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.)