Section 102.65  Abandoned Newborn Infant

a)         Effective January 1, 2024, in compliance with the Abandoned Newborn Infant Protection Act [325 ILCS 2] and in coordination with 89 Ill. Adm. Code 300.180, all hospitals shall complete, based on available information, and submit a medical application on behalf of a relinquished newborn infant ("infant") under their care, where:

1)         The infant is 30 days old or less, based on the reasonable belief of a licensed physician; and

2)         The infant was born outside of the hospital and later relinquished to a hospital, police station, fire station or emergency medical facility.

b)         Hospitals providing medical care to the infant shall:

1)         Complete form HFS-2378H (Instructions for Mail-In Application for Medical Benefits Form), which is available on the Department of Healthcare and Family Services' public website; and

2)         Submit form HFS-2378H via email as an attachment to HFS.ACA@Illinois.gov, with subject line "Abandoned Newborn Application".

c)         Applications shall be processed by the Department, and the infant shall be deemed eligible for medical assistance for 12 months. [325 ILCS 2/45]

d)         After the initial eligibility period, the caring agency or adult may submit a new medical application, as the infant will not automatically continue to be eligible for medical assistance at the time of redetermination.

(Source:  Added at 48 Ill. Reg. 13502, effective August 26, 2024)

Section 102.66  Suitability of Home

a)         The Department is required to consider the suitability of the home of a child in a family receiving financial assistance in relation to the standards of care and health fixed by the laws of the state (Section 4 of the "Abused and Neglected Child Reporting Act", Ill. Rev. Stat. 1983, ch. 23, par. 2054)) and by rules and regulations of the Illinois Department of Children and Family Services (89 Ill. Adm. Code 302:  Subpart B). If Department staff determine that the home of a child in a family receiving financial assistance does not appear to be suitable, such person shall file a report with the Department of Children and Family Services as required by the Abused and Neglected Child Reporting Act.

b)         This reporting requirement applies to all Department staff.  This includes income maintenance and any other staff who determine that a child with whom they have had contact in a working capacity resides in a home that is unsuitable.

(Source:  Added at 9 Ill. Reg. 327, effective December 31, 1984)

Section 102.70  Notice to Client

a)         Every applicant for assistance shall be sent or given a written notice of disposition of the application.

b)         Every recipient for assistance shall be sent or given a written notice whenever assistance is reduced or discontinued.

c)         Notices denying, reducing or discontinuing assistance shall contain the following information:

1)         A clear statement of the action being taken.

2)         A clear statement of the reason for the action.

3)         A reference to the statute, rule or policy provision under the authority of which the action is taken.  From March 1997 through March 1998, references to provisions of the Department's policy manuals using the numbering system in use in 1996 shall be deemed to be references to the corresponding provisions of the new numbering system introduced in 1997.

4)         A complete statement of the client's right to appeal (see subsection (d) and Sections 102.80 through 102.82).

d)         Timely Notice

1)         All notices concerning local office reduction or discontinuance of assistance shall be "timely", as defined in 42 CFR 431.211 (2013), except notices to cases in monthly reporting when the adverse action is due to information received on the monthly report or due to failure to submit a complete monthly report. A "timely" notice shall be mailed or given at least 10 calendar days prior to the date the reduction or discontinuance will occur, and shall inform the client that if the client files an appeal by the date the reduction or discontinuance will occur, his or her assistance will be continued at its previous level, pending the results of the appeal unless the client specifically requests that the assistance benefits not be continued. The notice shall be dated with the date it is mailed or given.  (Day one of the 10 day period is the day following the date on the notice. Day 10 may be no later than the date the reduction or discontinuance will occur.)

2)         Notices sent concerning reduction or discontinuance of assistance by agency action initiated centrally and notices to cases in monthly reporting when the action is due to information received on the monthly report or due to failure to submit a complete monthly report may be either "timely" or "adequate",  as defined in 42 CFR 435.919 (2010). When timely notice is not required and an adequate notice is sent less than 10 days before the date of change, the client may receive continued benefits if the appeal is filed within 10 days after the date of notice. (See 89 Ill. Adm. Code 112.302.)

e)         A written notice may be sent or given in hard copy or sent electronically.  The Department may use electronic means to send a written notice only if the individual to whom the notice would be sent has agreed to receive written notices electronically.

