Full Text of HB2019 98th General Assembly
HB2019 98TH GENERAL ASSEMBLY |
| | 98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014 HB2019 Introduced , by Rep. Tom Cross SYNOPSIS AS INTRODUCED: | | 305 ILCS 5/5-2 | from Ch. 23, par. 5-2 |
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Amends the Illinois Public Aid Code. Makes a technical change
in a Section concerning the classes of persons eligible for Medicaid.
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| | A BILL FOR |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing 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 | 8 | | under this
Article shall be available to any of the
the | 9 | | following classes of persons in
respect to whom a plan for | 10 | | coverage has been submitted to the Governor
by the Illinois | 11 | | Department and approved by him: | 12 | | 1. Recipients of basic maintenance grants under | 13 | | Articles III and IV.
| 14 | | 2. Persons otherwise eligible for basic maintenance | 15 | | under Articles
III and IV, excluding any eligibility | 16 | | requirements that are inconsistent with any federal law or | 17 | | federal regulation, as interpreted by the U.S. Department | 18 | | of Health and Human Services, but who fail to qualify | 19 | | thereunder on the basis of need or who qualify but are not | 20 | | receiving basic maintenance under Article IV, and
who have | 21 | | insufficient income and resources to meet the costs of
| 22 | | necessary medical care, including but not limited to the | 23 | | following:
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| 1 | | (a) All persons otherwise eligible for basic | 2 | | maintenance under Article
III but who fail to qualify | 3 | | under that Article on the basis of need and who
meet | 4 | | either of the following requirements:
| 5 | | (i) their income, as determined by the | 6 | | Illinois Department in
accordance with any federal | 7 | | requirements, is equal to or less than 70% in
| 8 | | fiscal year 2001, equal to or less than 85% in | 9 | | fiscal year 2002 and until
a date to be determined | 10 | | by the Department by rule, and equal to or less
| 11 | | than 100% beginning on the date determined by the | 12 | | Department by rule, of the nonfarm income official | 13 | | poverty
line, as defined by the federal Office of | 14 | | Management and Budget and revised
annually in | 15 | | accordance with Section 673(2) of the Omnibus | 16 | | Budget Reconciliation
Act of 1981, applicable to | 17 | | families of the same size; or
| 18 | | (ii) their income, after the deduction of | 19 | | costs incurred for medical
care and for other types | 20 | | of remedial care, is equal to or less than 70% in
| 21 | | fiscal year 2001, equal to or less than 85% in | 22 | | fiscal year 2002 and until
a date to be determined | 23 | | by the Department by rule, and equal to or less
| 24 | | than 100% beginning on the date determined by the | 25 | | Department by rule, of the nonfarm income official | 26 | | poverty
line, as defined in item (i) of this |
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| 1 | | subparagraph (a).
| 2 | | (b) All persons who, excluding any eligibility | 3 | | requirements that are inconsistent with any federal | 4 | | law or federal regulation, as interpreted by the U.S. | 5 | | Department of Health and Human Services, would be | 6 | | determined eligible for such basic
maintenance under | 7 | | Article IV by disregarding the maximum earned income
| 8 | | permitted by federal law.
| 9 | | 3. Persons who would otherwise qualify for Aid to the | 10 | | Medically
Indigent under Article VII.
| 11 | | 4. Persons not eligible under any of the preceding | 12 | | paragraphs who fall
sick, are injured, or die, not having | 13 | | sufficient money, property or other
resources to meet the | 14 | | costs of necessary medical care or funeral and burial
| 15 | | expenses.
| 16 | | 5.(a) Women during pregnancy, after the fact
of | 17 | | pregnancy has been determined by medical diagnosis, and | 18 | | during the
60-day period beginning on the last day of the | 19 | | pregnancy, together with
their infants and children born | 20 | | after September 30, 1983,
whose income and
resources are | 21 | | insufficient to meet the costs of necessary medical care to
| 22 | | the maximum extent possible under Title XIX of the
Federal | 23 | | Social Security Act.
