Public Act 096-1272
 
HB5927 EnrolledLRB096 18052 RPM 33426 b

    AN ACT concerning insurance.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Children's Health Insurance Program Act is
amended by changing Section 20 as follows:
 
    (215 ILCS 106/20)
    Sec. 20. Eligibility.
    (a) To be eligible for this Program, a person must be a
person who has a child eligible under this Act and who is
eligible under a waiver of federal requirements pursuant to an
application made pursuant to subdivision (a)(1) of Section 40
of this Act or who is a child who:
        (1) is a child who is not eligible for medical
    assistance;
        (2) is a child whose annual household income, as
    determined by the Department, is above 133% of the federal
    poverty level and at or below 200% of the federal poverty
    level;
        (3) is a resident of the State of Illinois; and
        (4) is a child who is either a United States citizen or
    included in one of the following categories of
    non-citizens:
            (A) unmarried dependent children of either a
        United States Veteran honorably discharged or a person
        on active military duty;
            (B) refugees under Section 207 of the Immigration
        and Nationality Act;
            (C) asylees under Section 208 of the Immigration
        and Nationality Act;
            (D) persons for whom deportation has been withheld
        under Section 243(h) of the Immigration and
        Nationality Act;
            (E) persons granted conditional entry under
        Section 203(a)(7) of the Immigration and Nationality
        Act as in effect prior to April 1, 1980;
            (F) persons lawfully admitted for permanent
        residence under the Immigration and Nationality Act;
        and
            (G) parolees, for at least one year, under Section
        212(d)(5) of the Immigration and Nationality Act.
    Those children who are in the categories set forth in
subdivisions (4)(F) and (4)(G) of this subsection, who enter
the United States on or after August 22, 1996, shall not be
eligible for 5 years beginning on the date the child entered
the United States.
    (b) A child who is determined to be eligible for assistance
may remain eligible for 12 months, provided the child maintains
his or her residence in the State, has not yet attained 19
years of age, and is not excluded pursuant to subsection (c). A
child who has been determined to be eligible for assistance
must reapply or otherwise establish eligibility at least
annually. An eligible child shall be required, as determined by
the Department by rule, to report promptly those changes in
income and other circumstances that affect eligibility. The
eligibility of a child may be redetermined based on the
information reported or may be terminated based on the failure
to report or failure to report accurately. A child's
responsible relative or caretaker may also be held liable to
the Department for any payments made by the Department on such
child's behalf that were inappropriate. An applicant shall be
provided with notice of these obligations.
    (c) A child shall not be eligible for coverage under this
Program if:
        (1) the premium required pursuant to Section 30 of this
    Act has not been paid. If the required premiums are not
    paid the liability of the Program shall be limited to
    benefits incurred under the Program for the time period for
    which premiums had been paid. If the required monthly
    premium is not paid, the child shall be ineligible for
    re-enrollment for a minimum period of 3 months.
    Re-enrollment shall be completed prior to the next covered
    medical visit and the first month's required premium shall
    be paid in advance of the next covered medical visit. The
    Department shall promulgate rules regarding grace periods,
    notice requirements, and hearing procedures pursuant to
    this subsection;
        (2) the child is an inmate of a public institution or a
    patient in an institution for mental diseases; or
        (3) the child is a member of a family that is eligible
    for health benefits covered under the State of Illinois
    health benefits plan on the basis of a member's employment
    with a public agency.
(Source: P.A. 92-597, eff. 6-28-02; 93-63, eff. 6-30-03.)
 
    Section 10. The Covering ALL KIDS Health Insurance Act is
amended by changing Section 20 as follows:
 
    (215 ILCS 170/20)
    (Section scheduled to be repealed on July 1, 2011)
    Sec. 20. Eligibility.
    (a) To be eligible for the Program, a person must be a
child:
        (1) who is a resident of the State of Illinois; and
        (2) who is ineligible for medical assistance under the
    Illinois Public Aid Code or benefits under the Children's
    Health Insurance Program Act; and
        (3) either (i) who has been without health insurance
    coverage for a period set forth by the Department in rules,
    but not less than 6 months during the first month of
    operation of the Program, 7 months during the second month
    of operation, 8 months during the third month of operation,
    9 months during the fourth month of operation, 10 months
    during the fifth month of operation, 11 months during the
    sixth month of operation, and 12 months thereafter, (ii)
    whose parent has lost employment that made available
    affordable dependent health insurance coverage, until such
    time as affordable employer-sponsored dependent health
    insurance coverage is again available for the child as set
    forth by the Department in rules, (iii) who is a newborn
    whose responsible relative does not have available
    affordable private or employer-sponsored health insurance,
    or (iv) who, within one year of applying for coverage under
    this Act, lost medical benefits under the Illinois Public
    Aid Code or the Children's Health Insurance Program Act.
    An entity that provides health insurance coverage (as
defined in Section 2 of the Comprehensive Health Insurance Plan
Act) to Illinois residents shall provide health insurance data
match to the Department of Healthcare and Family Services for
the purpose of determining eligibility for the Program under
this Act.
    The Department of Healthcare and Family Services, in
collaboration with the Department of Financial and
Professional Regulation, Division of Insurance, shall adopt
rules governing the exchange of information under this Section.
The rules shall be consistent with all laws relating to the
confidentiality or privacy of personal information or medical
records, including provisions under the Federal Health
Insurance Portability and Accountability Act (HIPAA).
    (b) The Department shall monitor the availability and
retention of employer-sponsored dependent health insurance
coverage and shall modify the period described in subdivision
(a)(3) if necessary to promote retention of private or
employer-sponsored health insurance and timely access to
healthcare services, but at no time shall the period described
in subdivision (a)(3) be less than 6 months.
    (c) The Department, at its discretion, may take into
account the affordability of dependent health insurance when
determining whether employer-sponsored dependent health
insurance coverage is available upon reemployment of a child's
parent as provided in subdivision (a)(3).
    (d) A child who is determined to be eligible for the
Program shall remain eligible for 12 months, provided that the
child maintains his or her residence in this State, has not yet
attained 19 years of age, and is not excluded under subsection
(e).
    (e) A child is not eligible for coverage under the Program
if:
        (1) the premium required under Section 40 has not been
    timely paid; if the required premiums are not paid, the
    liability of the Program shall be limited to benefits
    incurred under the Program for the time period for which
    premiums have been paid; if the required monthly premium is
    not paid, the child is ineligible for re-enrollment for a
    minimum period of 3 months; re-enrollment shall be
    completed before the next covered medical visit, and the
    first month's required premium shall be paid in advance of
    the next covered medical visit; or
        (2) the child is an inmate of a public institution or
    an institution for mental diseases.
    (f) The Department shall adopt eligibility rules,
including, but not limited to: rules regarding annual renewals
of eligibility for the Program; rules providing for
re-enrollment, grace periods, notice requirements, and hearing
procedures under subdivision (e)(1) of this Section; and rules
regarding what constitutes availability and affordability of
private or employer-sponsored health insurance, with
consideration of such factors as the percentage of income
needed to purchase children or family health insurance, the
availability of employer subsidies, and other relevant
factors.
(Source: P.A. 94-693, eff. 7-1-06.)