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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||||||||||||||||||||
5 | changing Section 5-2 as follows:
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6 | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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7 | Sec. 5-2. Classes of Persons Eligible. Medical assistance | ||||||||||||||||||||||||
8 | under this
Article shall be available to any of the following | ||||||||||||||||||||||||
9 | classes of persons in
respect to whom a plan for coverage has | ||||||||||||||||||||||||
10 | been submitted to the Governor
by the Illinois Department and | ||||||||||||||||||||||||
11 | approved by him:
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12 | 1. Recipients of basic maintenance grants under | ||||||||||||||||||||||||
13 | Articles III and IV.
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14 | 2. Persons otherwise eligible for basic maintenance | ||||||||||||||||||||||||
15 | under Articles
III and IV, excluding any eligibility | ||||||||||||||||||||||||
16 | requirements that are inconsistent with any federal law or | ||||||||||||||||||||||||
17 | federal regulation, as interpreted by the U.S. Department | ||||||||||||||||||||||||
18 | of Health and Human Services, but who fail to qualify | ||||||||||||||||||||||||
19 | thereunder on the basis of need or who qualify but are not | ||||||||||||||||||||||||
20 | receiving basic maintenance under Article IV, and
who have | ||||||||||||||||||||||||
21 | insufficient income and resources to meet the costs of
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22 | necessary medical care, including but not limited to the | ||||||||||||||||||||||||
23 | following:
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1 | (a) All persons otherwise eligible for basic | ||||||
2 | maintenance under Article
III but who fail to qualify | ||||||
3 | under that Article on the basis of need and who
meet | ||||||
4 | either of the following requirements:
| ||||||
5 | (i) their income, as determined by the | ||||||
6 | Illinois Department in
accordance with any federal | ||||||
7 | requirements, is equal to or less than 70% in
| ||||||
8 | fiscal year 2001, equal to or less than 85% in | ||||||
9 | fiscal year 2002 and until
a date to be determined | ||||||
10 | by the Department by rule, and equal to or less
| ||||||
11 | than 100% beginning on the date determined by the | ||||||
12 | Department by rule, of the nonfarm income official | ||||||
13 | poverty
line, as defined by the federal Office of | ||||||
14 | Management and Budget and revised
annually in | ||||||
15 | accordance with Section 673(2) of the Omnibus | ||||||
16 | Budget Reconciliation
Act of 1981, applicable to | ||||||
17 | families of the same size; or
| ||||||
18 | (ii) their income, after the deduction of | ||||||
19 | costs incurred for medical
care and for other types | ||||||
20 | of remedial care, is equal to or less than 70% in
| ||||||
21 | fiscal year 2001, equal to or less than 85% in | ||||||
22 | fiscal year 2002 and until
a date to be determined | ||||||
23 | by the Department by rule, and equal to or less
| ||||||
24 | than 100% beginning on the date determined by the | ||||||
25 | Department by rule, of the nonfarm income official | ||||||
26 | poverty
line, as defined in item (i) of this |
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| |||||||
1 | subparagraph (a).
| ||||||
2 | (b) All persons who, excluding any eligibility | ||||||
3 | requirements that are inconsistent with any federal | ||||||
4 | law or federal regulation, as interpreted by the U.S. | ||||||
5 | Department of Health and Human Services, would be | ||||||
6 | determined eligible for such basic
maintenance under | ||||||
7 | Article IV by disregarding the maximum earned income
| ||||||
8 | permitted by federal law.
| ||||||
9 | 3. Persons who would otherwise qualify for Aid to the | ||||||
10 | Medically
Indigent under Article VII.
| ||||||
11 | 4. Persons not eligible under any of the preceding | ||||||
12 | paragraphs who fall
sick, are injured, or die, not having | ||||||
13 | sufficient money, property or other
resources to meet the | ||||||
14 | costs of necessary medical care or funeral and burial
| ||||||
15 | expenses.
