Illinois General Assembly - Full Text of SB3062
Illinois General Assembly

Previous General Assemblies

Full Text of SB3062  102nd General Assembly




State of Illinois
2021 and 2022


Introduced 1/5/2022, by Sen. Mike Simmons


305 ILCS 5/5-2  from Ch. 23, par. 5-2

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that beginning on January 1, 2024, the Department of Healthcare and Family Services shall raise the income eligibility standard for all of its medical assistance programs to include persons whose income is equal to or less than 276% of the federal poverty level (or any higher percentage determined by the Department) plus 5% for the applicable family size as determined under federal law and applicable federal regulations. Provides that persons eligible for medical assistance under the amendatory Act shall receive coverage identical to the coverage provided to persons eligible for each medical assistance program under the income eligibility requirements in effect on December 31, 2023. Permits the Department to adopt rules for the implementation of the amendatory Act. Provides that the amendatory Act does not apply to programs in which the income eligibility standard is higher than the standard created by the amendatory Act.

LRB102 22925 KTG 32079 b





SB3062LRB102 22925 KTG 32079 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 5-2 as follows:
6    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
7    Sec. 5-2. Classes of persons eligible. Medical assistance
8under this Article shall be available to any of the following
9classes of persons in respect to whom a plan for coverage has
10been submitted to the Governor by the Illinois Department and
11approved by him. If changes made in this Section 5-2 require
12federal approval, they shall not take effect until such
13approval 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,
20    as 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



SB3062- 2 -LRB102 22925 KTG 32079 b

1    not 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
12            types of remedial care, is equal to or less than
13            100% of 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) Beginning January 1, 2020, individuals during
22    pregnancy and during the 12-month period beginning on the
23    last day of the pregnancy, together with their infants,
24    whose income is at or below 200% of the federal poverty
25    level. Until September 30, 2019, or sooner if the
26    maintenance of effort requirements under the Patient



SB3062- 3 -LRB102 22925 KTG 32079 b

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



SB3062- 4 -LRB102 22925 KTG 32079 b

1    standards that are not more restrictive than those
2    established under Article IV of this Code.
3        6. (a) Subject to federal approval, children younger
4    than age 19 when countable income is at or below 313% of
5    the federal poverty level, as determined by the Department
6    and in accordance with all applicable federal
7    requirements. The Department is authorized to adopt
8    emergency rules to implement the changes made to this
9    paragraph by Public Act 102-43 this amendatory Act of the
10    102nd General Assembly. Until September 30, 2019, or
11    sooner if the maintenance of effort requirements under the
12    Patient Protection and Affordable Care Act are eliminated
13    or may be waived before then, children younger than age 19
14    whose countable monthly income, after the deduction of
15    costs incurred for medical care and for other types of
16    remedial care as specified in administrative rule, is
17    equal to or less than the Medical Assistance-No Grant(C)
18    (MANG(C)) Income Standard in effect on April 1, 2013 as
19    set forth in administrative rule.
20        (b) Children and youth who are under temporary custody
21    or guardianship of the Department of Children and Family
22    Services or who receive financial assistance in support of
23    an adoption or guardianship placement from the Department
24    of Children and Family Services.
25        7. (Blank).
26        8. As required under federal law, persons who are



SB3062- 5 -LRB102 22925 KTG 32079 b

1    eligible for Transitional Medical Assistance as a result
2    of an increase in earnings or child or spousal support
3    received. The plan for coverage for this class of persons
4    shall:
5            (a) extend the medical assistance coverage to the
6        extent required by federal law; and
7            (b) offer persons who have initially received 6
8        months of the coverage provided in paragraph (a)
9        above, the option of receiving an additional 6 months
10        of coverage, subject to the following:
11                (i) such coverage shall be pursuant to
12            provisions of the federal Social Security Act;
13                (ii) such coverage shall include all services
14            covered under Illinois' State Medicaid Plan;
15                (iii) no premium shall be charged for such
16            coverage; and
17                (iv) such coverage shall be suspended in the
18            event of a person's failure without good cause to
19            file in a timely fashion reports required for this
20            coverage under the Social Security Act and
21            coverage shall be reinstated upon the filing of
22            such reports if the person remains otherwise
23            eligible.
24        9. Persons with acquired immunodeficiency syndrome
25    (AIDS) or with AIDS-related conditions with respect to
26    whom there has been a determination that but for home or



