Illinois General Assembly - Full Text of SB3136
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Full Text of SB3136  102nd General Assembly

SB3136 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB3136

 

Introduced 1/12/2022, by Sen. Mike Simmons

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-1.6 new
305 ILCS 5/11-5.1

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to seek a State Plan amendment or any federal waivers necessary to implement 12 months of continuous eligibility for adults participating in the medical assistance program. Requires the Department to secure federal financial participation in accordance with the amendatory Act for expenditures made in State Fiscal Year 2023 and every State fiscal year thereafter. Requires the Department to seek a State Plan amendment or any federal waivers or approvals necessary to implement an ex parte redetermination process for persons experiencing homelessness or who are without income at the time of application or redetermination. Requires the Department and the Department of Human Services to make necessary technical and rule changes to implement the ex parte redetermination process. Requires the Department to report on a monthly basis on its website the percentage of medical assistance recipients whose eligibility is renewed through the ex parte redetermination process. Requires the Department to share the data with the Medicaid Advisory Committee and the Medicaid Advisory Committee Public Education Subcommittee. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB3136LRB102 20901 KTG 29785 b

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 11-5.1 and by adding Section 5-1.6 as
6follows:
 
7    (305 ILCS 5/5-1.6 new)
8    Sec. 5-1.6. Continuous eligibility; ex parte
9redeterminations.
10    (a) By July 1, 2022, the Department of Healthcare and
11Family Services shall seek a State Plan amendment or any
12federal waivers necessary to make changes to the medical
13assistance program. The Department shall apply for federal
14approval to implement 12 months of continuous eligibility for
15adults participating in the medical assistance program. The
16Department shall secure federal financial participation in
17accordance with this Section for expenditures made by the
18Department in State Fiscal Year 2023 and every State fiscal
19year thereafter.
20    (b) By July 1, 2022, the Department of Healthcare and
21Family Services shall seek a State Plan amendment or any
22federal waivers or approvals necessary to make changes to the
23medical assistance redetermination process for people

 

 

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1experiencing homelessness and for people without any income at
2the time of application or redetermination. These changes
3shall seek to move all people experiencing homelessness and
4people without income into an automated redetermination
5process, commonly referred to as ex parte redetermination.
6Within 60 days of receiving federal approval or guidance, the
7Department of Healthcare and Family Services and the
8Department of Human Services shall make necessary technical
9and rule changes to implement changes to the redetermination
10process. Upon the receipt of federal approval or guidance, the
11Department of Healthcare and Family Services and the
12Department of Human Services shall produce internal guidance
13to all agency staff to inform them of these changes. The
14percentage of medical assistance recipients whose eligibility
15is renewed through the ex parte redetermination process shall
16be reported monthly by the Department of Healthcare and Family
17Services on its website in accordance with subsection (d) of
18Section 11-5.1 of this Code as well as shared in all Medicaid
19Advisory Committee meetings and Medicaid Advisory Committee
20Public Education Subcommittee meetings.
 
21    (305 ILCS 5/11-5.1)
22    Sec. 11-5.1. Eligibility verification. Notwithstanding any
23other provision of this Code, with respect to applications for
24medical assistance provided under Article V of this Code,
25eligibility shall be determined in a manner that ensures

 

 

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1program integrity and complies with federal laws and
2regulations while minimizing unnecessary barriers to
3enrollment. To this end, as soon as practicable, and unless
4the Department receives written denial from the federal
5government, this Section shall be implemented:
6    (a) The Department of Healthcare and Family Services or
7its designees shall:
8        (1) By no later than July 1, 2011, require
9    verification of, at a minimum, one month's income from all
10    sources required for determining the eligibility of
11    applicants for medical assistance under this Code. Such
12    verification shall take the form of pay stubs, business or
13    income and expense records for self-employed persons,
14    letters from employers, and any other valid documentation
15    of income including data obtained electronically by the
16    Department or its designees from other sources as
17    described in subsection (b) of this Section. A month's
18    income may be verified by a single pay stub with the
19    monthly income extrapolated from the time period covered
20    by the pay stub.
21        (2) By no later than October 1, 2011, require
22    verification of, at a minimum, one month's income from all
23    sources required for determining the continued eligibility
24    of recipients at their annual review of eligibility for
25    medical assistance under this Code. Information the
26    Department receives prior to the annual review, including