| ||||||
16 | 5.(a) Women during pregnancy, after the fact
of | ||||||
17 | pregnancy has been determined by medical diagnosis, and | ||||||
18 | during the
60-day period beginning on the last day of the | ||||||
19 | pregnancy, together with
their infants and children born | ||||||
20 | after September 30, 1983,
whose income and
resources are | ||||||
21 | insufficient to meet the costs of necessary medical care to
| ||||||
22 | the maximum extent possible under Title XIX of the
Federal | ||||||
23 | Social Security Act.
| ||||||
24 | (b) The Illinois Department and the Governor shall | ||||||
25 | provide a plan for
coverage of the persons eligible under | ||||||
26 | paragraph 5(a) by April 1, 1990. Such
plan shall provide |
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1 | ambulatory prenatal care to pregnant women during a
| ||||||
2 | presumptive eligibility period and establish an income | ||||||
3 | eligibility standard
that is equal to 133%
of the nonfarm | ||||||
4 | income official poverty line, as defined by
the federal | ||||||
5 | Office of Management and Budget and revised annually in
| ||||||
6 | accordance with Section 673(2) of the Omnibus Budget | ||||||
7 | Reconciliation Act of
1981, applicable to families of the | ||||||
8 | same size, provided that costs incurred
for medical care | ||||||
9 | are not taken into account in determining such income
| ||||||
10 | eligibility.
| ||||||
11 | (c) The Illinois Department may conduct a | ||||||
12 | demonstration in at least one
county that will provide | ||||||
13 | medical assistance to pregnant women, together
with their | ||||||
14 | infants and children up to one year of age,
where the | ||||||
15 | income
eligibility standard is set up to 185% of the | ||||||
16 | nonfarm income official
poverty line, as defined by the | ||||||
17 | federal Office of Management and Budget.
The Illinois | ||||||
18 | Department shall seek and obtain necessary authorization
| ||||||
19 | provided under federal law to implement such a | ||||||
20 | demonstration. Such
demonstration may establish resource | ||||||
21 | standards that are not more
restrictive than those | ||||||
22 | established under Article IV of this Code.
| ||||||
23 | 6. Persons under the age of 18 who fail to qualify as | ||||||
24 | dependent under
Article IV and who have insufficient income | ||||||
25 | and resources to meet the costs
of necessary medical care | ||||||
26 | to the maximum extent permitted under Title XIX
of the |
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| |||||||
1 | Federal Social Security Act.
| ||||||
2 | 7. Persons who are under 21 years of age and would
| ||||||
3 | qualify as
disabled as defined under the Federal | ||||||
4 | Supplemental Security Income Program,
provided medical | ||||||
5 | service for such persons would be eligible for Federal
| ||||||
6 | Financial Participation, and provided the Illinois | ||||||
7 | Department determines that:
| ||||||
8 | (a) the person requires a level of care provided by | ||||||
9 | a hospital, skilled
nursing facility, or intermediate | ||||||
10 | care facility, as determined by a physician
licensed to | ||||||
11 | practice medicine in all its branches;
| ||||||
12 | (b) it is appropriate to provide such care outside | ||||||
13 | of an institution, as
determined by a physician | ||||||
14 | licensed to practice medicine in all its branches;
| ||||||
15 | (c) the estimated amount which would be expended | ||||||
16 | for care outside the
institution is not greater than | ||||||
17 | the estimated amount which would be
expended in an | ||||||
18 | institution.
