Full Text of HB6253 97th General Assembly
HB6253ham001 97TH GENERAL ASSEMBLY | Rep. Sara Feigenholtz Filed: 1/2/2013
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| 1 | | AMENDMENT TO HOUSE BILL 6253
| 2 | | AMENDMENT NO. ______. Amend House Bill 6253 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Findings. The General Assembly finds it is in | 5 | | the best interests of the State to take advantage of the | 6 | | Patient Protection and Affordable Care Act to enable Illinois | 7 | | to receive enhanced federal revenue to cover the costs of | 8 | | health care for low-income adults who are otherwise not | 9 | | eligible for Medicaid. The General Assembly further finds that | 10 | | the administration and financing of the Medicaid program must | 11 | | be sound to ensure Illinois may take full advantage of national | 12 | | health care reform to keep people healthier; reimburse | 13 | | hospitals and clinics for uncompensated and charity care for | 14 | | the uninsured; and replace spending by county and local | 15 | | governments for healthcare costs now borne by local health | 16 | | departments, social service agencies, homeless shelters, | 17 | | mental health clinics, drug treatment centers, township |
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| 1 | | organizations, and others for the care of the uninsured. | 2 | | Accordingly, the General Assembly finds that, while filling the | 3 | | current gap in Medicaid coverage, it is essential that the | 4 | | State preserve and extend recent efforts to reform Illinois' | 5 | | Medicaid program. Changes designed to increase efficiencies | 6 | | and enhance program integrity must continue to prevent client | 7 | | and provider fraud and abuse; to impose controls on use of | 8 | | Medicaid services to prevent over-use or waste; to rationalize | 9 | | the Medicaid health care delivery system by adopting care | 10 | | coordination models wherever feasible to achieve effective and | 11 | | efficient care delivery across all covered services; and to | 12 | | operate the program within budget limits. | 13 | | Section 5. The Illinois Public Aid Code is amended by | 14 | | changing Sections 5-1.1, 5-1.4, and 5-2 as follows:
| 15 | | (305 ILCS 5/5-1.1) (from Ch. 23, par. 5-1.1)
| 16 | | Sec. 5-1.1. Definitions. The terms defined in this Section
| 17 | | shall have the meanings ascribed to them, except when the
| 18 | | context otherwise requires.
| 19 | | (a) "Nursing facility" means a facility, licensed by the | 20 | | Department of Public Health under the Nursing Home Care Act, | 21 | | that provides nursing facility services within the meaning of | 22 | | Title XIX of
the federal Social Security Act.
| 23 | | (b) "Intermediate care facility for the developmentally | 24 | | disabled" or "ICF/DD" means a facility, licensed by the |
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| 1 | | Department of Public Health under the ID/DD Community Care Act, | 2 | | that is an intermediate care facility for the mentally retarded | 3 | | within the meaning of Title XIX
of the federal Social Security | 4 | | Act.
| 5 | | (c) "Standard services" means those services required for
| 6 | | the care of all patients in the facility and shall, as a
| 7 | | minimum, include the following: (1) administration; (2)
| 8 | | dietary (standard); (3) housekeeping; (4) laundry and linen;
| 9 | | (5) maintenance of property and equipment, including | 10 | | utilities;
(6) medical records; (7) training of employees; (8) | 11 | | utilization
review; (9) activities services; (10) social | 12 | | services; (11)
disability services; and all other similar | 13 | | services required
by either the laws of the State of Illinois | 14 | | or one of its
political subdivisions or municipalities or by | 15 | | Title XIX of
the Social Security Act.
| 16 | | (d) "Patient services" means those which vary with the
| 17 | | number of personnel; professional and para-professional
skills | 18 | | of the personnel; specialized equipment, and reflect
the | 19 | | intensity of the medical and psycho-social needs of the
| 20 | | patients. Patient services shall as a minimum include:
(1) | 21 | | physical services; (2) nursing services, including
restorative | 22 | | nursing; (3) medical direction and patient care
planning; (4) | 23 | | health related supportive and habilitative
services and all | 24 | | similar services required by either the
laws of the State of | 25 | | Illinois or one of its political
subdivisions or municipalities | 26 | | or by Title XIX of the
Social Security Act.