(Source:  Amended at 38 Ill. Reg. 5944, effective February 26, 2014)

Section 102.80  Right to Appeal

a)         Any individual who applies for or receives financial or medical assistance, social services or food stamps benefits shall have the right to appeal any of the following:

1)         Refusal to accept an application or reapplication;

2)         Failure to act on an application within the mandated time period;

3)         A decision to deny an application;

4)         A decision to reduce, suspend, terminate or in any way change the amount of assistance/food stamps or manner in which it is provided;

5)         Failure to make a decision or take appropriate action on any request which the client makes;

6)         A decision affecting the basis of issuance of food stamps with which the client disagrees;

7)         A decision to deny the payment for a medical service or item that requires prior approval;

8)         A decision granting prior approval request for a lesser or different medical service or item than was originally requested;

9)         An issue of Department policy, if the client is aggrieved by its application;

10)         The determination of the amount of a premium that may be charged to a client under any medical assistance program.  The Department's determination of the amount of a premium shall remain in force during the appeal process;

11)         Imposition of a penalty period under 89 Ill. Adm. Code 120.387 or 120.388; or

12)         A denial of a request for a hardship waiver under 89 Ill. Adm. Code 120.379(i), 120.385(c)(3) or 120.388(r).

b)         The appeal may be filed by the client or the client's authorized representative.  For food stamp clients, the request for a hearing may be made orally or in writing, and the appeal process is initiated effective with the date of the request.

(Source:  Amended at 35 Ill. Reg. 14486, effective August 12, 2011)

Section 102.81  Continuation of Assistance Pending Appeal

a)         If an appeal is initiated by the date a reduction or discontinuance will occur or within ten (10) calendar days of the date of the adequate notice, assistance shall be continued at the level in effect prior to the proposed action, pending the results of the fair hearing process, unless the individual specifically request that his/her assistance benefits not be continued. If the date the reduction or discontinuance will occur or the 10th calendar day is a Saturday, Sunday or a holiday, the client has until the end of the next work day to file his/her appeal.

b)         If a food stamp household files an appeal as the result of normal expiration of the certification period, or as a result of action taken on the initial or subsequent application, benefits shall not be continued at the previous level.

c)         If a food stamp household timely appeals a suspension from program participation for failure to file a Monthly Report by the date the suspended benefits would have been issued or within ten (10) days from the date of notice of adverse action, whichever is later, (See 89 Ill. Adm. Code 121.91(i)) and the household admits that it did not submit the Monthly Report, the household is not entitled to continuation of benefits.

d)         If an individual appeals the Department's decision to initiate a protective payment plan by the date initiation of the plan will occur, the protective payment plan shall not be initiated pending the results of the fair hearing process.

(Source:  Amended at 15 Ill. Reg. 7202, effective April 30, 1991)

Section 102.82  Time Limit for Filing an Appeal

a)         The right of appeal (except for food stamp cases) must be exercised within 60 calendar days of the date of the Department's action to notify the client.  All written notifications to clients are to bear the same date as the date of mailing or delivery.  Day one of the 60 day time period shall be the day following:

1)         The date on a written notification of a decision on an application, reduction, suspension, termination or discontinuance assistance and/or food stamp benefits, absent definitive evidence to the contrary that the notification was mailed (or delivery attempted) on a different date;

2)         The date of the Department's notification of denial of a request or other action which aggrieves the client when that denial or action is other than an application decision or a decision to reduce, suspend or terminate assistance.

b)         The 60 day time limitation does not apply when the Department fails to send a required written notification, fails to take action on a specific request, or denies a request without informing the client.

c)         Food stamp clients may request a hearing on any action or loss of benefits which occurred in the prior 90 days.

(Source:  Amended at 6 Ill. Reg. 894, effective January 7, 1982)

Section 102.83  Examining Department Records

a)         At any time during the regular office hours of the Department, the Department shall permit a client (as defined at 89 Ill. Adm. Code 101.20) and/or a client's authorized representative to examine the client's case record(s) in the presence of a Department employee and to obtain copies of such case record material(s) upon payment of a charge for reproduction.

b)         At any time within 35 days following release of the decision the appellant and/or authorized representative may review, at the local office, the documents presented by the Department at the hearing, the findings of fact, and the decision.

