Public Act 096-0567
 
HB1033 Enrolled LRB096 09273 KTG 19427 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Public Aid Code is amended by
changing Section 5-2 as follows:
 
    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
    Sec. 5-2. Classes of Persons Eligible. Medical assistance
under this Article shall be available to any of the following
classes of persons in respect to whom a plan for coverage has
been submitted to the Governor by the Illinois Department and
approved by him:
        1. Recipients of basic maintenance grants under
    Articles III and IV.
        2. Persons otherwise eligible for basic maintenance
    under Articles III and IV but who fail to qualify
    thereunder on the basis of need, and who have insufficient
    income and resources to meet the costs of necessary medical
    care, including but not limited to the following:
            (a) All persons otherwise eligible for basic
        maintenance under Article III but who fail to qualify
        under that Article on the basis of need and who meet
        either of the following requirements:
                (i) their income, as determined by the
            Illinois Department in accordance with any federal
            requirements, is equal to or less than 70% in
            fiscal year 2001, equal to or less than 85% in
            fiscal year 2002 and until a date to be determined
            by the Department by rule, and equal to or less
            than 100% beginning on the date determined by the
            Department by rule, of the nonfarm income official
            poverty line, as defined by the federal Office of
            Management and Budget and revised annually in
            accordance with Section 673(2) of the Omnibus
            Budget Reconciliation Act of 1981, applicable to
            families of the same size; or
                (ii) their income, after the deduction of
            costs incurred for medical care and for other types
            of remedial care, is equal to or less than 70% in
            fiscal year 2001, equal to or less than 85% in
            fiscal year 2002 and until a date to be determined
            by the Department by rule, and equal to or less
            than 100% beginning on the date determined by the
            Department by rule, of the nonfarm income official
            poverty line, as defined in item (i) of this
            subparagraph (a).
            (b) All persons who would be determined eligible
        for such basic maintenance under Article IV by
        disregarding the maximum earned income permitted by
        federal law.
        3. Persons who would otherwise qualify for Aid to the
    Medically Indigent under Article VII.
        4. Persons not eligible under any of the preceding
    paragraphs who fall sick, are injured, or die, not having
    sufficient money, property or other resources to meet the
    costs of necessary medical care or funeral and burial
    expenses.
        5.(a) Women during pregnancy, after the fact of
    pregnancy has been determined by medical diagnosis, and
    during the 60-day period beginning on the last day of the
    pregnancy, together with their infants and children born
    after September 30, 1983, whose income and resources are
    insufficient to meet the costs of necessary medical care to
    the maximum extent possible under Title XIX of the Federal
    Social Security Act.
        (b) The Illinois Department and the Governor shall
    provide a plan for coverage of the persons eligible under
    paragraph 5(a) by April 1, 1990. Such plan shall provide
    ambulatory prenatal care to pregnant women during a
    presumptive eligibility period and establish an income
    eligibility standard that is equal to 133% of the nonfarm
    income official poverty line, as defined by the federal
    Office of Management and Budget and revised annually in
    accordance with Section 673(2) of the Omnibus Budget
    Reconciliation Act of 1981, applicable to families of the
    same size, provided that costs incurred for medical care
    are not taken into account in determining such income
    eligibility.
        (c) The Illinois Department may conduct a
    demonstration in at least one county that will provide
    medical assistance to pregnant women, together with their
    infants and children up to one year of age, where the
    income eligibility standard is set up to 185% of the
    nonfarm income official poverty line, as defined by the
    federal Office of Management and Budget. The Illinois
    Department shall seek and obtain necessary authorization
    provided under federal law to implement such a
    demonstration. Such demonstration may establish resource
    standards that are not more restrictive than those
    established under Article IV of this Code.
        6. Persons under the age of 18 who fail to qualify as
    dependent under Article IV and who have insufficient income
    and resources to meet the costs of necessary medical care
    to the maximum extent permitted under Title XIX of the
    Federal Social Security Act.