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| 1 | | (e) "Ancillary services" means those services which
| 2 | | require a specific physician's order and defined as under
the | 3 | | medical assistance program as not being routine in
nature for | 4 | | skilled nursing facilities and ICF/DDs.
Such services | 5 | | generally must be authorized prior to delivery
and payment as | 6 | | provided for under the rules of the Department
of Healthcare | 7 | | and Family Services.
| 8 | | (f) "Capital" means the investment in a facility's assets
| 9 | | for both debt and non-debt funds. Non-debt capital is the
| 10 | | difference between an adjusted replacement value of the assets
| 11 | | and the actual amount of debt capital.
| 12 | | (g) "Profit" means the amount which shall accrue to a
| 13 | | facility as a result of its revenues exceeding its expenses
as | 14 | | determined in accordance with generally accepted accounting
| 15 | | principles.
| 16 | | (h) "Non-institutional services" means those services | 17 | | provided under
paragraph (f) of Section 3 of the Disabled | 18 | | Persons Rehabilitation Act and those services provided under | 19 | | Section 4.02 of the Illinois Act on the Aging.
| 20 | | (i) (Blank).
| 21 | | (j) "Institutionalized person" means an individual who is | 22 | | an inpatient
in an ICF/DD or nursing facility, or who is an | 23 | | inpatient in
a medical
institution receiving a level of care | 24 | | equivalent to that of an ICF/DD or nursing facility, or who is | 25 | | receiving services under
Section 1915(c) of the Social Security | 26 | | Act.
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| 1 | | (k) "Institutionalized spouse" means an institutionalized | 2 | | person who is
expected to receive services at the same level of | 3 | | care for at least 30 days
and is married to a spouse who is not | 4 | | an institutionalized person.
| 5 | | (l) "Community spouse" is the spouse of an | 6 | | institutionalized spouse.
| 7 | | (m) "Health Benefits Service Package" means, subject to | 8 | | federal approval, benefits covered by the medical assistance | 9 | | program as determined by the Department by rule for individuals | 10 | | eligible for medical assistance under paragraph 18 of Section | 11 | | 5-2 of this Code. | 12 | | (Source: P.A. 96-1530, eff. 2-16-11; 97-227, eff. 1-1-12; | 13 | | 97-820, eff. 7-17-12.)
| 14 | | (305 ILCS 5/5-1.4) | 15 | | Sec. 5-1.4. Moratorium on eligibility expansions. | 16 | | Beginning on January 25, 2011 (the effective date of Public Act | 17 | | 96-1501), there shall be a 4-year moratorium on the expansion | 18 | | of eligibility through increasing financial eligibility | 19 | | standards, or through increasing income disregards, or through | 20 | | the creation of new programs which would add new categories of | 21 | | eligible individuals under the medical assistance program in | 22 | | addition to those categories covered on January 1, 2011 or | 23 | | above the level of any subsequent reduction in eligibility. | 24 | | This moratorium shall not apply to expansions required as a | 25 | | federal condition of State participation in the medical |
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| 1 | | assistance program or to expansions approved by the federal | 2 | | government that are financed entirely by units of local | 3 | | government and federal matching funds. If the State of Illinois | 4 | | finds that the State has borne a cost related to such an | 5 | | expansion, the unit of local government shall reimburse the | 6 | | State. All federal funds associated with an expansion funded by | 7 | | a unit of local government shall be returned to the local | 8 | | government entity funding the expansion, pursuant to an | 9 | | intergovernmental agreement between the Department of | 10 | | Healthcare and Family Services and the local government entity. | 11 | | Within 10 calendar days of the effective date of this | 12 | | amendatory Act of the 97th General Assembly, the Department of | 13 | | Healthcare and Family Services shall formally advise the | 14 | | Centers for Medicare and Medicaid Services of the passage of | 15 | | this amendatory Act of the 97th General Assembly. The State is | 16 | | prohibited from submitting additional waiver requests that | 17 | | expand or allow for an increase in the classes of persons | 18 | | eligible for medical assistance under this Article to the | 19 | | federal government for its consideration beginning on the 20th | 20 | | calendar day following the effective date of this amendatory | 21 | | Act of the 97th General Assembly until January 25, 2015. This | 22 | | moratorium shall not apply to those persons eligible for | 23 | | medical assistance pursuant to 42 U.S.C. | 24 | | 1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of | 25 | | Section 5-2 of this Code.
| 26 | | (Source: P.A. 96-1501, eff. 1-25-11; 97-687, eff. 6-14-12.)