SB3062- 6 -LRB102 22925 KTG 32079 b

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



SB3062- 7 -LRB102 22925 KTG 32079 b

1        1/2, and medical savings accounts established pursuant
2        to 26 U.S.C. 220;
3            (c) allow non-exempt assets up to $25,000 as to
4        those assets accumulated during periods of eligibility
5        under this paragraph 11; and
6            (d) continue to apply subparagraphs (b) and (c) in
7        determining the eligibility of the person under this
8        Article even if the person loses eligibility under
9        this paragraph 11.
10        12. Subject to federal approval, persons who are
11    eligible for medical assistance coverage under applicable
12    provisions of the federal Social Security Act and the
13    federal Breast and Cervical Cancer Prevention and
14    Treatment Act of 2000. Those eligible persons are defined
15    to include, but not be limited to, the following persons:
16            (1) persons who have been screened for breast or
17        cervical cancer under the U.S. Centers for Disease
18        Control and Prevention Breast and Cervical Cancer
19        Program established under Title XV of the federal
20        Public Health Service Act in accordance with the
21        requirements of Section 1504 of that Act as
22        administered by the Illinois Department of Public
23        Health; and
24            (2) persons whose screenings under the above
25        program were funded in whole or in part by funds
26        appropriated to the Illinois Department of Public



SB3062- 8 -LRB102 22925 KTG 32079 b

1        Health for breast or cervical cancer screening.
2        "Medical assistance" under this paragraph 12 shall be
3    identical to the benefits provided under the State's
4    approved plan under Title XIX of the Social Security Act.
5    The Department must request federal approval of the
6    coverage under this paragraph 12 within 30 days after July
7    3, 2001 (the effective date of Public Act 92-47).
8        In addition to the persons who are eligible for
9    medical assistance pursuant to subparagraphs (1) and (2)
10    of this paragraph 12, and to be paid from funds
11    appropriated to the Department for its medical programs,
12    any uninsured person as defined by the Department in rules
13    residing in Illinois who is younger than 65 years of age,
14    who has been screened for breast and cervical cancer in
15    accordance with standards and procedures adopted by the
16    Department of Public Health for screening, and who is
17    referred to the Department by the Department of Public
18    Health as being in need of treatment for breast or
19    cervical cancer is eligible for medical assistance
20    benefits that are consistent with the benefits provided to
21    those persons described in subparagraphs (1) and (2).
22    Medical assistance coverage for the persons who are
23    eligible under the preceding sentence is not dependent on
24    federal approval, but federal moneys may be used to pay
25    for services provided under that coverage upon federal
26    approval.



SB3062- 9 -LRB102 22925 KTG 32079 b

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



SB3062- 10 -LRB102 22925 KTG 32079 b

1    may adopt rules governing the implementation of this
2    paragraph 14.
3        15. Family Care Eligibility.
4            (a) On and after July 1, 2012, a parent or other
5        caretaker relative who is 19 years of age or older when
6        countable income is at or below 133% of the federal
7        poverty level. A person may not spend down to become
8        eligible under this paragraph 15.
9            (b) Eligibility shall be reviewed annually.
10            (c) (Blank).
11            (d) (Blank).
12            (e) (Blank).
13            (f) (Blank).
14            (g) (Blank).
15            (h) (Blank).
16            (i) Following termination of an individual's
17        coverage under this paragraph 15, the individual must
18        be determined eligible before the person can be
19        re-enrolled.
20        16. Subject to appropriation, uninsured persons who
21    are not otherwise eligible under this Section who have
22    been certified and referred by the Department of Public
23    Health as having been screened and found to need
24    diagnostic evaluation or treatment, or both diagnostic
25    evaluation and treatment, for prostate or testicular
26    cancer. For the purposes of this paragraph 16, uninsured



