Sen. Terry Link

Filed: 4/2/2008

 

 


 

 


 
09500HB0315sam007 LRB095 04658 DRJ 48809 a

1
AMENDMENT TO HOUSE BILL 315

2     AMENDMENT NO. ______. Amend House Bill 315, AS AMENDED, by
3 replacing everything after the enacting clause with the
4 following:
 
5     "Section 5. If and only if House Bill 473 and House Bill
6 3860 of the 95th General Assembly become law, the Illinois
7 Public Aid Code is amended by changing Section 5-2 as follows:
 
8     (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
9     Sec. 5-2. Classes of Persons Eligible. Medical assistance
10 under this Article shall be available to any of the following
11 classes of persons in respect to whom a plan for coverage has
12 been submitted to the Governor by the Illinois Department and
13 approved by him:
14         1. Recipients of basic maintenance grants under
15     Articles III and IV.
16         2. Persons otherwise eligible for basic maintenance

 

 

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1     under Articles III and IV but who fail to qualify
2     thereunder on the basis of need, and who have insufficient
3     income and resources to meet the costs of necessary medical
4     care, including but not limited to the following:
5             (a) All persons otherwise eligible for basic
6         maintenance under Article III but who fail to qualify
7         under that Article on the basis of need and who meet
8         either of the following requirements:
9                 (i) their income, as determined by the
10             Illinois Department in accordance with any federal
11             requirements, is equal to or less than 70% in
12             fiscal year 2001, equal to or less than 85% in
13             fiscal year 2002 and until a date to be determined
14             by the Department by rule, and equal to or less
15             than 100% beginning on the date determined by the
16             Department by rule, of the nonfarm income official
17             poverty line, as defined by the federal Office of
18             Management and Budget and revised annually in
19             accordance with Section 673(2) of the Omnibus
20             Budget Reconciliation Act of 1981, applicable to
21             families of the same size; or
22                 (ii) their income, after the deduction of
23             costs incurred for medical care and for other types
24             of remedial care, is equal to or less than 70% in
25             fiscal year 2001, equal to or less than 85% in
26             fiscal year 2002 and until a date to be determined

 

 

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1             by the Department by rule, and equal to or less
2             than 100% beginning on the date determined by the
3             Department by rule, of the nonfarm income official
4             poverty line, as defined in item (i) of this
5             subparagraph (a).
6             (b) All persons who would be determined eligible
7         for such basic maintenance under Article IV by
8         disregarding the maximum earned income permitted by
9         federal law.
10         3. Persons who would otherwise qualify for Aid to the
11     Medically Indigent under Article VII.
12         4. Persons not eligible under any of the preceding
13     paragraphs who fall sick, are injured, or die, not having
14     sufficient money, property or other resources to meet the
15     costs of necessary medical care or funeral and burial
16     expenses.
17         5.(a) Women during pregnancy, after the fact of
18     pregnancy has been determined by medical diagnosis, and
19     during the 60-day period beginning on the last day of the
20     pregnancy, together with their infants and children born
21     after September 30, 1983, whose income and resources are
22     insufficient to meet the costs of necessary medical care to
23     the maximum extent possible under Title XIX of the Federal
24     Social Security Act.
25         (b) The Illinois Department and the Governor shall
26     provide a plan for coverage of the persons eligible under

 

 

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1     paragraph 5(a) by April 1, 1990. Such plan shall provide
2     ambulatory prenatal care to pregnant women during a
3     presumptive eligibility period and establish an income
4     eligibility standard that is equal to 133% of the nonfarm
5     income official poverty line, as defined by the federal
6     Office of Management and Budget and revised annually in
7     accordance with Section 673(2) of the Omnibus Budget
8     Reconciliation Act of 1981, applicable to families of the
9     same size, provided that costs incurred for medical care
10     are not taken into account in determining such income
11     eligibility.
12         (c) The Illinois Department may conduct a
13     demonstration in at least one county that will provide
14     medical assistance to pregnant women, together with their
15     infants and children up to one year of age, where the
16     income eligibility standard is set up to 185% of the
17     nonfarm income official poverty line, as defined by the
18     federal Office of Management and Budget. The Illinois
19     Department shall seek and obtain necessary authorization
20     provided under federal law to implement such a
21     demonstration. Such demonstration may establish resource
22     standards that are not more restrictive than those
23     established under Article IV of this Code.
24         6. Persons under the age of 18 who fail to qualify as
25     dependent under Article IV and who have insufficient income
26     and resources to meet the costs of necessary medical care

 

 