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| 1 | | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
| 2 | | Sec. 5-2. Classes of Persons Eligible. Medical assistance | 3 | | under this
Article shall be available to any of the following | 4 | | classes of persons in
respect to whom a plan for coverage has | 5 | | been submitted to the Governor
by the Illinois Department and | 6 | | approved by him:
| 7 | | 1. Recipients of basic maintenance grants under | 8 | | Articles III and IV.
| 9 | | 2. Persons otherwise eligible for basic maintenance | 10 | | under Articles
III and IV, excluding any eligibility | 11 | | requirements that are inconsistent with any federal law or | 12 | | federal regulation, as interpreted by the U.S. Department | 13 | | of Health and Human Services, but who fail to qualify | 14 | | thereunder on the basis of need or who qualify but are not | 15 | | receiving basic maintenance under Article IV, and
who have | 16 | | insufficient income and resources to meet the costs of
| 17 | | necessary medical care, including but not limited to the | 18 | | following:
| 19 | | (a) All persons otherwise eligible for basic | 20 | | maintenance under Article
III but who fail to qualify | 21 | | under that Article on the basis of need and who
meet | 22 | | either of the following requirements:
| 23 | | (i) their income, as determined by the | 24 | | Illinois Department in
accordance with any federal | 25 | | requirements, is equal to or less than 70% in
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| 1 | | fiscal year 2001, equal to or less than 85% in | 2 | | fiscal year 2002 and until
a date to be determined | 3 | | by the Department by rule, and equal to or less
| 4 | | than 100% beginning on the date determined by the | 5 | | Department by rule, of the nonfarm income official | 6 | | poverty
line, as defined by the federal Office of | 7 | | Management and Budget and revised
annually in | 8 | | accordance with Section 673(2) of the Omnibus | 9 | | Budget Reconciliation
Act of 1981, applicable to | 10 | | families of the same size; or
| 11 | | (ii) their income, after the deduction of | 12 | | costs incurred for medical
care and for other types | 13 | | of remedial care, is equal to or less than 70% in
| 14 | | fiscal year 2001, equal to or less than 85% in | 15 | | fiscal year 2002 and until
a date to be determined | 16 | | by the Department by rule, and equal to or less
| 17 | | than 100% beginning on the date determined by the | 18 | | Department by rule, of the nonfarm income official | 19 | | poverty
line, as defined in item (i) of this | 20 | | subparagraph (a).
| 21 | | (b) All persons who, excluding any eligibility | 22 | | requirements that are inconsistent with any federal | 23 | | law or federal regulation, as interpreted by the U.S. | 24 | | Department of Health and Human Services, would be | 25 | | determined eligible for such basic
maintenance under | 26 | | Article IV by disregarding the maximum earned income
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| 1 | | permitted by federal law.
| 2 | | 3. Persons who would otherwise qualify for Aid to the | 3 | | Medically
Indigent under Article VII.
| 4 | | 4. Persons not eligible under any of the preceding | 5 | | paragraphs who fall
sick, are injured, or die, not having | 6 | | sufficient money, property or other
resources to meet the | 7 | | costs of necessary medical care or funeral and burial
| 8 | | expenses.
| 9 | | 5.(a) Women during pregnancy, after the fact
of | 10 | | pregnancy has been determined by medical diagnosis, and | 11 | | during the
60-day period beginning on the last day of the | 12 | | pregnancy, together with
their infants and children born | 13 | | after September 30, 1983,
whose income and
resources are | 14 | | insufficient to meet the costs of necessary medical care to
| 15 | | the maximum extent possible under Title XIX of the
Federal | 16 | | Social Security Act.
| 17 | | (b) The Illinois Department and the Governor shall | 18 | | provide a plan for
coverage of the persons eligible under | 19 | | paragraph 5(a) by April 1, 1990. Such
plan shall provide | 20 | | ambulatory prenatal care to pregnant women during a
| 21 | | presumptive eligibility period and establish an income | 22 | | eligibility standard
that is equal to 133%
of the nonfarm | 23 | | income official poverty line, as defined by
the federal | 24 | | Office of Management and Budget and revised annually in
| 25 | | accordance with Section 673(2) of the Omnibus Budget | 26 | | Reconciliation Act of
1981, applicable to families of the |
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| 1 | | same size, provided that costs incurred
for medical care | 2 | | are not taken into account in determining such income
| 3 | | eligibility.
| 4 | | (c) The Illinois Department may conduct a | 5 | | demonstration in at least one
county that will provide | 6 | | medical assistance to pregnant women, together
with their | 7 | | infants and children up to one year of age,
where the | 8 | | income
eligibility standard is set up to 185% of the | 9 | | nonfarm income official
poverty line, as defined by the | 10 | | federal Office of Management and Budget.