        7. Persons who are under 21 years of age and would
    qualify as disabled as defined under the Federal
    Supplemental Security Income Program, provided medical
    service for such persons would be eligible for Federal
    Financial Participation, and provided the Illinois
    Department determines that:
            (a) the person requires a level of care provided by
        a hospital, skilled nursing facility, or intermediate
        care facility, as determined by a physician licensed to
        practice medicine in all its branches;
            (b) it is appropriate to provide such care outside
        of an institution, as determined by a physician
        licensed to practice medicine in all its branches;
            (c) the estimated amount which would be expended
        for care outside the institution is not greater than
        the estimated amount which would be expended in an
        institution.
        8. Persons who become ineligible for basic maintenance
    assistance under Article IV of this Code in programs
    administered by the Illinois Department due to employment
    earnings and persons in assistance units comprised of
    adults and children who become ineligible for basic
    maintenance assistance under Article VI of this Code due to
    employment earnings. The plan for coverage for this class
    of persons shall:
            (a) extend the medical assistance coverage for up
        to 12 months following termination of basic
        maintenance assistance; and
            (b) offer persons who have initially received 6
        months of the coverage provided in paragraph (a) above,
        the option of receiving an additional 6 months of
        coverage, subject to the following:
                (i) such coverage shall be pursuant to
            provisions of the federal Social Security Act;
                (ii) such coverage shall include all services
            covered while the person was eligible for basic
            maintenance assistance;
                (iii) no premium shall be charged for such
            coverage; and
                (iv) such coverage shall be suspended in the
            event of a person's failure without good cause to
            file in a timely fashion reports required for this
            coverage under the Social Security Act and
            coverage shall be reinstated upon the filing of
            such reports if the person remains otherwise
            eligible.
        9. Persons with acquired immunodeficiency syndrome
    (AIDS) or with AIDS-related conditions with respect to whom
    there has been a determination that but for home or
    community-based services such individuals would require
    the level of care provided in an inpatient hospital,
    skilled nursing facility or intermediate care facility the
    cost of which is reimbursed under this Article. Assistance
    shall be provided to such persons to the maximum extent
    permitted under Title XIX of the Federal Social Security
    Act.
        10. Participants in the long-term care insurance
    partnership program established under the Illinois
    Long-Term Care Partnership Program Act Partnership for
    Long-Term Care Act who meet the qualifications for
    protection of resources described in Section 15 25 of that
    Act.
        11. Persons with disabilities who are employed and
    eligible for Medicaid, pursuant to Section
    1902(a)(10)(A)(ii)(xv) of the Social Security Act, as
    provided by the Illinois Department by rule. In
    establishing eligibility standards under this paragraph
    11, the Department shall, subject to federal approval:
            (a) set the income eligibility standard at not
        lower than 350% of the federal poverty level;
            (b) exempt retirement accounts that the person
        cannot access without penalty before the age of 59 1/2,
        and medical savings accounts established pursuant to
        26 U.S.C. 220;
            (c) allow non-exempt assets up to $25,000 as to
        those assets accumulated during periods of eligibility
        under this paragraph 11; and
            (d) continue to apply subparagraphs (b) and (c) in
        determining the eligibility of the person under this
        Article even if the person loses eligibility under this
        paragraph 11.
        12. Subject to federal approval, persons who are
    eligible for medical assistance coverage under applicable
    provisions of the federal Social Security Act and the
    federal Breast and Cervical Cancer Prevention and
    Treatment Act of 2000. Those eligible persons are defined
    to include, but not be limited to, the following persons:
            (1) persons who have been screened for breast or
        cervical cancer under the U.S. Centers for Disease
        Control and Prevention Breast and Cervical Cancer
        Program established under Title XV of the federal
        Public Health Services Act in accordance with the
        requirements of Section 1504 of that Act as
        administered by the Illinois Department of Public
        Health; and
            (2) persons whose screenings under the above
        program were funded in whole or in part by funds
        appropriated to the Illinois Department of Public
        Health for breast or cervical cancer screening.
        "Medical assistance" under this paragraph 12 shall be
    identical to the benefits provided under the State's
    approved plan under Title XIX of the Social Security Act.
    The Department must request federal approval of the
    coverage under this paragraph 12 within 30 days after the
    effective date of this amendatory Act of the 92nd General
    Assembly.