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1     to the maximum extent permitted under Title XIX of the
2     Federal Social Security Act.
3         7. Persons who are under 21 years of age and would
4     qualify as disabled as defined under the Federal
5     Supplemental Security Income Program, provided medical
6     service for such persons would be eligible for Federal
7     Financial Participation, and provided the Illinois
8     Department determines that:
9             (a) the person requires a level of care provided by
10         a hospital, skilled nursing facility, or intermediate
11         care facility, as determined by a physician licensed to
12         practice medicine in all its branches;
13             (b) it is appropriate to provide such care outside
14         of an institution, as determined by a physician
15         licensed to practice medicine in all its branches;
16             (c) the estimated amount which would be expended
17         for care outside the institution is not greater than
18         the estimated amount which would be expended in an
19         institution.
20         8. Persons who become ineligible for basic maintenance
21     assistance under Article IV of this Code in programs
22     administered by the Illinois Department due to employment
23     earnings and persons in assistance units comprised of
24     adults and children who become ineligible for basic
25     maintenance assistance under Article VI of this Code due to
26     employment earnings. The plan for coverage for this class

 

 

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1     of persons shall:
2             (a) extend the medical assistance coverage for up
3         to 12 months following termination of basic
4         maintenance assistance; and
5             (b) offer persons who have initially received 6
6         months of the coverage provided in paragraph (a) above,
7         the option of receiving an additional 6 months of
8         coverage, subject to the following:
9                 (i) such coverage shall be pursuant to
10             provisions of the federal Social Security Act;
11                 (ii) such coverage shall include all services
12             covered while the person was eligible for basic
13             maintenance assistance;
14                 (iii) no premium shall be charged for such
15             coverage; and
16                 (iv) such coverage shall be suspended in the
17             event of a person's failure without good cause to
18             file in a timely fashion reports required for this
19             coverage under the Social Security Act and
20             coverage shall be reinstated upon the filing of
21             such reports if the person remains otherwise
22             eligible.
23         9. Persons with acquired immunodeficiency syndrome
24     (AIDS) or with AIDS-related conditions with respect to whom
25     there has been a determination that but for home or
26     community-based services such individuals would require

 

 

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

 

 

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1         under this paragraph 11; and
2             (d) continue to apply subparagraphs (b) and (c) in
3         determining the eligibility of the person under this
4         Article even if the person loses eligibility under this
5         paragraph 11.
6         12. Subject to federal approval, persons who are
7     eligible for medical assistance coverage under applicable
8     provisions of the federal Social Security Act and the
9     federal Breast and Cervical Cancer Prevention and
10     Treatment Act of 2000. Those eligible persons are defined
11     to include, but not be limited to, the following persons:
12             (1) persons who have been screened for breast or
13         cervical cancer under the U.S. Centers for Disease
14         Control and Prevention Breast and Cervical Cancer
15         Program established under Title XV of the federal
16         Public Health Services Act in accordance with the
17         requirements of Section 1504 of that Act as
18         administered by the Illinois Department of Public
19         Health; and
20             (2) persons whose screenings under the above
21         program were funded in whole or in part by funds
22         available appropriated to the Illinois Department of
23         Public Health for breast or cervical cancer screening.
24         Additionally, uninsured persons for whom one or more
25     screening or diagnostic services for breast or cervical
26     cancer have been paid in whole or in part by public funds

 

 

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1     if, during the course of those screening or diagnostic
2     services, cancer was detected. Such persons shall be
3     eligible for medical assistance under this provision for so
4     long as they need treatment for the cancer.
5         "Medical assistance" under this paragraph 12 shall be
6     identical to the benefits provided under the State's
7     approved plan under Title XIX of the Social Security Act.
8     The Department must request federal approval of the
9     coverage under this paragraph 12 within 30 days after the
10     effective date of this amendatory Act of the 92nd General
11     Assembly.
12         13. Subject to appropriation and to federal approval,
13     persons living with HIV/AIDS who are not otherwise eligible
14     under this Article and who qualify for services covered
15     under Section 5-5.04 as provided by the Illinois Department
16     by rule.
17         14. Subject to the availability of funds for this
18     purpose, the Department may provide coverage under this
19     Article to persons who reside in Illinois who are not
20     eligible under any of the preceding paragraphs and who meet
21     the income guidelines of paragraph 2(a) of this Section and
22     (i) have an application for asylum pending before the
23     federal Department of Homeland Security or on appeal before
24     a court of competent jurisdiction and are represented
25     either by counsel or by an advocate accredited by the
26     federal Department of Homeland Security and employed by a

 

 