| 24 | | (b) The Illinois Department and the Governor shall | 25 | | provide a plan for
coverage of the persons eligible under | 26 | | paragraph 5(a) by April 1, 1990. Such
plan shall provide |
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| 1 | | ambulatory prenatal care to pregnant women during a
| 2 | | presumptive eligibility period and establish an income | 3 | | eligibility standard
that is equal to 133%
of the nonfarm | 4 | | income official poverty line, as defined by
the federal | 5 | | Office of Management and Budget and revised annually in
| 6 | | accordance with Section 673(2) of the Omnibus Budget | 7 | | Reconciliation Act of
1981, applicable to families of the | 8 | | same size, provided that costs incurred
for medical care | 9 | | are not taken into account in determining such income
| 10 | | eligibility.
| 11 | | (c) The Illinois Department may conduct a | 12 | | demonstration in at least one
county that will provide | 13 | | medical assistance to pregnant women, together
with their | 14 | | infants and children up to one year of age,
where the | 15 | | income
eligibility standard is set up to 185% of the | 16 | | nonfarm income official
poverty line, as defined by the | 17 | | federal Office of Management and Budget.
The Illinois | 18 | | Department shall seek and obtain necessary authorization
| 19 | | provided under federal law to implement such a | 20 | | demonstration. Such
demonstration may establish resource | 21 | | standards that are not more
restrictive than those | 22 | | established under Article IV of this Code.
| 23 | | 6. Persons under the age of 18 who fail to qualify as | 24 | | dependent under
Article IV and who have insufficient income | 25 | | and resources to meet the costs
of necessary medical care | 26 | | to the maximum extent permitted under Title XIX
of the |
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| 1 | | Federal Social Security Act.
| 2 | | 7. (Blank).
| 3 | | 8. Persons who become ineligible for basic maintenance | 4 | | assistance
under Article IV of this Code in programs | 5 | | administered by the Illinois
Department due to employment | 6 | | earnings and persons in
assistance units comprised of | 7 | | adults and children who become ineligible for
basic | 8 | | maintenance assistance under Article VI of this Code due to
| 9 | | employment earnings. The plan for coverage for this class | 10 | | of persons shall:
| 11 | | (a) extend the medical assistance coverage for up | 12 | | to 12 months following
termination of basic | 13 | | maintenance assistance; and
| 14 | | (b) offer persons who have initially received 6 | 15 | | months of the
coverage provided in paragraph (a) above, | 16 | | the option of receiving an
additional 6 months of | 17 | | coverage, subject to the following:
| 18 | | (i) such coverage shall be pursuant to | 19 | | provisions of the federal
Social Security Act;
| 20 | | (ii) such coverage shall include all services | 21 | | covered while the person
was eligible for basic | 22 | | maintenance assistance;
| 23 | | (iii) no premium shall be charged for such | 24 | | coverage; and
| 25 | | (iv) such coverage shall be suspended in the | 26 | | event of a person's
failure without good cause to |
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| 1 | | file in a timely fashion reports required for
this | 2 | | coverage under the Social Security Act and | 3 | | coverage shall be reinstated
upon the filing of | 4 | | such reports if the person remains otherwise | 5 | | eligible.
| 6 | | 9. Persons with acquired immunodeficiency syndrome | 7 | | (AIDS) or with
AIDS-related conditions with respect to whom | 8 | | there has been a determination
that but for home or | 9 | | community-based services such individuals would
require | 10 | | the level of care provided in an inpatient hospital, | 11 | | skilled
nursing facility or intermediate care facility the | 12 | | cost of which is
reimbursed under this Article. Assistance | 13 | | shall be provided to such
persons to the maximum extent | 14 | | permitted under Title
XIX of the Federal Social Security | 15 | | Act.
| 16 | | 10. Participants in the long-term care insurance | 17 | | partnership program
established under the Illinois | 18 | | Long-Term Care Partnership Program Act who meet the
| 19 | | qualifications for protection of resources described in | 20 | | Section 15 of that
Act.