        13. Subject to appropriation and to federal approval,
    persons living with HIV/AIDS who are not otherwise eligible
    under this Article and who qualify for services covered
    under Section 5-5.04 as provided by the Illinois Department
    by rule.
        14. Subject to the availability of funds for this
    purpose, the Department may provide coverage under this
    Article to persons who reside in Illinois who are not
    eligible under any of the preceding paragraphs and who meet
    the income guidelines of paragraph 2(a) of this Section and
    (i) have an application for asylum pending before the
    federal Department of Homeland Security or on appeal before
    a court of competent jurisdiction and are represented
    either by counsel or by an advocate accredited by the
    federal Department of Homeland Security and employed by a
    not-for-profit organization in regard to that application
    or appeal, or (ii) are receiving services through a
    federally funded torture treatment center. Medical
    coverage under this paragraph 14 may be provided for up to
    24 continuous months from the initial eligibility date so
    long as an individual continues to satisfy the criteria of
    this paragraph 14. If an individual has an appeal pending
    regarding an application for asylum before the Department
    of Homeland Security, eligibility under this paragraph 14
    may be extended until a final decision is rendered on the
    appeal. The Department may adopt rules governing the
    implementation of this paragraph 14.
        15. Subject to appropriation, uninsured persons who
    are not otherwise eligible under this Section who have been
    certified and referred by the Department of Public Health
    as having been screened and found to need diagnostic
    evaluation or treatment, or both diagnostic evaluation and
    treatment, for prostate or testicular cancer. For the
    purposes of this paragraph 15, uninsured persons are those
    who do not have creditable coverage, as defined under the
    Health Insurance Portability and Accountability Act, or
    have otherwise exhausted any insurance benefits they may
    have had, for prostate or testicular cancer diagnostic
    evaluation or treatment, or both diagnostic evaluation and
    treatment. To be eligible, a person must furnish a Social
    Security number. A person's assets are exempt from
    consideration in determining eligibility under this
    paragraph 15. Such persons shall be eligible for medical
    assistance under this paragraph 15 for so long as they need
    treatment for the cancer. A person shall be considered to
    need treatment if, in the opinion of the person's treating
    physician, the person requires therapy directed toward
    cure or palliation of prostate or testicular cancer,
    including recurrent metastatic cancer that is a known or
    presumed complication of prostate or testicular cancer and
    complications resulting from the treatment modalities
    themselves. Persons who require only routine monitoring
    services are not considered to need treatment. "Medical
    assistance" under this paragraph 15 shall be identical to
    the benefits provided under the State's approved plan under
    Title XIX of the Social Security Act. Notwithstanding any
    other provision of law, the Department (i) does not have a
    claim against the estate of a deceased recipient of
    services under this paragraph 15 and (ii) does not have a
    lien against any homestead property or other legal or
    equitable real property interest owned by a recipient of
    services under this paragraph 15.
    The Illinois Department and the Governor shall provide a
plan for coverage of the persons eligible under paragraph 7 as
soon as possible after July 1, 1984.
    The eligibility of any such person for medical assistance
under this Article is not affected by the payment of any grant
under the Senior Citizens and Disabled Persons Property Tax
Relief and Pharmaceutical Assistance Act or any distributions
or items of income described under subparagraph (X) of
paragraph (2) of subsection (a) of Section 203 of the Illinois
Income Tax Act. The Department shall by rule establish the
amounts of assets to be disregarded in determining eligibility
for medical assistance, which shall at a minimum equal the
amounts to be disregarded under the Federal Supplemental
Security Income Program. The amount of assets of a single
person to be disregarded shall not be less than $2,000, and the
amount of assets of a married couple to be disregarded shall
not be less than $3,000.
    To the extent permitted under federal law, any person found
guilty of a second violation of Article VIIIA shall be
ineligible for medical assistance under this Article, as
provided in Section 8A-8.
    The eligibility of any person for medical assistance under
this Article shall not be affected by the receipt by the person
of donations or benefits from fundraisers held for the person
in cases of serious illness, as long as neither the person nor
members of the person's family have actual control over the
donations or benefits or the disbursement of the donations or
benefits.
(Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06;
95-546, eff. 8-29-07; revised 1-22-08.)