SB1855 96TH GENERAL ASSEMBLY

LRB096 05702 DRJ 15768 b

96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
SB1855

Introduced 2/20/2009, by Sen. Jeffrey M. Schoenberg

SYNOPSIS AS INTRODUCED:

305 ILCS 5/Art. V-F heading new
305 ILCS 5/5F-5 new
305 ILCS 5/5F-10 new
305 ILCS 5/5F-15 new
305 ILCS 5/5F-20 new
305 ILCS 5/6-11	from Ch. 23, par. 6-11

Amends the Illinois Public Aid Code. Provides for medical assistance eligibility for persons who are: (i) age 50 through 64, or age 19 through 50 and meet certain requirements in connection with the Supplemental Security Income (SSI) program; (ii) have no medical insurance coverage; and (iii) have countable income equal to or less than 100% of the federal poverty income guidelines. Provides that these persons may be required to choose a medical home and a primary care provider. Provides that medical assistance under these provisions shall be identical to the benefits provided under the State's approved Medicaid plan, except that long-term care services shall not be covered. Requires the Department of Healthcare and Family Services to seek to maximize federal financial assistance. Effective January 1, 2010.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

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 6-11 and by adding the heading of Article V-F and Sections 5F-5, 5F-10, 5F-15, and 5F-20 as follows:

(305 ILCS 5/Art. V-F heading new)

ARTICLE V-F. ACCESS TO MEDICAL ASSISTANCE

(305 ILCS 5/5F-5 new)

Sec. 5F-5. Purpose of Article. The purpose of this Article V-F is to provide medical assistance to or in behalf of any person who meets the eligibility conditions set forth in this Article.

(305 ILCS 5/5F-10 new)

Sec. 5F-10. Eligibility.

(a) Any person who is not otherwise eligible for medical assistance under this Code shall be eligible for medical assistance under this Article if he or she meets all of the following criteria:

(1) He or she is either:

(A) at least 50 years of age and not older than 64 years of age; or

(B) at least 19 years of age and not older than 50 years of age, has applied for federal Supplemental Security Income (SSI), has been determined by the Department of Healthcare and Family Services to be probably eligible for SSI on the basis of disability, and has not received a final administrative decision from the federal Social Security Administration on the most recently filed application for SSI that he or she is not disabled.

(2) He or she has no medical insurance coverage at the time of application for medical assistance.

(3) He or she has countable income that is equal to or less than 100% of the federal poverty income guidelines as updated periodically in the Federal Register by the U.S. Department of Health and Human Services. A person's countable income shall be determined using the methodology used to determine countable income under paragraph 1(a)(i) of Section 5-2 that is in effect on the effective date of this amendatory Act of the 96th General Assembly.

(b) Notwithstanding any other provisions of this Code, eligible non-citizens, as defined in Section 1-11, may qualify for medical assistance under this Article regardless of when they entered the United States.

(305 ILCS 5/5F-15 new)

Sec. 5F-15. Scope of coverage. The Department of Healthcare and Family Services may require that persons enrolled under this Article choose a medical home and a primary care provider. Medical assistance under this Article shall be identical to the benefits provided under the State's approved plan under Title XIX of the Social Security Act, except that long-term care services shall not be covered. For services provided to persons for whom federal matching funds are not available, the Department may establish rates of reimbursement for, and make payments to, providers that are owned or operated by a State agency, a State university, or a county with a population of 3,000,000 or more that differ from rates otherwise established under this Code.

(305 ILCS 5/5F-20 new)

Sec. 5F-20. Maximization of federal assistance. The Department of Healthcare and Family Services shall undertake all efforts to secure federal matching funds for the costs of coverage under this Article, including, but not limited to, requiring that all enrollees under this Article apply for all federal benefits for which they may be entitled, including Supplemental Security Income.

(305 ILCS 5/6-11) (from Ch. 23, par. 6-11)

Sec. 6-11. State funded General Assistance.

(a) Effective July 1, 1992, all State funded General Assistance and related medical benefits shall be governed by this Section, except that medical assistance for individuals eligible under Article V-F of this Code shall be governed by that Article. Other parts of this Code or other laws related to General Assistance shall remain in effect to the extent they do not conflict with the provisions of this Section. If any other part of this Code or other laws of this State conflict with the provisions of this Section, the provisions of this Section shall control.

(b) State funded General Assistance shall consist of 2 separate programs. One program shall be for adults with no children and shall be known as State Transitional Assistance. The other program shall be for families with children and for pregnant women and shall be known as State Family and Children Assistance.

