Rep. Robert F. Flider

Filed: 5/13/2008

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 4634

2     AMENDMENT NO. ______. Amend House Bill 4634, AS AMENDED, by
3 replacing everything after the enacting clause with the
4 following:
 
5     "Section 5. The Illinois Public Aid Code is amended by
6 changing Section 5-2 as follows:
 
7     (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
8     Sec. 5-2. Classes of Persons Eligible. Medical assistance
9 under this Article shall be available to any of the following
10 classes of persons in respect to whom a plan for coverage has
11 been submitted to the Governor by the Illinois Department and
12 approved by him:
13         1. Recipients of basic maintenance grants under
14     Articles III and IV.
15         2. Persons otherwise eligible for basic maintenance
16     under Articles III and IV but who fail to qualify

 

 

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

 

 

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1             than 100% beginning on the date determined by the
2             Department by rule, of the nonfarm income official
3             poverty line, as defined in item (i) of this
4             subparagraph (a).
5             (b) All persons who would be determined eligible
6         for such basic maintenance under Article IV by
7         disregarding the maximum earned income permitted by
8         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,

 

 

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

 

 

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

 

 

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1     coverage under this paragraph 12 within 30 days after the
2     effective date of this amendatory Act of the 92nd General
3     Assembly.
4         13. Subject to appropriation and to federal approval,
5     persons living with HIV/AIDS who are not otherwise eligible
6     under this Article and who qualify for services covered
7     under Section 5-5.04 as provided by the Illinois Department
8     by rule.
9         14. Subject to the availability of funds for this
10     purpose, the Department may provide coverage under this
11     Article to persons who reside in Illinois who are not
12     eligible under any of the preceding paragraphs and who meet
13     the income guidelines of paragraph 2(a) of this Section and
14     (i) have an application for asylum pending before the
15     federal Department of Homeland Security or on appeal before
16     a court of competent jurisdiction and are represented
17     either by counsel or by an advocate accredited by the
18     federal Department of Homeland Security and employed by a
19     not-for-profit organization in regard to that application
20     or appeal, or (ii) are receiving services through a
21     federally funded torture treatment center. Medical
22     coverage under this paragraph 14 may be provided for up to
23     24 continuous months from the initial eligibility date so
24     long as an individual continues to satisfy the criteria of
25     this paragraph 14. If an individual has an appeal pending
26     regarding an application for asylum before the Department

 

 

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1     of Homeland Security, eligibility under this paragraph 14
2     may be extended until a final decision is rendered on the
3     appeal. The Department may adopt rules governing the
4     implementation of this paragraph 14.
5         15. Subject to appropriation, uninsured persons who
6     are not otherwise eligible under this Section who have been
7     certified and referred by the Department of Public Health
8     as having been screened and found to need diagnostic
9     evaluation or treatment, or both diagnostic evaluation and
10     treatment, for prostate or testicular cancer. For the
11     purposes of this paragraph 15, uninsured persons are those
12     who do not have creditable coverage, as defined under the
13     Health Insurance Portability and Accountability Act, or
14     have otherwise exhausted any insurance benefits they may
15     have had, for prostate or testicular cancer diagnostic
16     evaluation or treatment, or both diagnostic evaluation and
17     treatment. To be eligible, a person must furnish a Social
18     Security number. A person's assets are exempt from
19     consideration in determining eligibility under this
20     paragraph 15. Such persons shall be eligible for medical
21     assistance under this paragraph 15 for so long as they need
22     treatment for the cancer. A person shall be considered to
23     need treatment if, in the opinion of the person's treating
24     physician, the person requires therapy directed toward
25     cure or palliation of prostate or testicular cancer,
26     including recurrent metastatic cancer that is a known or

 

 

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1     presumed complication of prostate or testicular cancer and
2     complications resulting from the treatment modalities
3     themselves. Persons who require only routine monitoring
4     services are not considered to need treatment. "Medical
5     assistance" under this paragraph 15 shall be identical to
6     the benefits provided under the State's approved plan under
7     Title XIX of the Social Security Act. Notwithstanding any
8     other provision of law, the Department (i) does not have a
9     claim against the estate of a deceased recipient of
10     services under this paragraph 15 and (ii) does not have a
11     lien against any homestead property or other legal or
12     equitable real property interest owned by a recipient of
13     services under this paragraph 15.
14     The Illinois Department and the Governor shall provide a
15 plan for coverage of the persons eligible under paragraph 7 as
16 soon as possible after July 1, 1984.
17     The eligibility of any such person for medical assistance
18 under this Article is not affected by the payment of any grant
19 under the Senior Citizens and Disabled Persons Property Tax
20 Relief and Pharmaceutical Assistance Act or any distributions
21 or items of income described under subparagraph (X) of
22 paragraph (2) of subsection (a) of Section 203 of the Illinois
23 Income Tax Act. The Department shall by rule establish the
24 amounts of assets to be disregarded in determining eligibility
25 for medical assistance, which shall at a minimum equal the
26 amounts to be disregarded under the Federal Supplemental

 

 

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1 Security Income Program. The amount of assets of a single
2 person to be disregarded shall not be less than $2,000, and the
3 amount of assets of a married couple to be disregarded shall
4 not be less than $3,000.
5     To the extent permitted under federal law, any person found
6 guilty of a second violation of Article VIIIA shall be
7 ineligible for medical assistance under this Article, as
8 provided in Section 8A-8.
9     The eligibility of any person for medical assistance under
10 this Article shall not be affected by the receipt by the person
11 of donations or benefits from fundraisers held for the person
12 in cases of serious illness, as long as neither the person nor
13 members of the person's family have actual control over the
14 donations or benefits or the disbursement of the donations or
15 benefits.
16     Notwithstanding any other rulemaking authority that may
17 exist, neither the Governor nor any agency or agency head under
18 the jurisdiction of the Governor has any authority to make or
19 promulgate rules to implement or enforce the provisions of this
20 amendatory Act of the 95th General Assembly. If, however, the
21 Governor believes that rules are necessary to implement or
22 enforce the provisions of this amendatory Act of the 95th
23 General Assembly, the Governor may suggest rules to the General
24 Assembly by filing them with the Clerk of the House and
25 Secretary of the Senate and by requesting that the General
26 Assembly authorize such rulemaking by law, enact those

 

 

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1 suggested rules into law, or take any other appropriate action
2 in the General Assembly's discretion. Nothing contained in this
3 amendatory Act of the 95th General Assembly shall be
4 interpreted to grant rulemaking authority under any other
5 Illinois statute where such authority is not otherwise
6 explicitly given. For the purposes of this amendatory Act of
7 the 95th General Assembly, "rules" is given the meaning
8 contained in Section 1-70 of the Illinois Administrative
9 Procedure Act, and "agency" and "agency head" are given the
10 meanings contained in Sections 1-20 and 1-25 of the Illinois
11 Administrative Procedure Act to the extent that such
12 definitions apply to agencies or agency heads under the
13 jurisdiction of the Governor.
14 (Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06;
15 95-546, eff. 8-29-07; revised 1-22-08.)".