The Illinois | 11 | | Department shall seek and obtain necessary authorization
| 12 | | provided under federal law to implement such a | 13 | | demonstration. Such
demonstration may establish resource | 14 | | standards that are not more
restrictive than those | 15 | | established under Article IV of this Code.
| 16 | | 6. Persons under the age of 18 who fail to qualify as | 17 | | dependent under
Article IV and who have insufficient income | 18 | | and resources to meet the costs
of necessary medical care | 19 | | to the maximum extent permitted under Title XIX
of the | 20 | | Federal Social Security Act.
| 21 | | 7. (Blank).
| 22 | | 8. Persons who become ineligible for basic maintenance | 23 | | assistance
under Article IV of this Code in programs | 24 | | administered by the Illinois
Department due to employment | 25 | | earnings and persons in
assistance units comprised of | 26 | | adults and children who become ineligible for
basic |
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| 1 | | maintenance assistance under Article VI of this Code due to
| 2 | | employment earnings. The plan for coverage for this class | 3 | | of persons shall:
| 4 | | (a) extend the medical assistance coverage for up | 5 | | to 12 months following
termination of basic | 6 | | maintenance assistance; and
| 7 | | (b) offer persons who have initially received 6 | 8 | | months of the
coverage provided in paragraph (a) above, | 9 | | the option of receiving an
additional 6 months of | 10 | | 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 while the person
was eligible for basic | 15 | | maintenance assistance;
| 16 | | (iii) no premium shall be charged for such | 17 | | coverage; and
| 18 | | (iv) such coverage shall be suspended in the | 19 | | event of a person's
failure without good cause to | 20 | | file in a timely fashion reports required for
this | 21 | | coverage under the Social Security Act and | 22 | | coverage shall be reinstated
upon the filing of | 23 | | such reports if the person remains otherwise | 24 | | eligible.
| 25 | | 9. Persons with acquired immunodeficiency syndrome | 26 | | (AIDS) or with
AIDS-related conditions with respect to whom |
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| 1 | | there has been a determination
that but for home or | 2 | | community-based services such individuals would
require | 3 | | the level of care provided in an inpatient hospital, | 4 | | skilled
nursing facility or intermediate care facility the | 5 | | cost of which is
reimbursed under this Article. Assistance | 6 | | shall be provided to such
persons to the maximum extent | 7 | | permitted under Title
XIX of the Federal Social Security | 8 | | Act.
| 9 | | 10. Participants in the long-term care insurance | 10 | | partnership program
established under the Illinois | 11 | | Long-Term Care Partnership Program Act who meet the
| 12 | | qualifications for protection of resources described in | 13 | | Section 15 of that
Act.
| 14 | | 11. Persons with disabilities who are employed and | 15 | | eligible for Medicaid,
pursuant to Section | 16 | | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | 17 | | subject to federal approval, persons with a medically | 18 | | improved disability who are employed and eligible for | 19 | | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | 20 | | the Social Security Act, as
provided by the Illinois | 21 | | Department by rule. In establishing eligibility standards | 22 | | under this paragraph 11, the Department shall, subject to | 23 | | federal approval: | 24 | | (a) set the income eligibility standard at not | 25 | | lower than 350% of the federal poverty level; | 26 | | (b) exempt retirement accounts that the person |
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| 1 | | cannot access without penalty before the age
of 59 1/2, | 2 | | and medical savings accounts established pursuant to | 3 | | 26 U.S.C. 220; | 4 | | (c) allow non-exempt assets up to $25,000 as to | 5 | | those assets accumulated during periods of eligibility | 6 | | under this paragraph 11; and
| 7 | | (d) continue to apply subparagraphs (b) and (c) in | 8 | | determining the eligibility of the person under this | 9 | | Article even if the person loses eligibility under this | 10 | | paragraph 11.