 

 

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1    information available to the Department as a result of the
2    recipient's application for other non-Medicaid benefits,
3    that is sufficient to make a determination of continued
4    Medicaid eligibility may be reviewed and verified, and
5    subsequent action taken including client notification of
6    continued Medicaid eligibility. The date of client
7    notification establishes the date for subsequent annual
8    Medicaid eligibility reviews. Such verification shall take
9    the form of pay stubs, business or income and expense
10    records for self-employed persons, letters from employers,
11    and any other valid documentation of income including data
12    obtained electronically by the Department or its designees
13    from other sources as described in subsection (b) of this
14    Section. A month's income may be verified by a single pay
15    stub with the monthly income extrapolated from the time
16    period covered by the pay stub. The Department shall send
17    a notice to recipients at least 60 days prior to the end of
18    their period of eligibility that informs them of the
19    requirements for continued eligibility. If a recipient
20    does not fulfill the requirements for continued
21    eligibility by the deadline established in the notice a
22    notice of cancellation shall be issued to the recipient
23    and coverage shall end no later than the last day of the
24    month following the last day of the eligibility period. A
25    recipient's eligibility may be reinstated without
26    requiring a new application if the recipient fulfills the

 

 

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1    requirements for continued eligibility prior to the end of
2    the third month following the last date of coverage (or
3    longer period if required by federal regulations). Nothing
4    in this Section shall prevent an individual whose coverage
5    has been cancelled from reapplying for health benefits at
6    any time.
7        (3) By no later than July 1, 2011, require
8    verification of Illinois residency.
9    The Department, with federal approval, may choose to adopt
10continuous financial eligibility for a full 12 months for
11adults on Medicaid.
12    (b) The Department shall establish or continue cooperative
13arrangements with the Social Security Administration, the
14Illinois Secretary of State, the Department of Human Services,
15the Department of Revenue, the Department of Employment
16Security, and any other appropriate entity to gain electronic
17access, to the extent allowed by law, to information available
18to those entities that may be appropriate for electronically
19verifying any factor of eligibility for benefits under the
20Program. Data relevant to eligibility shall be provided for no
21other purpose than to verify the eligibility of new applicants
22or current recipients of health benefits under the Program.
23Data shall be requested or provided for any new applicant or
24current recipient only insofar as that individual's
25circumstances are relevant to that individual's or another
26individual's eligibility.

 

 

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1    (c) Within 90 days of the effective date of this
2amendatory Act of the 96th General Assembly, the Department of
3Healthcare and Family Services shall send notice to current
4recipients informing them of the changes regarding their
5eligibility verification.
6    (d) As soon as practical if the data is reasonably
7available, but no later than January 1, 2017, the Department
8shall compile on a monthly basis data on eligibility
9redeterminations of beneficiaries of medical assistance
10provided under Article V of this Code. In additional to the
11other data required under this subsection, the Department
12shall compile on a monthly basis data on the percentage of
13beneficiaries whose eligibility is renewed through ex parte
14redeterminations as described in subsection (b) of Section
155-1.6 of this Code, subject to federal approval of the changes
16made in subsection (b) of Section 5-1.6 by this amendatory Act
17of the 102nd General Assembly. This data shall be posted on the
18Department's website, and data from prior months shall be
19retained and available on the Department's website. The data
20compiled and reported shall include the following:
21        (1) The total number of redetermination decisions made
22    in a month and, of that total number, the number of
23    decisions to continue or change benefits and the number of
24    decisions to cancel benefits.
25        (2) A breakdown of enrollee language preference for
26    the total number of redetermination decisions made in a

 

 

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1    month and, of that total number, a breakdown of enrollee
2    language preference for the number of decisions to
3    continue or change benefits, and a breakdown of enrollee
4    language preference for the number of decisions to cancel
5    benefits. The language breakdown shall include, at a
6    minimum, English, Spanish, and the next 4 most commonly
7    used languages.
8        (3) The percentage of cancellation decisions made in a
9    month due to each of the following:
10            (A) The beneficiary's ineligibility due to excess
11        income.
12            (B) The beneficiary's ineligibility due to not
13        being an Illinois resident.
14            (C) The beneficiary's ineligibility due to being
15        deceased.
16            (D) The beneficiary's request to cancel benefits.
17            (E) The beneficiary's lack of response after
18        notices mailed to the beneficiary are returned to the
19        Department as undeliverable by the United States
20        Postal Service.
21            (F) The beneficiary's lack of response to a
22        request for additional information when reliable
23        information in the beneficiary's account, or other
24        more current information, is unavailable to the
25        Department to make a decision on whether to continue
26        benefits.

