(g).
29        The  Illinois Department and the Governor shall provide a
30    plan for coverage of the persons eligible under  paragraph  7
31    as soon as possible after July 1, 1984.
32        The eligibility of any such person for medical assistance
33    under  this  Article  is  not  affected by the payment of any
34    grant under the Senior Citizens and Disabled Persons Property
                            -6-                LRB9112082DJcs
 1    Tax  Relief  and  Pharmaceutical  Assistance   Act   or   any
 2    distributions or items of income described under subparagraph
 3    (X)  of paragraph (2) of subsection (a) of Section 203 of the
 4    Illinois Income  Tax  Act.   The  Department  shall  by  rule
 5    establish   the  amounts  of  assets  to  be  disregarded  in
 6    determining eligibility for medical assistance,  which  shall
 7    at  a  minimum  equal the amounts to be disregarded under the
 8    Federal Supplemental Security Income Program.  The amount  of
 9    assets of a single person to be disregarded shall not be less
10    than  $2,000, and the amount of assets of a married couple to
11    be disregarded shall not be less than $3,000.
12        To the extent permitted under  federal  law,  any  person
13    found  guilty of a second violation of Article VIIIA shall be
14    ineligible for medical  assistance  under  this  Article,  as
15    provided in Section 8A-8.
16        The  eligibility  of  any  person  for medical assistance
17    under this Article shall not be affected by  the  receipt  by
18    the person of donations or benefits from fundraisers held for
19    the  person  in  cases of serious illness, as long as neither
20    the person nor members of the  person's  family  have  actual
21    control over the donations or benefits or the disbursement of
22    the donations or benefits.
23    (Source: P.A. 91-676, eff. 12-23-99.)

24        Section  99.  Effective date.  This Act takes effect upon
25    becoming law.

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