99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB0985

 

Introduced , by Rep. Michael J. Madigan

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-2  from Ch. 23, par. 5-2

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning the classes of persons eligible for Medicaid.


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A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-2 as follows:
 
6    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
7    Sec. 5-2. Classes of Persons Eligible.
8    Medical assistance under this Article shall be available to
9any of the the following classes of persons in respect to whom
10a plan for coverage has been submitted to the Governor by the
11Illinois Department and approved by him. If changes made in
12this Section 5-2 require federal approval, they shall not take
13effect until such approval has been received:
14        1. Recipients of basic maintenance grants under
15    Articles III and IV.
16        2. Beginning January 1, 2014, persons otherwise
17    eligible for basic maintenance under Article III,
18    excluding any eligibility requirements that are
19    inconsistent with any federal law or federal regulation, as
20    interpreted by the U.S. Department of Health and Human
21    Services, but who fail to qualify thereunder on the basis
22    of need, and who have insufficient income and resources to
23    meet the costs of necessary medical care, including but not

 

 

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1    limited to the following:
2            (a) All persons otherwise eligible for basic
3        maintenance under Article III but who fail to qualify
4        under that Article on the basis of need and who meet
5        either of the following requirements:
6                (i) their income, as determined by the
7            Illinois Department in accordance with any federal
8            requirements, is equal to or less than 100% of the
9            federal poverty level; or
10                (ii) their income, after the deduction of
11            costs incurred for medical care and for other types
12            of remedial care, is equal to or less than 100% of
13            the federal poverty level.
14            (b) (Blank).
15        3. (Blank).
16        4. Persons not eligible under any of the preceding
17    paragraphs who fall sick, are injured, or die, not having
18    sufficient money, property or other resources to meet the
19    costs of necessary medical care or funeral and burial
20    expenses.
21        5.(a) Women during pregnancy and during the 60-day
22    period beginning on the last day of the pregnancy, together
23    with their infants, whose income is at or below 200% of the
24    federal poverty level. Until September 30, 2019, or sooner
25    if the maintenance of effort requirements under the Patient
26    Protection and Affordable Care Act are eliminated or may be

 

 

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1    waived before then, women during pregnancy and during the
2    60-day period beginning on the last day of the pregnancy,
3    whose countable monthly income, after the deduction of
4    costs incurred for medical care and for other types of
5    remedial care as specified in administrative rule, is equal
6    to or less than the Medical Assistance-No Grant(C)
7    (MANG(C)) Income Standard in effect on April 1, 2013 as set
8    forth in administrative rule.
9        (b) The plan for coverage shall provide ambulatory
10    prenatal care to pregnant women during a presumptive
11    eligibility period and establish an income eligibility
12    standard that is equal to 200% of the federal poverty
13    level, provided that costs incurred for medical care are
14    not taken into account in determining such income
15    eligibility.
16        (c) The Illinois Department may conduct a
17    demonstration in at least one county that will provide
18    medical assistance to pregnant women, together with their
19    infants and children up to one year of age, where the
20    income eligibility standard is set up to 185% of the
21    nonfarm income official poverty line, as defined by the
22    federal Office of Management and Budget. The Illinois
23    Department shall seek and obtain necessary authorization
24    provided under federal law to implement such a
25    demonstration. Such demonstration may establish resource
26    standards that are not more restrictive than those

 

 

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1    established under Article IV of this Code.
2        6. (a) Children younger than age 19 when countable
3    income is at or below 133% of the federal poverty level.
4    Until September 30, 2019, or sooner if the maintenance of
5    effort requirements under the Patient Protection and
6    Affordable Care Act are eliminated or may be waived before
7    then, children younger than age 19 whose countable monthly
8    income, after the deduction of costs incurred for medical
9    care and for other types of remedial care as specified in
10    administrative rule, is equal to or less than the Medical
11    Assistance-No Grant(C) (MANG(C)) Income Standard in effect
12    on April 1, 2013 as set forth in administrative rule.
13        (b) Children and youth who are under temporary custody
14    or guardianship of the Department of Children and Family
15    Services or who receive financial assistance in support of
16    an adoption or guardianship placement from the Department
17    of Children and Family Services.
18        7. (Blank).
19        8. As required under federal law, persons who are
20    eligible for Transitional Medical Assistance as a result of
21    an increase in earnings or child or spousal support
22    received. The plan for coverage for this class of persons
23    shall:
24            (a) extend the medical assistance coverage to the
25        extent required by federal law; and
26            (b) offer persons who have initially received 6

 

 