(Source:  Amended at 8 Ill. Reg. 18910, effective September 26, 1984)

Section 102.84  Child Care

a)         The Department shall authorize payment of child care expenses, if needed, to allow an AFDC or AABD (not MANG) client (active, pending, denied, or cancelled case status) to attend an appeal hearing.  (See 89 Ill. Adm. Code 112.308 for child care rates.)

b)         The appellant must request the payment no later than 30 days after the hearing.

(Source:  Amended at 7 Ill. Reg. 8350, effective July 1, 1983)

Section 102.90  Voluntary Repayment of Assistance

a)         A recipient or former recipient of assistance may voluntarily repay all or part of the assistance provided.

b)         A responsible relative or other person may, in behalf of a recipient or former recipient, repay all or part of the assistance provided.

Section 102.100  Excess Assistance (Recodified)

(Source:  Recodified to 89 Ill. Adm. Code 165.10 at 10 Ill. Reg. 21094, effective December 4, 1986)

Section 102.110  Recoupment of Overpayments (Recodified)

(Source:  Recodified to 89 Ill. Adm. Code 165.70 at 10 Ill. Reg. 21094, effective December 1, 1986)

Section 102.120  Correction of Underpayments

When it is determined that an AFDC assistance unit has not received all the assistance to which it is entitled, the Department shall provide retroactive corrective payments when the assistance unit is currently active.

(Source:  Amended at 5 Ill. Reg. 10775, effective October 1, 1981)

Section 102.200  Recovery of Assistance

a)         By means of claims against the estates of deceased recipients and the estates of their deceased spouses and liens against recipients' real property interests, the Department has a statutory right to recover assistance provided to or in behalf of recipients according to the terms prescribed in this Section.

b)         The Department shall effect its recoveries by one of the following actions:

1)         Acceptance of an amount, as settlement, equal to the estimated amount which would be collected if the estate were administered or the lien foreclosed;

2)         Administration of the estate; or

3)         Foreclosure of the lien.

c)         When the Department has both an estate claim and a real property lien, collection of the claim and lien shall be by one action.

(Source:  Amended at 21 Ill. Reg. 619, effective January 1, 1997)

Section 102.210  Estate Claims

a)         Definitions in this Section are as follows:

1)         "Estate" – all real and personal property within an individual's estate as provided in the Probate Act of 1975 [ 755 ILCS 5].  For a decedent who received benefits under a qualified long term care insurance policy in connection with which assets were disregarded (see subsection (f), the term "estate" includes all real and personal property in which the individual had legal title or interest at the time of death (to the extent of that interest), including assets conveyed to a survivor, heir or assignee of the deceased person through joint tenancy, tenancy in common, survivorship, life estate, living trust or other arrangement.

2)         "Beneficiary" – any person nominated in a will to receive an interest in property other than in a fiduciary capacity.

3)         "Heir" – any person entitled under the statutes to an interest in property of a decedent.

b)         The Department's claim against the estate of a deceased recipient or against the estate of the recipient's deceased spouse, regardless of the order of death, shall encompass:

1)         All income maintenance assistance paid out at any time; and

2)         All medical assistance paid out:

A)        at any time for a permanently institutionalized recipient whose real property is subject to the Department's lien; or

B)        except the costs of Community Care Program (CCP) services, prior to October 1, 1993, for a recipient 65 years of age or older; or

C)        on or after October 1, 1993, for a recipient 55 years of age or older; or

D)        for Medicare cost sharing expenses (Part A and B premiums, deductibles, coinsurance and copayments) made on behalf of persons described in 42 U.S.C. 1396a(a)(10)(E), when a request for payment of those expenses was received by the Department prior to January 1, 2010. Requests for payment of Medicare cost sharing expenses made after January 1, 2010 are exempt from estate recovery.