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1     not-for-profit organization in regard to that application
2     or appeal, or (ii) are receiving services through a
3     federally funded torture treatment center. Medical
4     coverage under this paragraph 14 may be provided for up to
5     24 continuous months from the initial eligibility date so
6     long as an individual continues to satisfy the criteria of
7     this paragraph 14. If an individual has an appeal pending
8     regarding an application for asylum before the Department
9     of Homeland Security, eligibility under this paragraph 14
10     may be extended until a final decision is rendered on the
11     appeal. The Department may adopt rules governing the
12     implementation of this paragraph 14.
13         15. FamilyCare eligibility.
14             (a) A caretaker relative who is 19 years of age or
15         older when countable income is at or below 133% of the
16         Federal Poverty Level Guidelines, as published
17         annually in the Federal Register, for the appropriate
18         family size. A person may not spend down to become
19         eligible under this paragraph 15.
20             (b) A caretaker relative, including a pregnant
21         woman or her spouse if living together, who is 19 years
22         of age or older qualifies for medical assistance under
23         subparagraph (a) of this paragraph 15 if all of the
24         following are met:
25                 (1) The individual is not otherwise eligible
26             for medical assistance or healthcare benefits

 

 

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1             under the Children's Health Insurance Program Act
2             or the Covering ALL KIDS Health Insurance Act.
3                 (2) The individual meets the requirements set
4             forth in the following subdivision (b)(2)(A) or
5             (b)(2)(B) as appropriate:
6                     (A) Upon initial determination of
7                 eligibility:
8                         (i) the individual has been without
9                     health insurance for at least 12 months
10                     prior to the date of application, unless
11                     the individual is a pregnant woman, in
12                     which case the individual was without
13                     health insurance when her pregnancy was
14                     medically confirmed;
15                         (ii) the individual lost
16                     employer-sponsored health insurance when
17                     his or her job or his or her spouse's job
18                     ended;
19                         (iii) the individual has exhausted the
20                     lifetime benefit limit of his or her health
21                     insurance;
22                         (iv) the individual's health insurance
23                     is purchased under the provisions of the
24                     Consolidated Omnibus Budget Reconciliation
25                     Act (COBRA);
26                         (v) the individual was disenrolled for

 

 

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1                     medical assistance under the Illinois
2                     Public Aid Code or benefits, including
3                     rebates, under the Children's Health
4                     Insurance Program Act or the Covering ALL
5                     KIDS Health Insurance Act within one year
6                     prior to applying under this paragraph 15,
7                     unless the individual has State-sponsored
8                     health insurance;
9                         (vi) the individual aged out of
10                     coverage under a parent's health
11                     insurance; or
12                         (vii) the individual's income, as
13                     determined for establishing the
14                     appropriate premium payment under
15                     subparagraph (g) of this paragraph 15, is
16                     at or below 200% of the Federal Poverty
17                     Level Guidelines.
18                     (B) Upon annual redetermination of
19                 eligibility:
20                         (i) the individual's income, as
21                     determined for establishing the
22                     appropriate premium payment under
23                     subparagraph (g) of this paragraph 15, is
24                     at or below 200% of the Federal Poverty
25                     Level Guidelines;
26                         (ii) the individual was initially

 

 

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1                     enrolled under subdivision (b)(2)(A)(i),
2                     (b)(2)(A)(v), or (b)(2)(A)(vi) of this
3                     paragraph 15; or
4                         (iii) affordable health insurance is
5                     not available to the individual. For the
6                     purposes of this paragraph 15, health
7                     insurance for an individual is affordable
8                     if the monthly cost to the policyholder of
9                     the premium for the insurance does not
10                     exceed 3% of the family's monthly
11                     countable income. The amount of income
12                     disregarded under subparagraph (c) of this
13                     paragraph 15 shall not be disregarded when
14                     making this determination.
15                     For the purposes of this subdivision
16                 (b)(2)(B), health insurance shall be
17                 considered unavailable to the individual if
18                 subdivision (b)(2)(A)(iii) or (b)(2)(A)(iv) of
19                 this paragraph 15 applies or if the individual
20                 has been enrolled under this paragraph 15
21                 longer than 12 months.
22             (c) For the purpose of determining eligibility
23         under this paragraph 15, the Department shall
24         disregard income in an amount equal to the difference
25         between 133% and 400% of the Federal Poverty Level
26         Guidelines for the appropriate family size.

 

 

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1             (d) A caretaker relative may not spend down to
2         become eligible under this paragraph 15.
3             (e) Eligibility shall commence as follows:
4                 (1) Eligibility determinations for the program
5             made by the 15th day of the month shall be
6             effective the first day of the following month.
7             Eligibility determinations for the program made
8             after the 15th day of the month shall be effective
9             no later than the first day of the second month
10             following that determination.
11                 (2) Individuals with income as determined for
12             establishing the appropriate premium payment under
13             subparagraph (g) of this paragraph 15 that is at or
14             below 200% of the Federal Poverty Level Guidelines
15             found eligible under this paragraph 15 may obtain
16             coverage for a period prior to the date of
17             application for the program subject to the
18             following:
19                     (A) The individual must request prior
20                 coverage within 6 months following the initial
21                 date of coverage.
22                     (B) The prior coverage shall be individual
23                 specific and shall only be available the first
24                 time the individual is enrolled under this
25                 paragraph 15.
26                     (C) The prior coverage shall begin with