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1        months of the coverage provided in paragraph (a) above,
2        the option of receiving an additional 6 months of
3        coverage, subject to the following:
4                (i) such coverage shall be pursuant to
5            provisions of the federal Social Security Act;
6                (ii) such coverage shall include all services
7            covered under Illinois' State Medicaid Plan;
8                (iii) no premium shall be charged for such
9            coverage; and
10                (iv) such coverage shall be suspended in the
11            event of a person's failure without good cause to
12            file in a timely fashion reports required for this
13            coverage under the Social Security Act and
14            coverage shall be reinstated upon the filing of
15            such reports if the person remains otherwise
16            eligible.
17        9. Persons with acquired immunodeficiency syndrome
18    (AIDS) or with AIDS-related conditions with respect to whom
19    there has been a determination that but for home or
20    community-based services such individuals would require
21    the level of care provided in an inpatient hospital,
22    skilled nursing facility or intermediate care facility the
23    cost of which is reimbursed under this Article. Assistance
24    shall be provided to such persons to the maximum extent
25    permitted under Title XIX of the Federal Social Security
26    Act.

 

 

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1        10. Participants in the long-term care insurance
2    partnership program established under the Illinois
3    Long-Term Care Partnership Program Act who meet the
4    qualifications for protection of resources described in
5    Section 15 of that Act.
6        11. Persons with disabilities who are employed and
7    eligible for Medicaid, pursuant to Section
8    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
9    subject to federal approval, persons with a medically
10    improved disability who are employed and eligible for
11    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
12    the Social Security Act, as provided by the Illinois
13    Department by rule. In establishing eligibility standards
14    under this paragraph 11, the Department shall, subject to
15    federal approval:
16            (a) set the income eligibility standard at not
17        lower than 350% of the federal poverty level;
18            (b) exempt retirement accounts that the person
19        cannot access without penalty before the age of 59 1/2,
20        and medical savings accounts established pursuant to
21        26 U.S.C. 220;
22            (c) allow non-exempt assets up to $25,000 as to
23        those assets accumulated during periods of eligibility
24        under this paragraph 11; and
25            (d) continue to apply subparagraphs (b) and (c) in
26        determining the eligibility of the person under this

 

 

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1        Article even if the person loses eligibility under this
2        paragraph 11.
3        12. Subject to federal approval, persons who are
4    eligible for medical assistance coverage under applicable
5    provisions of the federal Social Security Act and the
6    federal Breast and Cervical Cancer Prevention and
7    Treatment Act of 2000. Those eligible persons are defined
8    to include, but not be limited to, the following persons:
9            (1) persons who have been screened for breast or
10        cervical cancer under the U.S. Centers for Disease
11        Control and Prevention Breast and Cervical Cancer
12        Program established under Title XV of the federal
13        Public Health Services Act in accordance with the
14        requirements of Section 1504 of that Act as
15        administered by the Illinois Department of Public
16        Health; and
17            (2) persons whose screenings under the above
18        program were funded in whole or in part by funds
19        appropriated to the Illinois Department of Public
20        Health for breast or cervical cancer screening.
21        "Medical assistance" under this paragraph 12 shall be
22    identical to the benefits provided under the State's
23    approved plan under Title XIX of the Social Security Act.
24    The Department must request federal approval of the
25    coverage under this paragraph 12 within 30 days after the
26    effective date of this amendatory Act of the 92nd General

 

 

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1    Assembly.
2        In addition to the persons who are eligible for medical
3    assistance pursuant to subparagraphs (1) and (2) of this
4    paragraph 12, and to be paid from funds appropriated to the
5    Department for its medical programs, any uninsured person
6    as defined by the Department in rules residing in Illinois
7    who is younger than 65 years of age, who has been screened
8    for breast and cervical cancer in accordance with standards
9    and procedures adopted by the Department of Public Health
10    for screening, and who is referred to the Department by the
11    Department of Public Health as being in need of treatment
12    for breast or cervical cancer is eligible for medical
13    assistance benefits that are consistent with the benefits
14    provided to those persons described in subparagraphs (1)
15    and (2). Medical assistance coverage for the persons who
16    are eligible under the preceding sentence is not dependent
17    on federal approval, but federal moneys may be used to pay
18    for services provided under that coverage upon federal
19    approval.
20        13. Subject to appropriation and to federal approval,
21    persons living with HIV/AIDS who are not otherwise eligible
22    under this Article and who qualify for services covered
23    under Section 5-5.04 as provided by the Illinois Department
24    by rule.
25        14. Subject to the availability of funds for this
26    purpose, the Department may provide coverage under this

 

 