| 21 | | 11. Persons with disabilities who are employed and | 22 | | eligible for Medicaid,
pursuant to Section | 23 | | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | 24 | | subject to federal approval, persons with a medically | 25 | | improved disability who are employed and eligible for | 26 | | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of |
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| 1 | | the Social Security Act, as
provided by the Illinois | 2 | | Department by rule. In establishing eligibility standards | 3 | | under this paragraph 11, the Department shall, subject to | 4 | | federal approval: | 5 | | (a) set the income eligibility standard at not | 6 | | lower than 350% of the federal poverty level; | 7 | | (b) exempt retirement accounts that the person | 8 | | cannot access without penalty before the age
of 59 1/2, | 9 | | and medical savings accounts established pursuant to | 10 | | 26 U.S.C. 220; | 11 | | (c) allow non-exempt assets up to $25,000 as to | 12 | | those assets accumulated during periods of eligibility | 13 | | under this paragraph 11; and
| 14 | | (d) continue to apply subparagraphs (b) and (c) in | 15 | | determining the eligibility of the person under this | 16 | | Article even if the person loses eligibility under this | 17 | | paragraph 11.
| 18 | | 12. Subject to federal approval, persons who are | 19 | | eligible for medical
assistance coverage under applicable | 20 | | provisions of the federal Social Security
Act and the | 21 | | federal Breast and Cervical Cancer Prevention and | 22 | | Treatment Act of
2000. Those eligible persons are defined | 23 | | to include, but not be limited to,
the following persons:
| 24 | | (1) persons who have been screened for breast or | 25 | | cervical cancer under
the U.S. Centers for Disease | 26 | | Control and Prevention Breast and Cervical Cancer
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| 1 | | Program established under Title XV of the federal | 2 | | Public Health Services Act in
accordance with the | 3 | | requirements of Section 1504 of that Act as | 4 | | administered by
the Illinois Department of Public | 5 | | Health; and
| 6 | | (2) persons whose screenings under the above | 7 | | program were funded in whole
or in part by funds | 8 | | appropriated to the Illinois Department of Public | 9 | | Health
for breast or cervical cancer screening.
| 10 | | "Medical assistance" under this paragraph 12 shall be | 11 | | identical to the benefits
provided under the State's | 12 | | approved plan under Title XIX of the Social Security
Act. | 13 | | The Department must request federal approval of the | 14 | | coverage under this
paragraph 12 within 30 days after the | 15 | | effective date of this amendatory Act of
the 92nd General | 16 | | Assembly.
| 17 | | In addition to the persons who are eligible for medical | 18 | | assistance pursuant to subparagraphs (1) and (2) of this | 19 | | paragraph 12, and to be paid from funds appropriated to the | 20 | | Department for its medical programs, any uninsured person | 21 | | as defined by the Department in rules residing in Illinois | 22 | | who is younger than 65 years of age, who has been screened | 23 | | for breast and cervical cancer in accordance with standards | 24 | | and procedures adopted by the Department of Public Health | 25 | | for screening, and who is referred to the Department by the | 26 | | Department of Public Health as being in need of treatment |
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| 1 | | for breast or cervical cancer is eligible for medical | 2 | | assistance benefits that are consistent with the benefits | 3 | | provided to those persons described in subparagraphs (1) | 4 | | and (2). Medical assistance coverage for the persons who | 5 | | are eligible under the preceding sentence is not dependent | 6 | | on federal approval, but federal moneys may be used to pay | 7 | | for services provided under that coverage upon federal | 8 | | approval. | 9 | | 13. Subject to appropriation and to federal approval, | 10 | | persons living with HIV/AIDS who are not otherwise eligible | 11 | | under this Article and who qualify for services covered | 12 | | under Section 5-5.04 as provided by the Illinois Department | 13 | | by rule.