| ||||||
19 | 8. Persons who become ineligible for basic maintenance | ||||||
20 | assistance
under Article IV of this Code in programs | ||||||
21 | administered by the Illinois
Department due to employment | ||||||
22 | earnings and persons in
assistance units comprised of | ||||||
23 | adults and children who become ineligible for
basic | ||||||
24 | maintenance assistance under Article VI of this Code due to
| ||||||
25 | employment earnings. The plan for coverage for this class | ||||||
26 | of persons shall:
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| |||||||
1 | (a) extend the medical assistance coverage for up | ||||||
2 | to 12 months following
termination of basic | ||||||
3 | maintenance assistance; and
| ||||||
4 | (b) offer persons who have initially received 6 | ||||||
5 | months of the
coverage provided in paragraph (a) above, | ||||||
6 | the option of receiving an
additional 6 months of | ||||||
7 | coverage, subject to the following:
| ||||||
8 | (i) such coverage shall be pursuant to | ||||||
9 | provisions of the federal
Social Security Act;
| ||||||
10 | (ii) such coverage shall include all services | ||||||
11 | covered while the person
was eligible for basic | ||||||
12 | maintenance assistance;
| ||||||
13 | (iii) no premium shall be charged for such | ||||||
14 | coverage; and
| ||||||
15 | (iv) such coverage shall be suspended in the | ||||||
16 | event of a person's
failure without good cause to | ||||||
17 | file in a timely fashion reports required for
this | ||||||
18 | coverage under the Social Security Act and | ||||||
19 | coverage shall be reinstated
upon the filing of | ||||||
20 | such reports if the person remains otherwise | ||||||
21 | eligible.
| ||||||
22 | 9. Persons with acquired immunodeficiency syndrome | ||||||
23 | (AIDS) or with
AIDS-related conditions with respect to whom | ||||||
24 | there has been a determination
that but for home or | ||||||
25 | community-based services such individuals would
require | ||||||
26 | the level of care provided in an inpatient hospital, |
| |||||||
| |||||||
1 | skilled
nursing facility or intermediate care facility the | ||||||
2 | cost of which is
reimbursed under this Article. Assistance | ||||||
3 | shall be provided to such
persons to the maximum extent | ||||||
4 | permitted under Title
XIX of the Federal Social Security | ||||||
5 | Act.
| ||||||
6 | 10. Participants in the long-term care insurance | ||||||
7 | partnership program
established under the Illinois | ||||||
8 | Long-Term Care Partnership Program Act who meet the
| ||||||
9 | qualifications for protection of resources described in | ||||||
10 | Section 15 of that
Act.
| ||||||
11 | 11. Persons with disabilities who are employed and | ||||||
12 | eligible for Medicaid,
pursuant to Section | ||||||
13 | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | ||||||
14 | subject to federal approval, persons with a medically | ||||||
15 | improved disability who are employed and eligible for | ||||||
16 | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | ||||||
17 | the Social Security Act, as
provided by the Illinois | ||||||
18 | Department by rule. In establishing eligibility standards | ||||||
19 | under this paragraph 11, the Department shall, subject to | ||||||
20 | federal approval: | ||||||
21 | (a) set the income eligibility standard at not | ||||||
22 | lower than 350% of the federal poverty level; | ||||||
23 | (b) exempt retirement accounts that the person | ||||||
24 | cannot access without penalty before the age
of 59 1/2, | ||||||
25 | and medical savings accounts established pursuant to | ||||||
26 | 26 U.S.C. 220; |
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| |||||||
1 | (c) allow non-exempt assets up to $25,000 as to | ||||||
2 | those assets accumulated during periods of eligibility | ||||||
3 | under this paragraph 11; and
| ||||||
4 | (d) continue to apply subparagraphs (b) and (c) in | ||||||
5 | determining the eligibility of the person under this | ||||||
6 | Article even if the person loses eligibility under this | ||||||
7 | paragraph 11.
| ||||||
8 | 12. Subject to federal approval, persons who are | ||||||
9 | eligible for medical
assistance coverage under applicable | ||||||
10 | provisions of the federal Social Security
Act and the | ||||||
11 | federal Breast and Cervical Cancer Prevention and | ||||||
12 | Treatment Act of
2000. Those eligible persons are defined | ||||||
13 | to include, but not be limited to,
the following persons:
| ||||||
14 | (1) persons who have been screened for breast or | ||||||
15 | cervical cancer under
the U.S. Centers for Disease | ||||||
16 | Control and Prevention Breast and Cervical Cancer
| ||||||
17 | Program established under Title XV of the federal | ||||||
18 | Public Health Services Act in
accordance with the | ||||||
19 | requirements of Section 1504 of that Act as | ||||||
20 | administered by
the Illinois Department of Public | ||||||
21 | Health; and
| ||||||
22 | (2) persons whose screenings under the above | ||||||
23 | program were funded in whole
or in part by funds | ||||||
24 | appropriated to the Illinois Department of Public | ||||||
25 | Health
for breast or cervical cancer screening.
