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1 | AN ACT concerning insurance.
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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 Children's Health Insurance Program Act is | |||||||||||||||||||||
5 | amended by changing Section 20 as follows:
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6 | (215 ILCS 106/20)
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7 | Sec. 20. Eligibility.
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8 | (a) To be eligible for this Program, a person must be a | |||||||||||||||||||||
9 | person who
has a child eligible under this Act and who is | |||||||||||||||||||||
10 | eligible under a waiver
of federal requirements pursuant to an | |||||||||||||||||||||
11 | application made pursuant to
subdivision (a)(1) of Section 40 | |||||||||||||||||||||
12 | of this Act or who is a child who:
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13 | (1) is a child who is not eligible for medical | |||||||||||||||||||||
14 | assistance;
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15 | (2) is a child whose annual household income, as | |||||||||||||||||||||
16 | determined by the
Department, is above 133% of the federal | |||||||||||||||||||||
17 | poverty level and at or below
200%
of the federal poverty | |||||||||||||||||||||
18 | level;
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19 | (3) is a resident of the State of Illinois; and
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20 | (4) is a child who is either a United States citizen or | |||||||||||||||||||||
21 | included in one
of the following categories of | |||||||||||||||||||||
22 | non-citizens:
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23 | (A) unmarried dependent children of either a |
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1 | United States Veteran
honorably discharged or a person | ||||||
2 | on active military duty;
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3 | (B) refugees under Section 207 of the Immigration | ||||||
4 | and
Nationality Act;
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5 | (C) asylees under Section 208 of the Immigration | ||||||
6 | and
Nationality Act;
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7 | (D) persons for whom deportation has been withheld | ||||||
8 | under
Section 243(h) of the Immigration and | ||||||
9 | Nationality Act;
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10 | (E) persons granted conditional entry under | ||||||
11 | Section 203(a)(7) of the
Immigration and Nationality | ||||||
12 | Act as in effect prior to April 1, 1980;
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13 | (F) persons lawfully admitted for permanent | ||||||
14 | residence under
the Immigration and Nationality Act; | ||||||
15 | and
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16 | (G) parolees, for at least one year, under Section | ||||||
17 | 212(d)(5)
of the Immigration and Nationality Act ; and .
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18 | (5) is a child whose household assets do not exceed an | ||||||
19 | amount equal to 400% of the federal poverty guidelines for | ||||||
20 | a family of one, excluding (i) the value of the residence | ||||||
21 | in which the child lives and (ii) the value of a vehicle | ||||||
22 | used by the household for transportation purposes. | ||||||
23 | Those children who are in the categories set forth in | ||||||
24 | subdivisions
(4)(F) and (4)(G) of this subsection (a) , who | ||||||
25 | enter the United States on or
after August 22, 1996, shall not | ||||||
26 | be eligible for 5 years beginning on the
date the child entered |
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1 | the United States.
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2 | (b) A child who is determined to be eligible for assistance | ||||||
3 | may remain
eligible for 12 months, provided the child maintains | ||||||
4 | his or
her residence in the State, has not yet attained 19 | ||||||
5 | years of age, and is not
excluded pursuant to subsection (c). A | ||||||
6 | child who has been determined to
be eligible for assistance | ||||||
7 | must reapply or otherwise establish eligibility
at least | ||||||
8 | annually.
An eligible child shall be required, as determined by | ||||||
9 | the
Department by rule, to report promptly those changes in | ||||||
10 | income and other
circumstances that affect eligibility. The | ||||||
11 | eligibility of a child may be
redetermined based on the | ||||||
12 | information reported or may be terminated based on
the failure | ||||||
13 | to report or failure to report accurately. A child's | ||||||
14 | responsible
relative or caretaker may also be held liable to | ||||||
15 | the Department for any
payments made by the Department on such | ||||||
16 | child's behalf that were inappropriate.
An applicant shall be | ||||||
17 | provided with notice of these obligations.
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18 | (c) A child shall not be eligible for coverage under this | ||||||
19 | Program if:
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20 | (1) the premium required pursuant to
Section 30 of this | ||||||
21 | Act has not been paid. If the
required premiums are not | ||||||
22 | paid the liability of the Program
shall be limited to | ||||||
23 | benefits incurred under the
Program for the time period for | ||||||
24 | which premiums had been paid. If
the required monthly | ||||||
25 | premium is not paid, the child shall be ineligible for
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26 | re-enrollment for a minimum period of 3 months. |
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1 | Re-enrollment shall be
completed prior to the next covered | ||||||
2 | medical visit and the first month's
required premium shall | ||||||
3 | be paid in advance of the next covered medical visit.
The | ||||||
4 | Department shall promulgate rules regarding grace periods, | ||||||
5 | notice
requirements, and hearing procedures pursuant to | ||||||
6 | this subsection;
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7 | (2) the child is an inmate of a public institution or a | ||||||
8 | patient in an
institution for mental diseases; or
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9 | (3) the child is a member of a family that is eligible | ||||||
10 | for health benefits
covered under the State of Illinois | ||||||
11 | health benefits plan on the basis of a
member's employment | ||||||
12 | with a public agency.
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13 | (Source: P.A. 92-597, eff. 6-28-02; 93-63, eff. 6-30-03.)