(c) (1) To be eligible for State Transitional Assistance on or after July 1, 1992, an individual must be ineligible for assistance under any other Article of this Code, must be determined chronically needy, and must be one of the following:

(A) age 18 or over or

(B) married and living with a spouse, regardless of age.

(2) The Illinois Department or the local governmental unit shall determine whether individuals are chronically needy as follows:

(A) Individuals who have applied for Supplemental Security Income (SSI) and are awaiting a decision on eligibility for SSI who are determined disabled by the Illinois Department using the SSI standard shall be considered chronically needy, except that individuals whose disability is based solely on substance addictions (drug abuse and alcoholism) and whose disability would cease were their addictions to end shall be eligible only for medical assistance and shall not be eligible for cash assistance under the State Transitional Assistance program.

(B) If an individual has been denied SSI due to a finding of "not disabled" (either at the Administrative Law Judge level or above, or at a lower level if that determination was not appealed), the Illinois Department shall adopt that finding and the individual shall not be eligible for State Transitional Assistance or any related medical benefits. Such an individual may not be determined disabled by the Illinois Department for a period of 12 months, unless the individual shows that there has been a substantial change in his or her medical condition or that there has been a substantial change in other factors, such as age or work experience, that might change the determination of disability.

(C) The Illinois Department, by rule, may specify other categories of individuals as chronically needy; nothing in this Section, however, shall be deemed to require the inclusion of any specific category other than as specified in paragraphs (A) and (B).

(3) For individuals in State Transitional Assistance who are not eligible for medical assistance under Article V-F of this Code, medical assistance shall be provided in an amount and nature determined by the Department of Healthcare and Family Services by rule. The amount and nature of medical assistance provided need not be the same as that provided under paragraph (4) of subsection (d) of this Section, and nothing in this paragraph (3) shall be construed to require the coverage of any particular medical service. In addition, the amount and nature of medical assistance provided may be different for different categories of individuals determined chronically needy.

(4) The Illinois Department shall determine, by rule, those assistance recipients under Article VI who shall be subject to employment, training, or education programs including Earnfare, the content of those programs, and the penalties for failure to cooperate in those programs.

(5) The Illinois Department shall, by rule, establish further eligibility requirements, including but not limited to residence, need, and the level of payments.

(d) (1) To be eligible for State Family and Children Assistance, a family unit must be ineligible for assistance under any other Article of this Code and must contain a child who is:

(A) under age 18 or

(B) age 18 and a full-time student in a secondary school or the equivalent level of vocational or technical training, and who may reasonably be expected to complete the program before reaching age 19.

Those children shall be eligible for State Family and Children Assistance.

(2) The natural or adoptive parents of the child living in the same household may be eligible for State Family and Children Assistance.

(3) A pregnant woman whose pregnancy has been verified shall be eligible for income maintenance assistance under the State Family and Children Assistance program.

(4) The amount and nature of medical assistance provided under the State Family and Children Assistance program shall be determined by the Department of Healthcare and Family Services by rule. The amount and nature of medical assistance provided need not be the same as that provided under paragraph (3) of subsection (c) of this Section, and nothing in this paragraph (4) shall be construed to require the coverage of any particular medical service.

(5) The Illinois Department shall, by rule, establish further eligibility requirements, including but not limited to residence, need, and the level of payments.

(e) A local governmental unit that chooses to participate in a General Assistance program under this Section shall provide funding in accordance with Section 12-21.13 of this Act. Local governmental funds used to qualify for State funding may only be expended for clients eligible for assistance under this Section 6-11 and related administrative expenses.

(f) In order to qualify for State funding under this Section, a local governmental unit shall be subject to the supervision and the rules and regulations of the Illinois Department.

(g) Notwithstanding any other provision in this Code, the Illinois Department is authorized to reduce payment levels used to determine cash grants provided to recipients of State Transitional Assistance at any time within a Fiscal Year in order to ensure that cash benefits for State Transitional Assistance do not exceed the amounts appropriated for those cash benefits. Changes in payment levels may be accomplished by emergency rule under Section 5-45 of the Illinois Administrative Procedure Act, except that the limitation on the number of emergency rules that may be adopted in a 24-month period shall not apply and the provisions of Sections 5-115 and 5-125 of the Illinois Administrative Procedure Act shall not apply. This provision shall also be applicable to any reduction in payment levels made upon implementation of this amendatory Act of 1995.

(Source: P.A. 95-331, eff. 8-21-07.)

Section 99. Effective date. This Act takes effect January 1, 2010.