Public Act 096-0020
 
SB0367 Enrolled LRB096 06399 RCE 16483 b

    AN ACT concerning State government.
 
    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 and adding Section 12-4.38 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, excluding any eligibility
    requirements that are inconsistent with any federal law or
    federal regulation, as interpreted by the U.S. Department
    of Health and Human Services, but who fail to qualify
    thereunder on the basis of need or who qualify but are not
    receiving basic maintenance under Article IV, 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, excluding any eligibility
        requirements that are inconsistent with any federal
        law or federal regulation, as interpreted by the U.S.
        Department of Health and Human Services, 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 who meet the
    qualifications for protection of resources described in
    Section 15 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. Family Care Eligibility.
            (a) A caretaker relative who is 19 years of age or
        older when countable income is at or below 185% of the
        Federal Poverty Level Guidelines, as published
        annually in the Federal Register, for the appropriate
        family size. A person may not spend down to become
        eligible under this paragraph 15.
            (b) Eligibility shall be reviewed annually.
            (c) Caretaker relatives enrolled under this
        paragraph 15 in families with countable income above
        150% and at or below 185% of the Federal Poverty Level
        Guidelines shall be counted as family members and pay
        premiums as established under the Children's Health
        Insurance Program Act.
            (d) Premiums shall be billed by and payable to the
        Department or its authorized agent, on a monthly basis.
            (e) The premium due date is the last day of the
        month preceding the month of coverage.
            (f) Individuals shall have a grace period through
        the month of coverage to pay the premium.
            (g) Failure to pay the full monthly premium by the
        last day of the grace period shall result in
        termination of coverage.
            (h) Partial premium payments shall not be
        refunded.
            (i) Following termination of an individual's
        coverage under this paragraph 15, the following action
        is required before the individual can be re-enrolled:
                (1) A new application must be completed and the
            individual must be determined otherwise eligible.
                (2) There must be full payment of premiums due
            under this Code, the Children's Health Insurance
            Program Act, the Covering ALL KIDS Health
            Insurance Act, or any other healthcare program
            administered by the Department for periods in
            which a premium was owed and not paid for the
            individual.
                (3) The first month's premium must be paid if
            there was an unpaid premium on the date the
            individual's previous coverage was canceled.
        The Department is authorized to implement the
    provisions of this amendatory Act of the 95th General
    Assembly by adopting the medical assistance rules in effect
    as of October 1, 2007, at 89 Ill. Admin. Code 125, and at
    89 Ill. Admin. Code 120.32 along with only those changes
    necessary to conform to federal Medicaid requirements,
    federal laws, and federal regulations, including but not
    limited to Section 1931 of the Social Security Act (42
    U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department
    of Health and Human Services, and the countable income
    eligibility standard authorized by this paragraph 15. The
    Department may not otherwise adopt any rule to implement
    this increase except as authorized by law, to meet the
    eligibility standards authorized by the federal government
    in the Medicaid State Plan or the Title XXI Plan, or to
    meet an order from the federal government or any court.
    In implementing the provisions of this amendatory Act of
the 96th General Assembly, the Department is authorized to
adopt only those rules necessary, including emergency rules.
Nothing in this amendatory Act of the 96th General Assembly
permits the Department to adopt rules or issue a decision that
expands eligibility for the FamilyCare Program to a person
whose income exceeds 185% of the Federal Poverty Level as
determined from time to time by the U.S. Department of Health
and Human Services, unless the Department is provided with
express statutory authority.
    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; 95-1055, eff. 4-10-09.)
 
    (305 ILCS 5/12-4.38 new)
    Sec. 12-4.38. Special FamilyCare provisions.
    (a) The Department of Healthcare and Family Services may
submit to the Comptroller, and the Comptroller is authorized to
pay, on behalf of persons enrolled in the FamilyCare Program,
claims for services rendered to an enrollee during the period
beginning October 1, 2007, and ending on the effective date of
any rules adopted to implement the provisions of this
amendatory Act of the 96th General Assembly. The authorization
for payment of claims applies only to bona fide claims for
payment for services rendered. Any claim for payment which is
authorized pursuant to the provisions of this amendatory Act of
the 96th General Assembly must adhere to all other applicable
rules, regulations, and requirements.
    (b) Each person enrolled in the FamilyCare Program as of
the effective date of this amendatory Act of the 96th General
Assembly whose income exceeds 185% of the Federal Poverty
Level, but is not more than 400% of the Federal Poverty Level,
may remain enrolled in the FamilyCare Program pursuant to this
subsection so long as that person continues to meet the
eligibility criteria established under the emergency rule at 89
Ill. Adm. Code 120 (Illinois Register Volume 31, page 15854)
filed November 7, 2007. In no case may a person continue to be
enrolled in the FamilyCare Program pursuant to this subsection
if the person's income rises above 400% of the Federal Poverty
Level or falls below 185% of the Federal Poverty Level at any
subsequent time. Nothing contained in this subsection shall
prevent an individual from enrolling in the FamilyCare Program
as authorized by paragraph 15 of Section 5-2 of this Code if he
or she otherwise qualifies under that Section.
    (c) In implementing the provisions of this amendatory Act
of the 96th General Assembly, the Department of Healthcare and
Family Services is authorized to adopt only those rules
necessary, including emergency rules. Nothing in this
amendatory Act of the 96th General Assembly permits the
Department to adopt rules or issue a decision that expands
eligibility for the FamilyCare Program to a person whose income
exceeds 185% of the Federal Poverty Level as determined from
time to time by the U.S. Department of Health and Human
Services, unless the Department is provided with express
statutory authority.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.