 

 

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1            (G) Other reasons tracked by the Department for
2        the purpose of ensuring program integrity.
3        (4) If a vendor is utilized to provide services in
4    support of the Department's redetermination decision
5    process, the total number of redetermination decisions
6    made in a month and, of that total number, the number of
7    decisions to continue or change benefits, and the number
8    of decisions to cancel benefits (i) with the involvement
9    of the vendor and (ii) without the involvement of the
10    vendor.
11        (5) Of the total number of benefit cancellations in a
12    month, the number of beneficiaries who return from
13    cancellation within one month, the number of beneficiaries
14    who return from cancellation within 2 months, and the
15    number of beneficiaries who return from cancellation
16    within 3 months. Of the number of beneficiaries who return
17    from cancellation within 3 months, the percentage of those
18    cancellations due to each of the reasons listed under
19    paragraph (3) of this subsection.
20    (e) The Department shall conduct a complete review of the
21Medicaid redetermination process in order to identify changes
22that can increase the use of ex parte redetermination
23processing. This review shall be completed within 90 days
24after the effective date of this amendatory Act of the 101st
25General Assembly. Within 90 days of completion of the review,
26the Department shall seek written federal approval of policy

 

 

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1changes the review recommended and implement once approved.
2The review shall specifically include, but not be limited to,
3use of ex parte redeterminations of the following populations:
4        (1) Recipients of developmental disabilities services.
5        (2) Recipients of benefits under the State's Aid to
6    the Aged, Blind, or Disabled program.
7        (3) Recipients of Medicaid long-term care services and
8    supports, including waiver services.
9        (4) All Modified Adjusted Gross Income (MAGI)
10    populations.
11        (5) Populations with no verifiable income.
12        (6) Self-employed people.
13    The report shall also outline populations and
14circumstances in which an ex parte redetermination is not a
15recommended option.
16    (f) The Department shall explore and implement, as
17practical and technologically possible, roles that
18stakeholders outside State agencies can play to assist in
19expediting eligibility determinations and redeterminations
20within 24 months after the effective date of this amendatory
21Act of the 101st General Assembly. Such practical roles to be
22explored to expedite the eligibility determination processes
23shall include the implementation of hospital presumptive
24eligibility, as authorized by the Patient Protection and
25Affordable Care Act.
26    (g) The Department or its designee shall seek federal

 

 

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1approval to enhance the reasonable compatibility standard from
25% to 10%.
3    (h) Reporting. The Department of Healthcare and Family
4Services and the Department of Human Services shall publish
5quarterly reports on their progress in implementing policies
6and practices pursuant to this Section as modified by this
7amendatory Act of the 101st General Assembly.
8        (1) The reports shall include, but not be limited to,
9    the following:
10            (A) Medical application processing, including a
11        breakdown of the number of MAGI, non-MAGI, long-term
12        care, and other medical cases pending for various
13        incremental time frames between 0 to 181 or more days.
14            (B) Medical redeterminations completed, including:
15        (i) a breakdown of the number of households that were
16        redetermined ex parte and those that were not; (ii)
17        the reasons households were not redetermined ex parte;
18        and (iii) the relative percentages of these reasons.
19            (C) A narrative discussion on issues identified in
20        the functioning of the State's Integrated Eligibility
21        System and progress on addressing those issues, as
22        well as progress on implementing strategies to address
23        eligibility backlogs, including expanding ex parte
24        determinations to ensure timely eligibility
25        determinations and renewals.
26        (2) Initial reports shall be issued within 90 days

 

 

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1    after the effective date of this amendatory Act of the
2    101st General Assembly.
3        (3) All reports shall be published on the Department's
4    website.
5(Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20.)
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.