| 11 | | 12. Subject to federal approval, persons who are | 12 | | eligible for medical
assistance coverage under applicable | 13 | | provisions of the federal Social Security
Act and the | 14 | | federal Breast and Cervical Cancer Prevention and | 15 | | Treatment Act of
2000. Those eligible persons are defined | 16 | | to include, but not be limited to,
the following persons:
| 17 | | (1) persons who have been screened for breast or | 18 | | cervical cancer under
the U.S. Centers for Disease | 19 | | Control and Prevention Breast and Cervical Cancer
| 20 | | Program established under Title XV of the federal | 21 | | Public Health Services Act in
accordance with the | 22 | | requirements of Section 1504 of that Act as | 23 | | administered by
the Illinois Department of Public | 24 | | Health; and
| 25 | | (2) persons whose screenings under the above | 26 | | program were funded in whole
or in part by funds |
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| 1 | | appropriated to the Illinois Department of Public | 2 | | Health
for breast or cervical cancer screening.
| 3 | | "Medical assistance" under this paragraph 12 shall be | 4 | | identical to the benefits
provided under the State's | 5 | | approved plan under Title XIX of the Social Security
Act. | 6 | | The Department must request federal approval of the | 7 | | coverage under this
paragraph 12 within 30 days after the | 8 | | effective date of this amendatory Act of
the 92nd General | 9 | | Assembly.
| 10 | | In addition to the persons who are eligible for medical | 11 | | assistance pursuant to subparagraphs (1) and (2) of this | 12 | | paragraph 12, and to be paid from funds appropriated to the | 13 | | Department for its medical programs, any uninsured person | 14 | | as defined by the Department in rules residing in Illinois | 15 | | who is younger than 65 years of age, who has been screened | 16 | | for breast and cervical cancer in accordance with standards | 17 | | and procedures adopted by the Department of Public Health | 18 | | for screening, and who is referred to the Department by the | 19 | | Department of Public Health as being in need of treatment | 20 | | for breast or cervical cancer is eligible for medical | 21 | | assistance benefits that are consistent with the benefits | 22 | | provided to those persons described in subparagraphs (1) | 23 | | and (2). Medical assistance coverage for the persons who | 24 | | are eligible under the preceding sentence is not dependent | 25 | | on federal approval, but federal moneys may be used to pay | 26 | | for services provided under that coverage upon federal |
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| 1 | | approval. | 2 | | 13. Subject to appropriation and to federal approval, | 3 | | persons living with HIV/AIDS who are not otherwise eligible | 4 | | under this Article and who qualify for services covered | 5 | | under Section 5-5.04 as provided by the Illinois Department | 6 | | by rule.
| 7 | | 14. Subject to the availability of funds for this | 8 | | purpose, the Department may provide coverage under this | 9 | | Article to persons who reside in Illinois who are not | 10 | | eligible under any of the preceding paragraphs and who meet | 11 | | the income guidelines of paragraph 2(a) of this Section and | 12 | | (i) have an application for asylum pending before the | 13 | | federal Department of Homeland Security or on appeal before | 14 | | a court of competent jurisdiction and are represented | 15 | | either by counsel or by an advocate accredited by the | 16 | | federal Department of Homeland Security and employed by a | 17 | | not-for-profit organization in regard to that application | 18 | | or appeal, or (ii) are receiving services through a | 19 | | federally funded torture treatment center. Medical | 20 | | coverage under this paragraph 14 may be provided for up to | 21 | | 24 continuous months from the initial eligibility date so | 22 | | long as an individual continues to satisfy the criteria of | 23 | | this paragraph 14. If an individual has an appeal pending | 24 | | regarding an application for asylum before the Department | 25 | | of Homeland Security, eligibility under this paragraph 14 | 26 | | may be extended until a final decision is rendered on the |
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| 1 | | appeal. The Department may adopt rules governing the | 2 | | implementation of this paragraph 14.