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1    Article to persons who reside in Illinois who are not
2    eligible under any of the preceding paragraphs and who meet
3    the income guidelines of paragraph 2(a) of this Section and
4    (i) have an application for asylum pending before the
5    federal Department of Homeland Security or on appeal before
6    a court of competent jurisdiction and are represented
7    either by counsel or by an advocate accredited by the
8    federal Department of Homeland Security and employed by a
9    not-for-profit organization in regard to that application
10    or appeal, or (ii) are receiving services through a
11    federally funded torture treatment center. Medical
12    coverage under this paragraph 14 may be provided for up to
13    24 continuous months from the initial eligibility date so
14    long as an individual continues to satisfy the criteria of
15    this paragraph 14. If an individual has an appeal pending
16    regarding an application for asylum before the Department
17    of Homeland Security, eligibility under this paragraph 14
18    may be extended until a final decision is rendered on the
19    appeal. The Department may adopt rules governing the
20    implementation of this paragraph 14.
21        15. Family Care Eligibility.
22            (a) On and after July 1, 2012, a parent or other
23        caretaker relative who is 19 years of age or older when
24        countable income is at or below 133% of the federal
25        poverty level. A person may not spend down to become
26        eligible under this paragraph 15.

 

 

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1            (b) Eligibility shall be reviewed annually.
2            (c) (Blank).
3            (d) (Blank).
4            (e) (Blank).
5            (f) (Blank).
6            (g) (Blank).
7            (h) (Blank).
8            (i) Following termination of an individual's
9        coverage under this paragraph 15, the individual must
10        be determined eligible before the person can be
11        re-enrolled.
12        16. Subject to appropriation, uninsured persons who
13    are not otherwise eligible under this Section who have been
14    certified and referred by the Department of Public Health
15    as having been screened and found to need diagnostic
16    evaluation or treatment, or both diagnostic evaluation and
17    treatment, for prostate or testicular cancer. For the
18    purposes of this paragraph 16, uninsured persons are those
19    who do not have creditable coverage, as defined under the
20    Health Insurance Portability and Accountability Act, or
21    have otherwise exhausted any insurance benefits they may
22    have had, for prostate or testicular cancer diagnostic
23    evaluation or treatment, or both diagnostic evaluation and
24    treatment. To be eligible, a person must furnish a Social
25    Security number. A person's assets are exempt from
26    consideration in determining eligibility under this

 

 

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1    paragraph 16. Such persons shall be eligible for medical
2    assistance under this paragraph 16 for so long as they need
3    treatment for the cancer. A person shall be considered to
4    need treatment if, in the opinion of the person's treating
5    physician, the person requires therapy directed toward
6    cure or palliation of prostate or testicular cancer,
7    including recurrent metastatic cancer that is a known or
8    presumed complication of prostate or testicular cancer and
9    complications resulting from the treatment modalities
10    themselves. Persons who require only routine monitoring
11    services are not considered to need treatment. "Medical
12    assistance" under this paragraph 16 shall be identical to
13    the benefits provided under the State's approved plan under
14    Title XIX of the Social Security Act. Notwithstanding any
15    other provision of law, the Department (i) does not have a
16    claim against the estate of a deceased recipient of
17    services under this paragraph 16 and (ii) does not have a
18    lien against any homestead property or other legal or
19    equitable real property interest owned by a recipient of
20    services under this paragraph 16.
21        17. Persons who, pursuant to a waiver approved by the
22    Secretary of the U.S. Department of Health and Human
23    Services, are eligible for medical assistance under Title
24    XIX or XXI of the federal Social Security Act.
25    Notwithstanding any other provision of this Code and
26    consistent with the terms of the approved waiver, the

 

 

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1    Illinois Department, may by rule:
2            (a) Limit the geographic areas in which the waiver
3        program operates.
4            (b) Determine the scope, quantity, duration, and
5        quality, and the rate and method of reimbursement, of
6        the medical services to be provided, which may differ
7        from those for other classes of persons eligible for
8        assistance under this Article.
9            (c) Restrict the persons' freedom in choice of
10        providers.
11        18. Beginning January 1, 2014, persons aged 19 or
12    older, but younger than 65, who are not otherwise eligible
13    for medical assistance under this Section 5-2, who qualify
14    for medical assistance pursuant to 42 U.S.C.
15    1396a(a)(10)(A)(i)(VIII) and applicable federal
16    regulations, and who have income at or below 133% of the
17    federal poverty level plus 5% for the applicable family
18    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
19    applicable federal regulations. Persons eligible for
20    medical assistance under this paragraph 18 shall receive
21    coverage for the Health Benefits Service Package as that
22    term is defined in subsection (m) of Section 5-1.1 of this
23    Code. If Illinois' federal medical assistance percentage
24    (FMAP) is reduced below 90% for persons eligible for
25    medical assistance under this paragraph 18, eligibility
26    under this paragraph 18 shall cease no later than the end