SB3062- 11 -LRB102 22925 KTG 32079 b

1    persons are those who do not have creditable coverage, as
2    defined under the Health Insurance Portability and
3    Accountability Act, or have otherwise exhausted any
4    insurance benefits they may have had, for prostate or
5    testicular cancer diagnostic evaluation or treatment, or
6    both diagnostic evaluation and treatment. To be eligible,
7    a person must furnish a Social Security number. A person's
8    assets are exempt from consideration in determining
9    eligibility under this paragraph 16. Such persons shall be
10    eligible for medical assistance under this paragraph 16
11    for so long as they need treatment for the cancer. A person
12    shall be considered to need treatment if, in the opinion
13    of the person's treating physician, the person requires
14    therapy directed toward cure or palliation of prostate or
15    testicular cancer, including recurrent metastatic cancer
16    that is a known or presumed complication of prostate or
17    testicular cancer and complications resulting from the
18    treatment modalities themselves. Persons who require only
19    routine monitoring services are not considered to need
20    treatment. "Medical assistance" under this paragraph 16
21    shall be identical to the benefits provided under the
22    State's approved plan under Title XIX of the Social
23    Security Act. Notwithstanding any other provision of law,
24    the Department (i) does not have a claim against the
25    estate of a deceased recipient of services under this
26    paragraph 16 and (ii) does not have a lien against any



SB3062- 12 -LRB102 22925 KTG 32079 b

1    homestead property or other legal or equitable real
2    property interest owned by a recipient of services under
3    this paragraph 16.
4        17. Persons who, pursuant to a waiver approved by the
5    Secretary of the U.S. Department of Health and Human
6    Services, are eligible for medical assistance under Title
7    XIX or XXI of the federal Social Security Act.
8    Notwithstanding any other provision of this Code and
9    consistent with the terms of the approved waiver, the
10    Illinois Department, may by rule:
11            (a) Limit the geographic areas in which the waiver
12        program operates.
13            (b) Determine the scope, quantity, duration, and
14        quality, and the rate and method of reimbursement, of
15        the medical services to be provided, which may differ
16        from those for other classes of persons eligible for
17        assistance under this Article.
18            (c) Restrict the persons' freedom in choice of
19        providers.
20        18. Beginning January 1, 2014, persons aged 19 or
21    older, but younger than 65, who are not otherwise eligible
22    for medical assistance under this Section 5-2, who qualify
23    for medical assistance pursuant to 42 U.S.C.
24    1396a(a)(10)(A)(i)(VIII) and applicable federal
25    regulations, and who have income at or below 133% of the
26    federal poverty level plus 5% for the applicable family



SB3062- 13 -LRB102 22925 KTG 32079 b

1    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
2    applicable federal regulations. Persons eligible for
3    medical assistance under this paragraph 18 shall receive
4    coverage for the Health Benefits Service Package as that
5    term is defined in subsection (m) of Section 5-1.1 of this
6    Code. If Illinois' federal medical assistance percentage
7    (FMAP) is reduced below 90% for persons eligible for
8    medical assistance under this paragraph 18, eligibility
9    under this paragraph 18 shall cease no later than the end
10    of the third month following the month in which the
11    reduction in FMAP takes effect.
12        19. Beginning January 1, 2014, as required under 42
13    U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
14    and younger than age 26 who are not otherwise eligible for
15    medical assistance under paragraphs (1) through (17) of
16    this Section who (i) were in foster care under the
17    responsibility of the State on the date of attaining age
18    18 or on the date of attaining age 21 when a court has
19    continued wardship for good cause as provided in Section
20    2-31 of the Juvenile Court Act of 1987 and (ii) received
21    medical assistance under the Illinois Title XIX State Plan
22    or waiver of such plan while in foster care.
23        20. Beginning January 1, 2018, persons who are
24    foreign-born victims of human trafficking, torture, or
25    other serious crimes as defined in Section 2-19 of this
26    Code and their derivative family members if such persons:



SB3062- 14 -LRB102 22925 KTG 32079 b

1    (i) reside in Illinois; (ii) are not eligible under any of
2    the preceding paragraphs; (iii) meet the income guidelines
3    of subparagraph (a) of paragraph 2; and (iv) meet the
4    nonfinancial eligibility requirements of Sections 16-2,
5    16-3, and 16-5 of this Code. The Department may extend
6    medical assistance for persons who are foreign-born
7    victims of human trafficking, torture, or other serious
8    crimes whose medical assistance would be terminated
9    pursuant to subsection (b) of Section 16-5 if the
10    Department determines that the person, during the year of
11    initial eligibility (1) experienced a health crisis, (2)
12    has been unable, after reasonable attempts, to obtain
13    necessary information from a third party, or (3) has other
14    extenuating circumstances that prevented the person from
15    completing his or her application for status. The
16    Department may adopt any rules necessary to implement the
17    provisions of this paragraph.
18        21. Persons who are not otherwise eligible for medical
19    assistance under this Section who may qualify for medical
20    assistance pursuant to 42 U.S.C.
21    1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the
22    duration of any federal or State declared emergency due to
23    COVID-19. Medical assistance to persons eligible for
24    medical assistance solely pursuant to this paragraph 21
25    shall be limited to any in vitro diagnostic product (and
26    the administration of such product) described in 42 U.S.C.