| ||||||
26 | "Medical assistance" under this paragraph 12 shall be |
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1 | identical to the benefits
provided under the State's | ||||||
2 | approved plan under Title XIX of the Social Security
Act. | ||||||
3 | The Department must request federal approval of the | ||||||
4 | coverage under this
paragraph 12 within 30 days after the | ||||||
5 | effective date of this amendatory Act of
the 92nd General | ||||||
6 | Assembly.
| ||||||
7 | In addition to the persons who are eligible for medical | ||||||
8 | assistance pursuant to subparagraphs (1) and (2) of this | ||||||
9 | paragraph 12, and subject to appropriation, any uninsured | ||||||
10 | person as defined by the Department in rules residing in | ||||||
11 | Illinois who is younger than 65 years of age, who has been | ||||||
12 | screened for breast and cervical cancer in accordance with | ||||||
13 | standards and procedures adopted by the Department of | ||||||
14 | Public Health for screening, and who is referred to the | ||||||
15 | Department by the Department of Public Health as being in | ||||||
16 | need of treatment for breast or cervical cancer is eligible | ||||||
17 | for medical assistance benefits that are consistent with | ||||||
18 | the benefits provided to those persons described in | ||||||
19 | subparagraphs (1) and (2). Medical assistance coverage for | ||||||
20 | the persons who are eligible under the preceding sentence | ||||||
21 | is not dependent on federal approval, but federal moneys | ||||||
22 | may be used to pay for services provided under that | ||||||
23 | coverage upon federal approval. | ||||||
24 | 13. Subject to appropriation and to federal approval, | ||||||
25 | persons living with HIV/AIDS who are not otherwise eligible | ||||||
26 | under this Article and who qualify for services covered |
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| |||||||
1 | under Section 5-5.04 as provided by the Illinois Department | ||||||
2 | by rule.
| ||||||
3 | 14. Subject to the availability of funds for this | ||||||
4 | purpose, the Department may provide coverage under this | ||||||
5 | Article to persons who reside in Illinois who are not | ||||||
6 | eligible under any of the preceding paragraphs and who meet | ||||||
7 | the income guidelines of paragraph 2(a) of this Section and | ||||||
8 | (i) have an application for asylum pending before the | ||||||
9 | federal Department of Homeland Security or on appeal before | ||||||
10 | a court of competent jurisdiction and are represented | ||||||
11 | either by counsel or by an advocate accredited by the | ||||||
12 | federal Department of Homeland Security and employed by a | ||||||
13 | not-for-profit organization in regard to that application | ||||||
14 | or appeal, or (ii) are receiving services through a | ||||||
15 | federally funded torture treatment center. Medical | ||||||
16 | coverage under this paragraph 14 may be provided for up to | ||||||
17 | 24 continuous months from the initial eligibility date so | ||||||
18 | long as an individual continues to satisfy the criteria of | ||||||
19 | this paragraph 14. If an individual has an appeal pending | ||||||
20 | regarding an application for asylum before the Department | ||||||
21 | of Homeland Security, eligibility under this paragraph 14 | ||||||
22 | may be extended until a final decision is rendered on the | ||||||
23 | appeal. The Department may adopt rules governing the | ||||||
24 | implementation of this paragraph 14.