| 3 | | 15. Family Care Eligibility. | 4 | | (a) On and after July 1, 2012, a caretaker relative | 5 | | who is 19 years of age or older when countable income | 6 | | is at or below 133% of the Federal Poverty Level | 7 | | Guidelines, as published annually in the Federal | 8 | | Register, for the appropriate family size. A person may | 9 | | not spend down to become eligible under this paragraph | 10 | | 15. | 11 | | (b) Eligibility shall be reviewed annually. | 12 | | (c) (Blank). | 13 | | (d) (Blank). | 14 | | (e) (Blank). | 15 | | (f) (Blank). | 16 | | (g) (Blank). | 17 | | (h) (Blank). | 18 | | (i) Following termination of an individual's | 19 | | coverage under this paragraph 15, the individual must | 20 | | be determined eligible before the person can be | 21 | | re-enrolled. | 22 | | 16. Subject to appropriation, uninsured persons who | 23 | | are not otherwise eligible under this Section who have been | 24 | | certified and referred by the Department of Public Health | 25 | | as having been screened and found to need diagnostic | 26 | | evaluation or treatment, or both diagnostic evaluation and |
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| 1 | | treatment, for prostate or testicular cancer. For the | 2 | | purposes of this paragraph 16, uninsured persons are those | 3 | | who do not have creditable coverage, as defined under the | 4 | | Health Insurance Portability and Accountability Act, or | 5 | | have otherwise exhausted any insurance benefits they may | 6 | | have had, for prostate or testicular cancer diagnostic | 7 | | evaluation or treatment, or both diagnostic evaluation and | 8 | | treatment.
To be eligible, a person must furnish a Social | 9 | | Security number.
A person's assets are exempt from | 10 | | consideration in determining eligibility under this | 11 | | paragraph 16.
Such persons shall be eligible for medical | 12 | | assistance under this paragraph 16 for so long as they need | 13 | | treatment for the cancer. A person shall be considered to | 14 | | need treatment if, in the opinion of the person's treating | 15 | | physician, the person requires therapy directed toward | 16 | | cure or palliation of prostate or testicular cancer, | 17 | | including recurrent metastatic cancer that is a known or | 18 | | presumed complication of prostate or testicular cancer and | 19 | | complications resulting from the treatment modalities | 20 | | themselves. Persons who require only routine monitoring | 21 | | services are not considered to need treatment.
"Medical | 22 | | assistance" under this paragraph 16 shall be identical to | 23 | | the benefits provided under the State's approved plan under | 24 | | Title XIX of the Social Security Act.
Notwithstanding any | 25 | | other provision of law, the Department (i) does not have a | 26 | | claim against the estate of a deceased recipient of |
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| 1 | | services under this paragraph 16 and (ii) does not have a | 2 | | lien against any homestead property or other legal or | 3 | | equitable real property interest owned by a recipient of | 4 | | services under this paragraph 16. | 5 | | 17. Persons who, pursuant to a waiver approved by the | 6 | | Secretary of the U.S. Department of Health and Human | 7 | | Services, are eligible for medical assistance under Title | 8 | | XIX or XXI of the federal Social Security Act. | 9 | | Notwithstanding any other provision of this Code and | 10 | | consistent with the terms of the approved waiver, the | 11 | | Illinois Department, may by rule: | 12 | | (a) Limit the geographic areas in which the waiver | 13 | | program operates. | 14 | | (b) Determine the scope, quantity, duration, and | 15 | | quality, and the rate and method of reimbursement, of | 16 | | the medical services to be provided, which may differ | 17 | | from those for other classes of persons eligible for | 18 | | assistance under this Article. | 19 | | (c) Restrict the persons' freedom in choice of | 20 | | providers. | 21 | | 18. Beginning January 1, 2014, persons aged 19 or | 22 | | older, but younger than 65, who are not otherwise eligible | 23 | | for medical assistance under this Section 5-2, who qualify | 24 | | for medical assistance pursuant to 42 U.S.C. | 25 | | 1396a(a)(10)(A)(i)(VIII) and as set forth in 42 CFR | 26 | | 435.119, and who have income at or below 133% of the |
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| 1 | | federal poverty level plus 5% for the applicable family | 2 | | size as determined pursuant to 42 U.S.C. 1396a(e)(14) and | 3 | | as set forth in 42 CFR 435.603. Persons eligible for | 4 | | medical assistance under this paragraph 18 shall receive | 5 | | coverage for the Health Benefits Service Package as that | 6 | | term is defined in subsection (m) of Section 5-1.1 of this | 7 | | Code. If Illinois' federal medical assistance percentage | 8 | | (FMAP) is reduced below 90% for persons eligible for | 9 | | medical
assistance under this paragraph 18, eligibility | 10 | | under this paragraph 18 shall cease, subject to federal | 11 | | approval, no later than the end of the third month | 12 | | following the month in which the reduction in FMAP takes | 13 | | effect. | 14 | | In implementing the provisions of Public Act 96-20, the | 15 | | Department is authorized to adopt only those rules necessary, | 16 | | including emergency rules. Nothing in Public Act 96-20 permits | 17 | | the Department to adopt rules or issue a decision that expands | 18 | | eligibility for the FamilyCare Program to a person whose income | 19 | | exceeds 185% of the Federal Poverty Level as determined from | 20 | | time to time by the U.S. Department of Health and Human | 21 | | Services, unless the Department is provided with express | 22 | | statutory authority. | 23 | | The Illinois Department and the Governor shall provide a | 24 | | plan for
coverage of the persons eligible under paragraph 7 as | 25 | | soon as possible after
July 1, 1984.