SB3062- 15 -LRB102 22925 KTG 32079 b

1    1396d(a)(3)(B) on or after March 18, 2020, any visit
2    described in 42 U.S.C. 1396o(a)(2)(G), or any other
3    medical assistance that may be federally authorized for
4    this class of persons. The Department may also cover
5    treatment of COVID-19 for this class of persons, or any
6    similar category of uninsured individuals, to the extent
7    authorized under a federally approved 1115 Waiver or other
8    federal authority. Notwithstanding the provisions of
9    Section 1-11 of this Code, due to the nature of the
10    COVID-19 public health emergency, the Department may cover
11    and provide the medical assistance described in this
12    paragraph 21 to noncitizens who would otherwise meet the
13    eligibility requirements for the class of persons
14    described in this paragraph 21 for the duration of the
15    State emergency period.
16    In implementing the provisions of Public Act 96-20, the
17Department is authorized to adopt only those rules necessary,
18including emergency rules. Nothing in Public Act 96-20 permits
19the Department to adopt rules or issue a decision that expands
20eligibility for the FamilyCare Program to a person whose
21income exceeds 185% of the Federal Poverty Level as determined
22from time to time by the U.S. Department of Health and Human
23Services, unless the Department is provided with express
24statutory authority.
25    The eligibility of any such person for medical assistance
26under this Article is not affected by the payment of any grant



SB3062- 16 -LRB102 22925 KTG 32079 b

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



SB3062- 17 -LRB102 22925 KTG 32079 b

1or if a holding of Public Law 111-148 makes Medicaid
2eligibility allowed under Section 2001(a) inoperable, the
3State or a unit of local government shall be prohibited from
4enrolling individuals in the Medical Assistance Program as the
5result of federal approval of a State Medicaid waiver on or
6after June 14, 2012 (the effective date of Public Act 97-687),
7and any individuals enrolled in the Medical Assistance Program
8pursuant to eligibility permitted as a result of such a State
9Medicaid waiver shall become immediately ineligible.
10    Notwithstanding any other provision of this Code, if an
11Act of Congress that becomes a Public Law eliminates Section
122001(a) of Public Law 111-148, the State or a unit of local
13government shall be prohibited from enrolling individuals in
14the Medical Assistance Program as the result of federal
15approval of a State Medicaid waiver on or after June 14, 2012
16(the effective date of Public Act 97-687), and any individuals
17enrolled in the Medical Assistance Program pursuant to
18eligibility permitted as a result of such a State Medicaid
19waiver shall become immediately ineligible.
20    Effective October 1, 2013, the determination of
21eligibility of persons who qualify under paragraphs 5, 6, 8,
2215, 17, and 18 of this Section shall comply with the
23requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
25    The Department of Healthcare and Family Services, the
26Department of Human Services, and the Illinois health



SB3062- 18 -LRB102 22925 KTG 32079 b

1insurance marketplace shall work cooperatively to assist
2persons who would otherwise lose health benefits as a result
3of changes made under Public Act 98-104 to transition to other
4health insurance coverage.
5    Notwithstanding any provision of this Section, beginning
6on January 1, 2024, the Department shall raise the income
7eligibility standard for all of its medical assistance
8programs to include persons whose income is equal to or less
9than 276% of the federal poverty level (or any higher
10percentage determined by the Department) plus 5% for the
11applicable family size as determined under 42 U.S.C.
121396a(e)(14) and applicable federal regulations. Persons
13eligible for medical assistance under this amendatory Act of
14the 102nd General Assembly shall receive coverage identical to
15the coverage provided to persons eligible for each medical
16assistance program under the income eligibility requirements
17in effect on December 31, 2023. The Department may adopt rules
18for the implementation of this amendatory Act of the 102nd
19General Assembly. This amendatory Act of the 102nd General
20Assembly does not apply to programs in which the income
21eligibility standard is higher than the standard created by
22this amendatory Act of the 102nd General Assembly.
23(Source: P.A. 101-10, eff. 6-5-19; 101-649, eff. 7-7-20;
24102-43, eff. 7-6-21; 102-558, eff. 8-20-21; 102-665, eff.
2510-8-21; revised 11-18-21.)