| ||||||
25 | 15. Family Care Eligibility. | ||||||
26 | (a) A caretaker relative who is 19 years of age or |
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| |||||||
1 | older when countable income is at or below 185% of the | ||||||
2 | Federal Poverty Level Guidelines, as published | ||||||
3 | annually in the Federal Register, for the appropriate | ||||||
4 | family size. A person may not spend down to become | ||||||
5 | eligible under this paragraph 15. | ||||||
6 | (b) Eligibility shall be reviewed annually. | ||||||
7 | (c) Caretaker relatives enrolled under this | ||||||
8 | paragraph 15 in families with countable income above | ||||||
9 | 150% and at or below 185% of the Federal Poverty Level | ||||||
10 | Guidelines shall be counted as family members and pay | ||||||
11 | premiums as established under the Children's Health | ||||||
12 | Insurance Program Act. | ||||||
13 | (d) Premiums shall be billed by and payable to the | ||||||
14 | Department or its authorized agent, on a monthly basis. | ||||||
15 | (e) The premium due date is the last day of the | ||||||
16 | month preceding the month of coverage. | ||||||
17 | (f) Individuals shall have a grace period through | ||||||
18 | the month of coverage to pay the premium. | ||||||
19 | (g) Failure to pay the full monthly premium by the | ||||||
20 | last day of the grace period shall result in | ||||||
21 | termination of coverage. | ||||||
22 | (h) Partial premium payments shall not be | ||||||
23 | refunded. | ||||||
24 | (i) Following termination of an individual's | ||||||
25 | coverage under this paragraph 15, the following action | ||||||
26 | is required before the individual can be re-enrolled: |
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| |||||||
1 | (1) A new application must be completed and the | ||||||
2 | individual must be determined otherwise eligible. | ||||||
3 | (2) There must be full payment of premiums due | ||||||
4 | under this Code, the Children's Health Insurance | ||||||
5 | Program Act, the Covering ALL KIDS Health | ||||||
6 | Insurance Act, or any other healthcare program | ||||||
7 | administered by the Department for periods in | ||||||
8 | which a premium was owed and not paid for the | ||||||
9 | individual. | ||||||
10 | (3) The first month's premium must be paid if | ||||||
11 | there was an unpaid premium on the date the | ||||||
12 | individual's previous coverage was canceled. | ||||||
13 | The Department is authorized to implement the | ||||||
14 | provisions of this amendatory Act of the 95th General | ||||||
15 | Assembly by adopting the medical assistance rules in effect | ||||||
16 | as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | ||||||
17 | 89 Ill. Admin. Code 120.32 along with only those changes | ||||||
18 | necessary to conform to federal Medicaid requirements, | ||||||
19 | federal laws, and federal regulations, including but not | ||||||
20 | limited to Section 1931 of the Social Security Act (42 | ||||||
21 | U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | ||||||
22 | of Health and Human Services, and the countable income | ||||||
23 | eligibility standard authorized by this paragraph 15. The | ||||||
24 | Department may not otherwise adopt any rule to implement | ||||||
25 | this increase except as authorized by law, to meet the | ||||||
26 | eligibility standards authorized by the federal government |
| |||||||
| |||||||
1 | in the Medicaid State Plan or the Title XXI Plan, or to | ||||||
2 | meet an order from the federal government or any court. | ||||||
3 | 16. 15. Subject to appropriation, uninsured persons | ||||||
4 | who are not otherwise eligible under this Section who have | ||||||
5 | been certified and referred by the Department of Public | ||||||
6 | Health as having been screened and found to need diagnostic | ||||||
7 | evaluation or treatment, or both diagnostic evaluation and | ||||||
8 | treatment, for prostate or testicular cancer. For the | ||||||
9 | purposes of this paragraph 16 15 , uninsured persons are | ||||||
10 | those who do not have creditable coverage, as defined under | ||||||
11 | the Health Insurance Portability and Accountability Act, | ||||||
12 | or have otherwise exhausted any insurance benefits they may | ||||||
13 | have had, for prostate or testicular cancer diagnostic | ||||||
14 | evaluation or treatment, or both diagnostic evaluation and | ||||||
15 | treatment.
To be eligible, a person must furnish a Social | ||||||
16 | Security number.
A person's assets are exempt from | ||||||
17 | consideration in determining eligibility under this | ||||||
18 | paragraph 16 15 .