 

 

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1                 services rendered during the 2 weeks prior to
2                 the date the individual's application was
3                 filed and shall continue until the
4                 individual's coverage under subdivision (e)(1)
5                 of this paragraph 15 is effective.
6             (f) Eligibility shall be reviewed annually.
7             (g) Caretaker relatives enrolled under this
8         paragraph 15 must pay monthly premiums as follows:
9                 (1) Individuals who are not American Indians
10             or Alaska Natives in families with countable
11             income above 150% and at or below 200% of the
12             Federal Poverty Level Guidelines shall be counted
13             as family members and pay premiums as established
14             under the Children's Health Insurance Program Act.
15                 (2) Individuals in families with countable
16             income above 200% but at or below 300% of the
17             Federal Poverty Level Guidelines shall pay
18             premiums of $80 per person per month.
19                 (3) Individuals in families with countable
20             income above 300% but at or below 400% of the
21             Federal Poverty Level Guidelines shall pay
22             premiums of $140 per person per month.
23             (h) Individuals who are American Indians or Alaska
24         Natives shall have no co-payments if their family
25         income is at or below 200% of the Federal Poverty Level
26         Guidelines.

 

 

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1             (i) The amount of income disregarded under
2         subparagraph (c) of this paragraph 15 shall not be
3         disregarded in determining premium levels or in
4         determining co-payments or eligibility for prior
5         coverage or rebates.
6             (j) Premiums shall be billed by and payable to the
7         Department or its authorized agent, on a monthly basis.
8             (k) The premium due date is the last day of the
9         month preceding the month of coverage.
10             (l) Individuals shall have a grace period through
11         the month of coverage to pay the premium.
12             (m) Failure to pay the full monthly premium by the
13         last day of the grace period shall result in
14         termination of coverage.
15             (n) Partial premium payments shall not be
16         refunded.
17             (o) When termination of coverage is recorded by the
18         15th day of the month, it shall be effective the first
19         day of the following month. When termination of
20         coverage is recorded after the 15th day of the month,
21         it shall be effective no later than the first day of
22         the second month following that determination.
23             (p) Following termination of an individual's
24         coverage under this paragraph 15, the following action
25         is required before the individual can be re-enrolled:
26                 (1) A new application must be completed and the

 

 

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1             individual must be determined otherwise eligible.
2                 (2) There must be full payment of premiums due
3             under this Code, the Children's Health Insurance
4             Program Act, the Covering ALL KIDS Health
5             Insurance Act, or any other healthcare program
6             administered by the Department for periods in
7             which a premium was owed and not paid for the
8             individual.
9                 (3) If the termination was the result of
10             non-payment of premiums, the individual must be
11             out of the program for 3 months before
12             re-enrollment.
13                 (4) The first month's premium must be paid if
14             there was an unpaid premium on the date the
15             individual's previous coverage was canceled.
16             (q) For the purposes of this paragraph 15, "health
17         insurance" means any health insurance coverage as
18         defined in Section 2 of the Comprehensive Health
19         Insurance Plan Act.
20     The Illinois Department and the Governor shall provide a
21 plan for coverage of the persons eligible under paragraph 7 as
22 soon as possible after July 1, 1984.
23     The eligibility of any such person for medical assistance
24 under this Article is not affected by the payment of any grant
25 under the Senior Citizens and Disabled Persons Property Tax
26 Relief and Pharmaceutical Assistance Act or any distributions

 

 

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1 or items of income described under subparagraph (X) of
2 paragraph (2) of subsection (a) of Section 203 of the Illinois
3 Income Tax Act. The Department shall by rule establish the
4 amounts of assets to be disregarded in determining eligibility
5 for medical assistance, which shall at a minimum equal the
6 amounts to be disregarded under the Federal Supplemental
7 Security Income Program. The amount of assets of a single
8 person to be disregarded shall not be less than $2,000, and the
9 amount of assets of a married couple to be disregarded shall
10 not be less than $3,000.
11     To the extent permitted under federal law, any person found
12 guilty of a second violation of Article VIIIA shall be
13 ineligible for medical assistance under this Article, as
14 provided in Section 8A-8.
15     The eligibility of any person for medical assistance under
16 this Article shall not be affected by the receipt by the person
17 of donations or benefits from fundraisers held for the person
18 in cases of serious illness, as long as neither the person nor
19 members of the person's family have actual control over the
20 donations or benefits or the disbursement of the donations or
21 benefits.
22 (Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06;
23 95-546, eff. 8-29-07; revised 1-22-08.)
 
24     Section 99. Effective date. This Act takes effect upon
25 becoming law.".