| 26 | | The eligibility of any such person for medical assistance |
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| 1 | | under this
Article is not affected by the payment of any grant | 2 | | under the Senior
Citizens and Disabled Persons Property Tax | 3 | | Relief Act or any distributions or items of income described | 4 | | under
subparagraph (X) of
paragraph (2) of subsection (a) of | 5 | | Section 203 of the Illinois Income Tax
Act. The Department | 6 | | shall by rule establish the amounts of
assets to be disregarded | 7 | | in determining eligibility for medical assistance,
which shall | 8 | | at a minimum equal the amounts to be disregarded under the
| 9 | | Federal Supplemental Security Income Program. The amount of | 10 | | assets of a
single person to be disregarded
shall not be less | 11 | | than $2,000, and the amount of assets of a married couple
to be | 12 | | disregarded shall not be less than $3,000.
| 13 | | To the extent permitted under federal law, any person found | 14 | | guilty of a
second violation of Article VIIIA
shall be | 15 | | ineligible for medical assistance under this Article, as | 16 | | provided
in Section 8A-8.
| 17 | | The eligibility of any person for medical assistance under | 18 | | this Article
shall not be affected by the receipt by the person | 19 | | of donations or benefits
from fundraisers held for the person | 20 | | in cases of serious illness,
as long as neither the person nor | 21 | | members of the person's family
have actual control over the | 22 | | donations or benefits or the disbursement
of the donations or | 23 | | benefits.
| 24 | | Notwithstanding any other provision of this Code, if the | 25 | | United States Supreme Court holds Title II, Subtitle A, Section | 26 | | 2001(a) of Public Law 111-148 to be unconstitutional, or if a |
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| 1 | | holding of Public Law 111-148 makes Medicaid eligibility | 2 | | allowed under Section 2001(a) inoperable, the State or a unit | 3 | | of local government shall be prohibited from enrolling | 4 | | individuals in the Medical Assistance Program as the result of | 5 | | federal approval of a State Medicaid waiver on or after the | 6 | | effective date of this amendatory Act of the 97th General | 7 | | Assembly, and any individuals enrolled in the Medical | 8 | | Assistance Program pursuant to eligibility permitted as a | 9 | | result of such a State Medicaid waiver shall become immediately | 10 | | ineligible. | 11 | | Notwithstanding any other provision of this Code, if an Act | 12 | | of Congress that becomes a Public Law eliminates Section | 13 | | 2001(a) of Public Law 111-148, the State or a unit of local | 14 | | government shall be prohibited from enrolling individuals in | 15 | | the Medical Assistance Program as the result of federal | 16 | | approval of a State Medicaid waiver on or after the effective | 17 | | date of this amendatory Act of the 97th General Assembly, and | 18 | | any individuals enrolled in the Medical Assistance Program | 19 | | pursuant to eligibility permitted as a result of such a State | 20 | | Medicaid waiver shall become immediately ineligible. | 21 | | (Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; | 22 | | 96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. | 23 | | 7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, | 24 | | eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; | 25 | | 97-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff. | 26 | | 7-13-12; revised 7-23-12.)
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| 1 | | Section 99. Effective date. This Act takes effect upon | 2 | | becoming law.".
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