 

 

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1    of the third month following the month in which the
2    reduction in FMAP takes effect.
3        19. Beginning January 1, 2014, as required under 42
4    U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
5    and younger than age 26 who are not otherwise eligible for
6    medical assistance under paragraphs (1) through (17) of
7    this Section who (i) were in foster care under the
8    responsibility of the State on the date of attaining age 18
9    or on the date of attaining age 21 when a court has
10    continued wardship for good cause as provided in Section
11    2-31 of the Juvenile Court Act of 1987 and (ii) received
12    medical assistance under the Illinois Title XIX State Plan
13    or waiver of such plan while in foster care.
14    In implementing the provisions of Public Act 96-20, the
15Department is authorized to adopt only those rules necessary,
16including emergency rules. Nothing in Public Act 96-20 permits
17the Department to adopt rules or issue a decision that expands
18eligibility for the FamilyCare Program to a person whose income
19exceeds 185% of the Federal Poverty Level as determined from
20time to time by the U.S. Department of Health and Human
21Services, unless the Department is provided with express
22statutory authority.
23    The eligibility of any such person for medical assistance
24under this Article is not affected by the payment of any grant
25under the Senior Citizens and Disabled Persons Property Tax
26Relief Act or any distributions or items of income described

 

 

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1under subparagraph (X) of paragraph (2) of subsection (a) of
2Section 203 of the Illinois Income Tax Act.
3    The Department shall by rule establish the amounts of
4assets to be disregarded in determining eligibility for medical
5assistance, which shall at a minimum equal the amounts to be
6disregarded under the Federal Supplemental Security Income
7Program. The amount of assets of a single person to be
8disregarded shall not be less than $2,000, and the amount of
9assets of a married couple to be disregarded shall not be less
10than $3,000.
11    To the extent permitted under federal law, any person found
12guilty of a second violation of Article VIIIA shall be
13ineligible for medical assistance under this Article, as
14provided in Section 8A-8.
15    The eligibility of any person for medical assistance under
16this Article shall not be affected by the receipt by the person
17of donations or benefits from fundraisers held for the person
18in cases of serious illness, as long as neither the person nor
19members of the person's family have actual control over the
20donations or benefits or the disbursement of the donations or
21benefits.
22    Notwithstanding any other provision of this Code, if the
23United States Supreme Court holds Title II, Subtitle A, Section
242001(a) of Public Law 111-148 to be unconstitutional, or if a
25holding of Public Law 111-148 makes Medicaid eligibility
26allowed under Section 2001(a) inoperable, the State or a unit

 

 

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1of local government shall be prohibited from enrolling
2individuals in the Medical Assistance Program as the result of
3federal approval of a State Medicaid waiver on or after the
4effective date of this amendatory Act of the 97th General
5Assembly, and any individuals enrolled in the Medical
6Assistance Program pursuant to eligibility permitted as a
7result of such a State Medicaid waiver shall become immediately
8ineligible.
9    Notwithstanding any other provision of this Code, if an Act
10of Congress that becomes a Public Law eliminates Section
112001(a) of Public Law 111-148, the State or a unit of local
12government shall be prohibited from enrolling individuals in
13the Medical Assistance Program as the result of federal
14approval of a State Medicaid waiver on or after the effective
15date of this amendatory Act of the 97th General Assembly, and
16any individuals enrolled in the Medical Assistance Program
17pursuant to eligibility permitted as a result of such a State
18Medicaid waiver shall become immediately ineligible.
19    Effective October 1, 2013, the determination of
20eligibility of persons who qualify under paragraphs 5, 6, 8,
2115, 17, and 18 of this Section shall comply with the
22requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
23regulations.
24    The Department of Healthcare and Family Services, the
25Department of Human Services, and the Illinois health insurance
26marketplace shall work cooperatively to assist persons who

 

 

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1would otherwise lose health benefits as a result of changes
2made under this amendatory Act of the 98th General Assembly to
3transition to other health insurance coverage.
4(Source: P.A. 97-48, eff. 6-28-11; 97-74, eff. 6-30-11; 97-333,
5eff. 8-12-11; 97-687, eff. 6-14-12; 97-689, eff. 6-14-12;
697-813, eff. 7-13-12; 98-104, eff. 7-22-13; 98-463, eff.
78-16-13.)