Such persons shall be eligible for medical | ||||||
19 | assistance under this paragraph 16 15 for so long as they | ||||||
20 | need treatment for the cancer. A person shall be considered | ||||||
21 | to need treatment if, in the opinion of the person's | ||||||
22 | treating physician, the person requires therapy directed | ||||||
23 | toward cure or palliation of prostate or testicular cancer, | ||||||
24 | including recurrent metastatic cancer that is a known or | ||||||
25 | presumed complication of prostate or testicular cancer and | ||||||
26 | complications resulting from the treatment modalities |
| |||||||
| |||||||
1 | themselves. Persons who require only routine monitoring | ||||||
2 | services are not considered to need treatment.
"Medical | ||||||
3 | assistance" under this paragraph 16 15 shall be identical | ||||||
4 | to the benefits provided under the State's approved plan | ||||||
5 | under Title XIX of the Social Security Act.
Notwithstanding | ||||||
6 | any other provision of law, the Department (i) does not | ||||||
7 | have a claim against the estate of a deceased recipient of | ||||||
8 | services under this paragraph 16 15 and (ii) does not have | ||||||
9 | a lien against any homestead property or other legal or | ||||||
10 | equitable real property interest owned by a recipient of | ||||||
11 | services under this paragraph 16 15 . | ||||||
12 | In implementing the provisions of Public Act 96-20 this | ||||||
13 | amendatory Act of the 96th General Assembly , the Department is | ||||||
14 | authorized to adopt only those rules necessary, including | ||||||
15 | emergency rules. Nothing in Public Act 96-20 this amendatory | ||||||
16 | Act of the 96th General Assembly permits the Department to | ||||||
17 | adopt rules or issue a decision that expands eligibility for | ||||||
18 | the FamilyCare Program to a person whose income exceeds 185% of | ||||||
19 | the Federal Poverty Level as determined from time to time by | ||||||
20 | the U.S. Department of Health and Human Services, unless the | ||||||
21 | Department is provided with express statutory authority. | ||||||
22 | The Illinois Department and the Governor shall provide a | ||||||
23 | plan for
coverage of the persons eligible under paragraph 7 as | ||||||
24 | soon as possible after
July 1, 1984.
| ||||||
25 | The eligibility of any such person for medical assistance | ||||||
26 | under this
Article is not affected by the payment of any grant |
| |||||||
| |||||||
1 | under the Senior
Citizens and Disabled Persons Property Tax | ||||||
2 | Relief and Pharmaceutical
Assistance Act or any distributions | ||||||
3 | or items of income described under
subparagraph (X) of
| ||||||
4 | paragraph (2) of subsection (a) of Section 203 of the Illinois | ||||||
5 | Income Tax
Act. The Department shall by rule establish the | ||||||
6 | amounts of
assets to be disregarded in determining eligibility | ||||||
7 | for medical assistance,
which shall at a minimum equal the | ||||||
8 | amounts to be disregarded under the
Federal Supplemental | ||||||
9 | Security Income Program. The amount of assets of a
single | ||||||
10 | person to be disregarded
shall not be less than $2,000, and the | ||||||
11 | amount of assets of a married couple
to be disregarded shall | ||||||
12 | not be less than $3,000.
| ||||||
13 | To the extent permitted under federal law, any person found | ||||||
14 | guilty of a
second violation of Article VIIIA
shall be | ||||||
15 | ineligible for medical assistance under this Article, as | ||||||
16 | provided
in Section 8A-8.
| ||||||
17 | The eligibility of any person for medical assistance under | ||||||
18 | this Article
shall not be affected by the receipt by the person | ||||||
19 | of donations or benefits
from fundraisers held for the person | ||||||
20 | in cases of serious illness,
as long as neither the person nor | ||||||
21 | members of the person's family
have actual control over the | ||||||
22 | donations or benefits or the disbursement
of the donations or | ||||||
23 | benefits.
| ||||||
24 | (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; | ||||||
25 | 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. | ||||||
26 | 8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
|
| |||||||
| |||||||
1 | Section 99. Effective date. This Act takes effect upon | ||||||
2 | becoming law.
|