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Rep. Greg Harris
Filed: 3/1/2022
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1 | | AMENDMENT TO HOUSE BILL 4343
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2 | | AMENDMENT NO. ______. Amend House Bill 4343, AS AMENDED, |
3 | | by replacing everything after the enacting clause with the |
4 | | following:
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5 | | "Section 5. The Illinois Public Aid Code is amended by |
6 | | changing Section 11-5.1 and by adding Sections 5-1.6, 5-13.1 |
7 | | and 11-5.5 as follows: |
8 | | (305 ILCS 5/5-1.6 new) |
9 | | Sec. 5-1.6. Continuous eligibility; ex parte |
10 | | redeterminations. |
11 | | (a) By July 1, 2022, the Department of Healthcare and |
12 | | Family Services shall seek a State Plan amendment or any |
13 | | federal waivers necessary to make changes to the medical |
14 | | assistance program. The Department shall apply for federal |
15 | | approval to implement 12 months of continuous eligibility for |
16 | | adults participating in the medical assistance program. The |
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1 | | Department shall secure federal financial participation in |
2 | | accordance with this Section for expenditures made by the |
3 | | Department in State Fiscal Year 2023 and every State fiscal |
4 | | year thereafter. |
5 | | (b) By July 1, 2022, the Department of Healthcare and |
6 | | Family Services shall seek a State Plan amendment or any |
7 | | federal waivers or approvals necessary to make changes to the |
8 | | medical assistance redetermination process for people without |
9 | | any income at the time of redetermination. These changes shall |
10 | | seek to allow all people without income to be considered for ex |
11 | | parte redetermination. If there is no non-income related |
12 | | disqualifying information for medical assistance recipients |
13 | | without any income, then a person without any income shall be |
14 | | redetermined ex parte. Within 60 days after receiving federal |
15 | | approval or guidance, the Department of Healthcare and Family |
16 | | Services and the Department of Human Services shall make |
17 | | necessary technical and rule changes to implement changes to |
18 | | the redetermination process. The percentage of medical |
19 | | assistance recipients whose eligibility is renewed through the |
20 | | ex parte redetermination process shall be reported monthly by |
21 | | the Department of Healthcare and Family Services on its |
22 | | website in accordance with subsection (d) of Section 11-5.1 of |
23 | | this Code as well as shared in all Medicaid Advisory Committee |
24 | | meetings and Medicaid Advisory Committee Public Education |
25 | | Subcommittee meetings. |
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1 | | (305 ILCS 5/5-13.1 new) |
2 | | Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers, |
3 | | and making information about waivers more accessible. |
4 | | (a) It is the intent of the General Assembly to ease the |
5 | | burden of liens and estate recovery for correctly paid |
6 | | benefits for participants, applicants, and their families and |
7 | | heirs, and to make information about waivers more widely |
8 | | available. |
9 | | (b) The Department shall waive estate recovery under |
10 | | Sections 3-9 and 5-13 where recovery would not be |
11 | | cost-effective, would work an undue hardship, or for any other |
12 | | just reason, and shall make information about waivers and |
13 | | estate recovery easily accessible. |
14 | | (1) Cost-effectiveness waiver. Subject to federal |
15 | | approval, the Department shall waive any claim against the |
16 | | first $25,000 of any estate to prevent substantial and |
17 | | unreasonable hardship. The Department shall consider the |
18 | | gross assets in the estate, including, but not limited to, |
19 | | the net value of real estate less mortgages or liens with |
20 | | priority over the Department's claims. The Department may |
21 | | increase the cost-effectiveness threshold in the future. |
22 | | (2) Undue hardship waiver. The Department may develop |
23 | | additional hardship waiver standards in addition to those |
24 | | already employed, including, but not limited to, waivers |
25 | | aimed at preserving income-producing real property or a |
26 | | modest home as defined by rule. |
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1 | | (3) Accessible information. The Department shall make |
2 | | information about estate recovery and hardship waivers |
3 | | easily accessible. The Department shall maintain |
4 | | information about how to request a hardship waiver on its |
5 | | website in English, Spanish, and the next 4 most commonly |
6 | | used languages, including a short guide and simple form to |
7 | | facilitate requesting hardship exemptions in each |
8 | | language. On an annual basis, the Department shall |
9 | | publicly report on the number of estate recovery cases |
10 | | that are pursued and the number of undue hardship |
11 | | exemptions granted, including demographic data of the |
12 | | deceased beneficiaries where available. |
13 | | (305 ILCS 5/11-5.1) |
14 | | Sec. 11-5.1. Eligibility verification. Notwithstanding any |
15 | | other provision of this Code, with respect to applications for |
16 | | medical assistance provided under Article V of this Code, |
17 | | eligibility shall be determined in a manner that ensures |
18 | | program integrity and complies with federal laws and |
19 | | regulations while minimizing unnecessary barriers to |
20 | | enrollment. To this end, as soon as practicable, and unless |