c)         The claim shall apply to assistance provided to or on behalf of a recipient on or after the following dates:

d)         The Department shall not enforce a claim for medical assistance against any property, real or personal, of a deceased recipient while one or more of the following relatives survives:  spouse of decedent, child under 21, or child over 21 who is blind or permanently and totally disabled.

e)         The Department shall not enforce a claim for income maintenance assistance against homestead property of a deceased recipient while the homestead is occupied by one or more of the surviving relatives previously specified.

f)         The Department shall not enforce a claim against the estate of a decedent to the extent assets were disregarded because the person was covered under a qualified long term care policy as provided under 89 Ill. Adm. Code 120.382(c).

g)         To avoid undue hardship, the Department will waive its right to recover from a decedent's estate if pursuing recovery would cause an heir or beneficiary of the estate to become or remain eligible for a public benefit program, such as SSI, TANF or SNAP.  The Department may limit the scope of its waiver to that portion of the estate that the heir or beneficiary would receive and pursue recovery against the balance of the estate, if any.  The Department will not waive recovery despite undue hardship if payment of the claims of other estate creditors that are equal or inferior in priority to the Department's claim will exhaust the estate and defeat the purpose of the waiver.  The Department will provide written notice to heirs and beneficiaries known to the Department of the opportunity, time frame and method to request a waiver of estate recovery based on undue hardship.

h)         For decedents dying on or after July 1, 2022, to prevent substantial and unreasonable hardship, the Department shall:

1)         Waive any claim against the first $25,000.00 of an estate; and

2)         Consider the gross assets in the estate, including, but not limited to, the net value of real estate less mortgages or liens with priority over the Department's claims.

i)          The Department may defer or waive enforcement of its claim for income maintenance assistance if it determines that:

1)         The deceased recipient is survived by a dependent spouse and minor child or children; or

2)         Rehabilitative training for employment or other means of self-support for the surviving spouse or children is feasible, and deferment or waiver will facilitate achievement of self-support status and prevent or reduce the likelihood of return to dependency on public assistance of the spouse or children.

(Source:  Amended at 47 Ill. Reg. 18017, effective November 21, 2023)

Section 102.220  Real Property Liens

The Department's lien against a recipient's real property shall encompass:

a)         all medical assistance paid out at any time for a permanently institutionalized recipient on or after July 14, 1993, and

b)         all income maintenance assistance paid to or on behalf of a recipient on or after the following dates:

(Source:  Amended at 18 Ill. Reg. 273, effective December 28, 1993)

Section 102.230  Filing and Renewal of Liens

a)         The Department shall file a lien against:

1)         The homestead property owned by:

A)        a recipient of AABD; or

B)        a permanently institutionalized recipient of MANG(A), (B) or (D), except as provided in Section 102.235;

2)         Any other legal or equitable real property interests, regardless of value, which the recipient owns.

b)         The lien shall be renewed every five years by the Department until it is satisfied.

(Source:  Amended at 25 Ill. Reg. 16111, effective December 1, 2001)

Section 102.235  Liens on Property of Institutionalized Recipients

a)         Definitions in this Section are as follows:

1)         "Institutionalized individual" – individual of any age who is an inpatient in a nursing facility or other medical institution and who must, as a condition of receiving services in the institution, apply his or her income to the cost of care.

2)         "Individual's home" – dwelling with adjoining and related real estate which the individual owns and occupies, or when temporarily absent, dwelling in which the individual maintains an intent to return.

3)         "Equity interest in the home" – current market value of the home less all encumbrances.

4)         "Residing in the home for at least one or two years on a continuous basis" – occupancy of an individual's home by a sibling or child of the individual as a primary place of residence.  During the one or two year period, the individual's home address was used by the sibling or child as his or her mailing address, or his or her address used for driver's license or voter registration purposes, and the address remained unchanged.

5)         "Discharge from the medical institution and return home" – the attending physician has signed an order for discharge from the medical institution, following which the individual has returned to reside in his or her own home.