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14 | Section 10. The Covering ALL KIDS Health Insurance Act is | ||||||
15 | amended by changing Section 20 as follows: | ||||||
16 | (215 ILCS 170/20) | ||||||
17 | (Section scheduled to be repealed on July 1, 2011)
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18 | Sec. 20. Eligibility. | ||||||
19 | (a) To be eligible for the Program, a person must be a | ||||||
20 | child:
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21 | (1) who is a resident of the State of Illinois; and
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22 | (2) who is ineligible for medical assistance under the | ||||||
23 | Illinois Public Aid Code or benefits under the Children's | ||||||
24 | Health Insurance Program Act; and
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1 | (3) either (i) who has been without health insurance | ||||||
2 | coverage for a period set forth by the Department in rules, | ||||||
3 | but not less than 6 months during the first month of | ||||||
4 | operation of the Program, 7 months during the second month | ||||||
5 | of operation, 8 months during the third month of operation, | ||||||
6 | 9 months during the fourth month of operation, 10 months | ||||||
7 | during the fifth month of operation, 11 months during the | ||||||
8 | sixth month of operation, and 12 months thereafter, (ii) | ||||||
9 | whose parent has lost employment that made available | ||||||
10 | affordable dependent health insurance coverage, until such | ||||||
11 | time as affordable employer-sponsored dependent health | ||||||
12 | insurance coverage is again available for the child as set | ||||||
13 | forth by the Department in rules, (iii) who is a newborn | ||||||
14 | whose responsible relative does not have available | ||||||
15 | affordable private or employer-sponsored health insurance, | ||||||
16 | or (iv) who, within one year of applying for coverage under | ||||||
17 | this Act, lost medical benefits under the Illinois Public | ||||||
18 | Aid Code or the Children's Health Insurance Program Act ; | ||||||
19 | and . | ||||||
20 | (4) whose household assets do not exceed an amount | ||||||
21 | equal to 400% of the federal poverty guidelines for a | ||||||
22 | family of one, excluding (i) the value of the residence in | ||||||
23 | which the child lives and (ii) the value of a vehicle used | ||||||
24 | by the household for transportation purposes. | ||||||
25 | An entity that provides health insurance coverage (as | ||||||
26 | defined in Section 2 of the Comprehensive Health Insurance Plan |
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1 | Act) to Illinois residents shall provide health insurance data | ||||||
2 | match to the Department of Healthcare and Family Services for | ||||||
3 | the purpose of determining eligibility for the Program under | ||||||
4 | this Act. | ||||||
5 | The Department of Healthcare and Family Services, in | ||||||
6 | collaboration with the Department of Financial and | ||||||
7 | Professional Regulation, Division of Insurance, shall adopt | ||||||
8 | rules governing the exchange of information under this Section. | ||||||
9 | The rules shall be consistent with all laws relating to the | ||||||
10 | confidentiality or privacy of personal information or medical | ||||||
11 | records, including provisions under the Federal Health | ||||||
12 | Insurance Portability and Accountability Act (HIPAA). | ||||||
13 | (b) The Department shall monitor the availability and | ||||||
14 | retention of employer-sponsored dependent health insurance | ||||||
15 | coverage and shall modify the period described in subdivision | ||||||
16 | (a)(3) if necessary to promote retention of private or | ||||||
17 | employer-sponsored health insurance and timely access to | ||||||
18 | healthcare services, but at no time shall the period described | ||||||
19 | in subdivision (a)(3) be less than 6 months.
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20 | (c) The Department, at its discretion, may take into | ||||||
21 | account the affordability of dependent health insurance when | ||||||
22 | determining whether employer-sponsored dependent health | ||||||
23 | insurance coverage is available upon reemployment of a child's | ||||||
24 | parent as provided in subdivision (a)(3). | ||||||
25 | (d) A child who is determined to be eligible for the | ||||||
26 | Program shall remain eligible for 12 months, provided that the |
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1 | child maintains his or her residence in this State, has not yet | ||||||
2 | attained 19 years of age, and is not excluded under subsection | ||||||
3 | (e). | ||||||
4 | (e) A child is not eligible for coverage under the Program | ||||||
5 | if: | ||||||
6 | (1) the premium required under Section 40 has not been | ||||||
7 | timely paid; if the required premiums are not paid, the | ||||||
8 | liability of the Program shall be limited to benefits | ||||||
9 | incurred under the Program for the time period for which | ||||||
10 | premiums have been paid; if the required monthly premium is | ||||||
11 | not paid, the child is ineligible for re-enrollment for a | ||||||
12 | minimum period of 3 months; re-enrollment shall be | ||||||
13 | completed before the next covered medical visit, and the | ||||||
14 | first month's required premium shall be paid in advance of | ||||||
15 | the next covered medical visit; or | ||||||
16 | (2) the child is an inmate of a public institution or | ||||||
17 | an institution for mental diseases.
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18 | (f) The Department shall adopt eligibility rules, | ||||||
19 | including, but not limited to: rules regarding annual renewals | ||||||
20 | of eligibility for the Program; rules providing for | ||||||
21 | re-enrollment, grace periods, notice requirements, and hearing | ||||||
22 | procedures under subdivision (e)(1) of this Section; and rules | ||||||
23 | regarding what constitutes availability and affordability of | ||||||
24 | private or employer-sponsored health insurance, with | ||||||
25 | consideration of such factors as the percentage of income | ||||||
26 | needed to purchase children or family health insurance, the |
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1 | availability of employer subsidies, and other relevant | ||||||
2 | factors.
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3 | (Source: P.A. 94-693, eff. 7-1-06 .)
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4 | Section 99. Effective date. This Act takes effect January | ||||||
5 | 1, 2011.
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