21 | | the Department receives written denial from the federal |
22 | | government, this Section shall be implemented: |
23 | | (a) The Department of Healthcare and Family Services or |
24 | | its designees shall: |
25 | | (1) By no later than July 1, 2011, require |
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1 | | verification of, at a minimum, one month's income from all |
2 | | sources required for determining the eligibility of |
3 | | applicants for medical assistance under this Code. Such |
4 | | verification shall take the form of pay stubs, business or |
5 | | income and expense records for self-employed persons, |
6 | | letters from employers, and any other valid documentation |
7 | | of income including data obtained electronically by the |
8 | | Department or its designees from other sources as |
9 | | described in subsection (b) of this Section. A month's |
10 | | income may be verified by a single pay stub with the |
11 | | monthly income extrapolated from the time period covered |
12 | | by the pay stub. |
13 | | (2) By no later than October 1, 2011, require |
14 | | verification of, at a minimum, one month's income from all |
15 | | sources required for determining the continued eligibility |
16 | | of recipients at their annual review of eligibility for |
17 | | medical assistance under this Code. Information the |
18 | | Department receives prior to the annual review, including |
19 | | information available to the Department as a result of the |
20 | | recipient's application for other non-Medicaid benefits, |
21 | | that is sufficient to make a determination of continued |
22 | | Medicaid eligibility may be reviewed and verified, and |
23 | | subsequent action taken including client notification of |
24 | | continued Medicaid eligibility. The date of client |
25 | | notification establishes the date for subsequent annual |
26 | | Medicaid eligibility reviews. Such verification shall take |
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1 | | the form of pay stubs, business or income and expense |
2 | | records for self-employed persons, letters from employers, |
3 | | and any other valid documentation of income including data |
4 | | obtained electronically by the Department or its designees |
5 | | from other sources as described in subsection (b) of this |
6 | | Section. A month's income may be verified by a single pay |
7 | | stub with the monthly income extrapolated from the time |
8 | | period covered by the pay stub. The
Department shall send |
9 | | a notice to
recipients at least 60 days prior to the end of |
10 | | their period
of eligibility that informs them of the
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11 | | requirements for continued eligibility. If a recipient
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12 | | does not fulfill the requirements for continued |
13 | | eligibility by the
deadline established in the notice a |
14 | | notice of cancellation shall be issued to the recipient |
15 | | and coverage shall end no later than the last day of the |
16 | | month following the last day of the eligibility period. A |
17 | | recipient's eligibility may be reinstated without |
18 | | requiring a new application if the recipient fulfills the |
19 | | requirements for continued eligibility prior to the end of |
20 | | the third month following the last date of coverage (or |
21 | | longer period if required by federal regulations). Nothing |
22 | | in this Section shall prevent an individual whose coverage |
23 | | has been cancelled from reapplying for health benefits at |
24 | | any time. |
25 | | (3) By no later than July 1, 2011, require |
26 | | verification of Illinois residency. |
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1 | | The Department, with federal approval, may choose to adopt |
2 | | continuous financial eligibility for a full 12 months for |
3 | | adults on Medicaid. |
4 | | (b) The Department shall establish or continue cooperative
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5 | | arrangements with the Social Security Administration, the
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6 | | Illinois Secretary of State, the Department of Human Services,
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7 | | the Department of Revenue, the Department of Employment
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8 | | Security, and any other appropriate entity to gain electronic
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9 | | access, to the extent allowed by law, to information available
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10 | | to those entities that may be appropriate for electronically
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11 | | verifying any factor of eligibility for benefits under the
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12 | | Program. Data relevant to eligibility shall be provided for no
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13 | | other purpose than to verify the eligibility of new applicants |
14 | | or current recipients of health benefits under the Program. |
15 | | Data shall be requested or provided for any new applicant or |
16 | | current recipient only insofar as that individual's |
17 | | circumstances are relevant to that individual's or another |
18 | | individual's eligibility. |
19 | | (c) Within 90 days of the effective date of this |
20 | | amendatory Act of the 96th General Assembly, the Department of |
21 | | Healthcare and Family Services shall send notice to current |
22 | | recipients informing them of the changes regarding their |
23 | | eligibility verification.