6)         "Lawfully residing" – use of the property of an individual in a medical institution as the home of a spouse or a minor, blind or disabled child, or a sibling with an ownership interest in the home.  Such property must be the spouse's child's or sibling's mailing address, or his or her address used for driver's license or voter registration purposes.

b)         Except as provided in subsection (c) of this Section, the Department shall file a lien on all real property, including the home of a recipient of MANG(A), (B) or (D) who it determines to be permanently institutionalized, that is, cannot reasonably be expected to be discharged and return home from a medical institution.

c)         The Department will not file a lien on the home if it is occupied by the permanently institutionalized recipient's spouse, minor or disabled or blind child, or sibling who has an equity interest in the home and has legally resided in it continuously for at least one year immediately before the date the recipient was admitted to a medical institution.

d)         There shall be a rebuttable presumption of permanent institutionalization when a recipient has resided for at least 120 calendar days in one or more medical institutions.

e)         The Department shall provide the recipient with at least 10 calendar days advance notice of its intention to file a lien on the recipient's real property, based on its determination that the recipient is permanently institutionalized, and of the recipient's right to request and obtain a fair hearing on this determination.

(Source:  Amended at 21 Ill. Reg. 619, effective January 1, 1997)

Section 102.240  Foreclosure of Liens

a)         The Department may enforce a lien by foreclosure:

1)         At any time when there is a transfer of a recipient's real property subject to the lien;

2)         In case of fraud; or

3)         At the time of the recipient's death.

b)         The Department shall defer foreclosure of a lien on homestead property, except in case of fraud, if:

1)         the property is occupied by the recipient or the recipient's surviving spouse, child under 21, or child over 21 who is blind or permanently and totally disabled, or

2)         in the case of a permanently institutionalized recipient,

A)        a sibling of the recipient has resided continuously in the property since at least one year immediately before the date the recipient was admitted to the institution, or

B)        a child of the recipient who has resided continuously in the property since at least two years immediately before the date the recipient was admitted to the institution establishes that he or she provided care for at least two years before admission that enabled the recipient to live at home rather than in an institution.

(Source:  Amended at 18 Ill. Reg. 273, effective December 28, 1993)

Section 102.250  Release of Liens

a)         The Department shall release a lien when:

1)         The Department receives full repayment of the assistance granted subject to the lien;

2)         A bond is filed, with a surety or sureties acceptable to the Department, which guarantees payment of the amount of the lien;

3)         The lien was filed in error; or

4)         MANG(A), (B) or (D) recipient has been medically discharged from an institution and returns to his or her home on which the Department holds a lien.

b)         The Department may also release a lien when:

1)         It receives the value of the property to which the lien attaches, but its claim for any balance due on the lien is reserved against any of the recipient's subsequently discovered assets; or

2)         The recipient has a dependent spouse and minor children; or

3)         Rehabilitative training for employment or other means of self-support is feasible where release of the lien would facilitate achievement of self-support status and prevent or reduce the likelihood of a return to dependency on public assistance.

(Source:  Amended at 18 Ill. Reg. 273, effective December 28, 1993)

Section 102.260  Personal Injury Claims

a)         Clients who suffer a personal injury and have a potential for recovery of damages as a result of the type or severity of the injury, must report such injuries to the Department and take action to collect any damages which may be due.

b)         The Department shall collect payment from personal injury settlements paid in behalf of clients.  The Department shall not collect payment from claims covered by the Workers' Compensation Act (Ill. Rev. Stat. 1985, ch., 48, par. 138.1 et seq.), the Workers' Occupational Diseases Act (Ill. Rev. Stat. 1985, ch. 48, par. 172.36 et seq.) or an Act requiring compensation for causing death by wrongful act, neglect or default (Ill. Rev. Stat. 1985, ch. 70, pars. 1-22).

c)         The Department shall have a charge equal to the total cost of medical assistance provided to an injured individual from the date of the injury to the date of recovery of damages.

d)         If an employable individual receives assistance for himself and/or dependents, the Department's charge shall also include the total cost of cash and medical assistance issued as a result of the injury which was provided for the individual and his dependents from the date of injury to the date of recovery of damages.  The Department's charge is for assistance provided for the injured recipient and his dependents even if all persons are not included in a single assistance unit.

e)         Payment received by a client as damages for a personal injury shall be considered nonexempt unearned income after payment of the following expenses:

1)         necessary costs of litigation or settlement;

2)         the Department's charge;

3)         medical costs resulting from the injury and paid by the client; and

4)         expenses to repair or replace personal property which was damaged as a result of the injury.