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24 | | (d) As soon as practical if the data is reasonably |
25 | | available, but no later than January 1, 2017, the Department |
26 | | shall compile on a monthly basis data on eligibility |
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1 | | redeterminations of beneficiaries of medical assistance |
2 | | provided under Article V of this Code. In addition to the
other |
3 | | data required under this subsection, the Department
shall |
4 | | compile on a monthly basis data on the percentage of
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5 | | beneficiaries whose eligibility is renewed through ex parte
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6 | | redeterminations as described in subsection (b) of Section
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7 | | 5-1.6 of this Code, subject to federal approval of the changes
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8 | | made in subsection (b) of Section 5-1.6 by this amendatory Act
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9 | | of the 102nd General Assembly. This data shall be posted on the |
10 | | Department's website, and data from prior months shall be |
11 | | retained and available on the Department's website. The data |
12 | | compiled and reported shall include the following: |
13 | | (1) The total number of redetermination decisions made |
14 | | in a month and, of that total number, the number of |
15 | | decisions to continue or change benefits and the number of |
16 | | decisions to cancel benefits. |
17 | | (2) A breakdown of enrollee language preference for |
18 | | the total number of redetermination decisions made in a |
19 | | month and, of that total number, a breakdown of enrollee |
20 | | language preference for the number of decisions to |
21 | | continue or change benefits, and a breakdown of enrollee |
22 | | language preference for the number of decisions to cancel |
23 | | benefits. The language breakdown shall include, at a |
24 | | minimum, English, Spanish, and the next 4 most commonly |
25 | | used languages. |
26 | | (3) The percentage of cancellation decisions made in a |
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1 | | month due to each of the following: |
2 | | (A) The beneficiary's ineligibility due to excess |
3 | | income. |
4 | | (B) The beneficiary's ineligibility due to not |
5 | | being an Illinois resident. |
6 | | (C) The beneficiary's ineligibility due to being |
7 | | deceased. |
8 | | (D) The beneficiary's request to cancel benefits. |
9 | | (E) The beneficiary's lack of response after |
10 | | notices mailed to the beneficiary are returned to the |
11 | | Department as undeliverable by the United States |
12 | | Postal Service. |
13 | | (F) The beneficiary's lack of response to a |
14 | | request for additional information when reliable |
15 | | information in the beneficiary's account, or other |
16 | | more current information, is unavailable to the |
17 | | Department to make a decision on whether to continue |
18 | | benefits. |
19 | | (G) Other reasons tracked by the Department for |
20 | | the purpose of ensuring program integrity. |
21 | | (4) If a vendor is utilized to provide services in |
22 | | support of the Department's redetermination decision |
23 | | process, the total number of redetermination decisions |
24 | | made in a month and, of that total number, the number of |
25 | | decisions to continue or change benefits, and the number |
26 | | of decisions to cancel benefits (i) with the involvement |
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1 | | of the vendor and (ii) without the involvement of the |
2 | | vendor. |
3 | | (5) Of the total number of benefit cancellations in a |
4 | | month, the number of beneficiaries who return from |
5 | | cancellation within one month, the number of beneficiaries |
6 | | who return from cancellation within 2 months, and the |
7 | | number of beneficiaries who return from cancellation |
8 | | within 3 months. Of the number of beneficiaries who return |
9 | | from cancellation within 3 months, the percentage of those |
10 | | cancellations due to each of the reasons listed under |
11 | | paragraph (3) of this subsection. |
12 | | (e) The Department shall conduct a complete review of the |
13 | | Medicaid redetermination process in order to identify changes |
14 | | that can increase the use of ex parte redetermination |
15 | | processing. This review shall be completed within 90 days |
16 | | after the effective date of this amendatory Act of the 101st |
17 | | General Assembly. Within 90 days of completion of the review, |
18 | | the Department shall seek written federal approval of policy |
19 | | changes the review recommended and implement once approved. |
20 | | The review shall specifically include, but not be limited to, |
21 | | use of ex parte redeterminations of the following populations: |
22 | | (1) Recipients of developmental disabilities services. |
23 | | (2) Recipients of benefits under the State's Aid to |
24 | | the Aged, Blind, or Disabled program. |
25 | | (3) Recipients of Medicaid long-term care services and |
26 | | supports, including waiver services. |
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1 | | (4) All Modified Adjusted Gross Income (MAGI) |
2 | | populations. |
3 | | (5) Populations with no verifiable income. |
4 | | (6) Self-employed people. |
5 | | The report shall also outline populations and |
6 | | circumstances in which an ex parte redetermination is not a |
7 | | recommended option. |
8 | | (f) The Department shall explore and implement, as |
9 | | practical and technologically possible, roles that |
10 | | stakeholders outside State agencies can play to assist in |
11 | | expediting eligibility determinations and redeterminations |
12 | | within 24 months after the effective date of this amendatory |
13 | | Act of the 101st General Assembly. Such practical roles to be |
14 | | explored to expedite the eligibility determination processes |
15 | | shall include the implementation of hospital presumptive |
16 | | eligibility, as authorized by the Patient Protection and |
17 | | Affordable Care Act. |
18 | | (g) The Department or its designee shall seek federal |
19 | | approval to enhance the reasonable compatibility standard from |
20 | | 5% to 10%. |
21 | | (h) Reporting. The Department of Healthcare and Family |
22 | | Services and the Department of Human Services shall publish |
23 | | quarterly reports on their progress in implementing policies |
24 | | and practices pursuant to this Section as modified by this |
25 | | amendatory Act of the 101st General Assembly. |
26 | | (1) The reports shall include, but not be limited to, |
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1 | | the following: |
2 | | (A) Medical application processing, including a |
3 | | breakdown of the number of MAGI, non-MAGI, long-term |
4 | | care, and other medical cases pending for various |
5 | | incremental time frames between 0 to 181 or more days. |
6 | | (B) Medical redeterminations completed, including: |
7 | | (i) a breakdown of the number of households that were |
8 | | redetermined ex parte and those that were not; (ii) |
9 | | the reasons households were not redetermined ex parte; |
10 | | and (iii) the relative percentages of these reasons. |
11 | | (C) A narrative discussion on issues identified in |
12 | | the functioning of the State's Integrated Eligibility |
13 | | System and progress on addressing those issues, as |
14 | | well as progress on implementing strategies to address |
15 | | eligibility backlogs, including expanding ex parte |
16 | | determinations to ensure timely eligibility |
17 | | determinations and renewals. |
18 | | (2) Initial reports shall be issued within 90 days |
19 | | after the effective date of this amendatory Act of the |
20 | | 101st General Assembly. |
21 | | (3) All reports shall be published on the Department's |
22 | | website. |
23 | | (i) It is the determination of the General Assembly that |
24 | | the Department must include seniors and persons with |
25 | | disabilities in ex parte renewals. It is the determination of |
26 | | the General Assembly that the Department must use its asset |
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1 | | verification system to assist in the determination of whether |
2 | | an individual's coverage can be renewed using the ex parte |
3 | | process. If a State Plan amendment is required, the Department |
4 | | shall pursue such State Plan amendment by July 1, 2022. Within |
5 | | 60 days after receiving federal approval or guidance, the |
6 | | Department of Healthcare and Family Services and the |
7 | | Department of Human Services shall make necessary technical |
8 | | and rule changes to implement these changes to the |
9 | | redetermination process. |
10 | | (Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20.) |
11 | | (305 ILCS 5/11-5.5 new) |
12 | | Sec. 11-5.5. Streamlining enrollment into the Medicare |
13 | | Savings Program. |
14 | | (a) The Department shall investigate how to align the |
15 | | Medicare Part D Low-Income Subsidy and Medicare Savings |
16 | | Program eligibility criteria. |
17 | | (b) The Department shall issue a report making |
18 | | recommendations on how to streamline enrollment into Medicare |
19 | | Savings Program benefits by July 1, 2022. |
20 | | (c) Within 90 days after issuing its report, the |
21 | | Department shall seek public feedback on those recommendations |
22 | | and plans. |
23 | | (d) By July 1, 2023, the Department shall implement the |
24 | | necessary changes to streamline enrollment into the Medicare |
25 | | Savings Program. The Department may adopt any rules necessary |
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1 | | to implement the provisions of this paragraph.
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2 | | (305 ILCS 5/3-10 rep.)
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3 | | (305 ILCS 5/3-10.1 rep.)
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4 | | (305 ILCS 5/3-10.2 rep.)
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5 | | (305 ILCS 5/3-10.3 rep.)
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6 | | (305 ILCS 5/3-10.4 rep.)
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7 | | (305 ILCS 5/3-10.5 rep.)
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8 | | (305 ILCS 5/3-10.6 rep.)
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9 | | (305 ILCS 5/3-10.7 rep.)
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10 | | (305 ILCS 5/3-10.8 rep.)
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11 | | (305 ILCS 5/3-10.9 rep.)
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12 | | (305 ILCS 5/3-10.10 rep.)
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13 | | (305 ILCS 5/5-13.5 rep.) |
14 | | Section 10. The Illinois Public Aid Code is amended by |
15 | | repealing Sections 3-10, 3-10.1, 3-10.2, 3-10.3, 3-10.4, |
16 | | 3-10.5, 3-10.6, 3-10.7, 3-10.8, 3-10.9, and 3-10.10, and |
17 | | 5-13.5.
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18 | | Section 99. Effective date. This Act takes effect upon |
19 | | becoming law.".
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