(Source:  Amended at 10 Ill. Reg. 19088, effective October 24, 1986)

Section 102.270  Convictions of Fraud – Eligibility

a)         Multiple Convictions

Any person who has been found guilty of a criminal violation of Article VIIIA of the Illinois Public Aid Code [305 ILCS 5/Art. VIIIA] or of any law of the United States or another state which is substantially similar to Sections 8A-2 through 8A-5 of Article VIIIA, two or more times, shall be ineligible for assistance under the GA program (in the City of Chicago) or the State AABD program.  Children for whom such a person is a caretaker relative shall remain eligible for assistance under this Code.

b)         Single Convictions of $10,000 or more

Any person who has been found guilty of a criminal violation of Article VIIIA of the Illinois Public Aid Code [305 ILCS 5/Art. VIIIA], who has not previously been convicted of a criminal violation of Article VIIIA and has amassed $10,000 or more in such criminal violation, shall be ineligible for assistance under the GA program (in the City of Chicago) or the State AABD program for a period of two years following conviction or until the total amount of money, including the value of food stamps, is repaid, whichever first occurs. Children for whom such a person is a caretaker relative shall remain eligible for assistance.

(Source:  Amended at 21 Ill. Reg. 7438, effective June 1, 1997)

Section 102.280  Single Conviction of Fraud – Administrative Review Board

Except as provided in Section 102.270, any person who has been found guilty of a criminal violation of Article VIIIA of the Illinois Public Aid Code [305 ILCS 5/Art. VIIIA] or of any law of the United States or of any state which is substantially similar to Sections 8A-2 through 8A-5 for violations related to public assistance programs and who has not previously been convicted for a criminal violation of Article VIIIA or of any law of the United States or of any state which is substantially similar to Sections 8A-2 through 8A-5 for violations related to public assistance programs shall be subject to the provisions of this Section upon filing a subsequent application for public assistance under AFDC, AABD, Refugee Assistance, or the GA program (in the City of Chicago).

a)         The application will be reviewed by an Administrative Review Board (ARB) prior to approval or disapproval.  The ARB shall consist of the Local Office Administrator of the local office where the application is made and a representative of the Zone Office, appointed by the Zone Office Administrator.

b)         The review by the ARB shall be for the purpose of determining the person's eligibility for assistance and to determine whether any additional administrative safeguards are required to prevent any future violations of Article VIIIA.

c)         The review shall be informal.  The applicant will be notified, in writing, of the review at least five days in advance.  The review will be held in the county where the applicant resides.  The applicant may attend the review, and may bring other persons to the review to speak on his or her behalf, including an attorney, relatives or friends. The review shall be open to the public, unless the applicant and the ARB determine otherwise.  The review shall be held within such a time as not to delay the decision on the application beyond the time allowed under State and Federal law and regulations.  (See 89 Ill. Adm. Code 110.20).

d)         If the ARB determines the applicant is not eligible for public assistance, based on applicable eligibility factors of the program or programs for which the applicant is applying, the applicant will be notified in the same manner as other applicants.  The applicant shall be entitled to appeal any decision of denial.  (The grounds for appeal and appeal procedure to be followed is found at 89 Ill. Adm. Code 102 and 104.)

e)         If the ARB determines the applicant is eligible for public assistance, the ARB shall also determine what administrative safeguards, if any, are required to ensure that the person does not commit further violations of Article VIIIA.  Such safeguards shall be based on the individual factors of each case and may include, but are not limited to, more frequent home visits, more frequent reports regarding financial or other factors, appointment of a substitute payee, or any other actions which are permitted by State and Federal law and regulations.

f)         The applicant will be notified, in writing, of the decision of the ARB and an explanation of the administrative safeguards required in his or her case.  The applicant shall be entitled to appeal any decision of the ARB.

g)         The ARB shall review the necessity for any administrative safeguard every six months.  At the review, the necessity to continue or reverse the administrative safeguards will be determined.

(Source:  Amended at 21 Ill. Reg. 7438, effective June 1, 1997)