| 14 | | 14. Subject to the availability of funds for this | 15 | | purpose, the Department may provide coverage under this | 16 | | Article to persons who reside in Illinois who are not | 17 | | eligible under any of the preceding paragraphs and who meet | 18 | | the income guidelines of paragraph 2(a) of this Section and | 19 | | (i) have an application for asylum pending before the | 20 | | federal Department of Homeland Security or on appeal before | 21 | | a court of competent jurisdiction and are represented | 22 | | either by counsel or by an advocate accredited by the | 23 | | federal Department of Homeland Security and employed by a | 24 | | not-for-profit organization in regard to that application | 25 | | or appeal, or (ii) are receiving services through a | 26 | | federally funded torture treatment center. Medical |
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| 1 | | coverage under this paragraph 14 may be provided for up to | 2 | | 24 continuous months from the initial eligibility date so | 3 | | long as an individual continues to satisfy the criteria of | 4 | | this paragraph 14. If an individual has an appeal pending | 5 | | regarding an application for asylum before the Department | 6 | | of Homeland Security, eligibility under this paragraph 14 | 7 | | may be extended until a final decision is rendered on the | 8 | | appeal. The Department may adopt rules governing the | 9 | | implementation of this paragraph 14.
| 10 | | 15. Family Care Eligibility. | 11 | | (a) On and after July 1, 2012, a caretaker relative | 12 | | who is 19 years of age or older when countable income | 13 | | is at or below 133% of the Federal Poverty Level | 14 | | Guidelines, as published annually in the Federal | 15 | | Register, for the appropriate family size. A person may | 16 | | not spend down to become eligible under this paragraph | 17 | | 15. | 18 | | (b) Eligibility shall be reviewed annually. | 19 | | (c) (Blank). | 20 | | (d) (Blank). | 21 | | (e) (Blank). | 22 | | (f) (Blank). | 23 | | (g) (Blank). | 24 | | (h) (Blank). | 25 | | (i) Following termination of an individual's | 26 | | coverage under this paragraph 15, the individual must |
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| 1 | | be determined eligible before the person can be | 2 | | re-enrolled. | 3 | | 16. Subject to appropriation, uninsured persons who | 4 | | are not otherwise eligible under this Section who have been | 5 | | certified and referred by the Department of Public Health | 6 | | as having been screened and found to need diagnostic | 7 | | evaluation or treatment, or both diagnostic evaluation and | 8 | | treatment, for prostate or testicular cancer. For the | 9 | | purposes of this paragraph 16, uninsured persons are those | 10 | | who do not have creditable coverage, as defined under the | 11 | | Health Insurance Portability and Accountability Act, or | 12 | | have otherwise exhausted any insurance benefits they may | 13 | | have had, for prostate or testicular cancer diagnostic | 14 | | evaluation or treatment, or both diagnostic evaluation and | 15 | | treatment.
To be eligible, a person must furnish a Social | 16 | | Security number.
A person's assets are exempt from | 17 | | consideration in determining eligibility under this | 18 | | paragraph 16.
Such persons shall be eligible for medical | 19 | | assistance under this paragraph 16 for so long as they need | 20 | | treatment for the cancer. A person shall be considered to | 21 | | need treatment if, in the opinion of the person's treating | 22 | | physician, the person requires therapy directed toward | 23 | | cure or palliation of prostate or testicular cancer, | 24 | | including recurrent metastatic cancer that is a known or | 25 | | presumed complication of prostate or testicular cancer and | 26 | | complications resulting from the treatment modalities |
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| 1 | | themselves. Persons who require only routine monitoring | 2 | | services are not considered to need treatment.
"Medical | 3 | | assistance" under this paragraph 16 shall be identical to | 4 | | the benefits provided under the State's approved plan under | 5 | | Title XIX of the Social Security Act.
Notwithstanding any | 6 | | other provision of law, the Department (i) does not have a | 7 | | claim against the estate of a deceased recipient of | 8 | | services under this paragraph 16 and (ii) does not have a | 9 | | lien against any homestead property or other legal or | 10 | | equitable real property interest owned by a recipient of | 11 | | services under this paragraph 16. | 12 | | 17. Persons who, pursuant to a waiver approved by the | 13 | | Secretary of the U.S. Department of Health and Human | 14 | | Services, are eligible for medical assistance under Title | 15 | | XIX or XXI of the federal Social Security Act. | 16 | | Notwithstanding any other provision of this Code and | 17 | | consistent with the terms of the approved waiver, the | 18 | | Illinois Department, may by rule: | 19 | | (a) Limit the geographic areas in which the waiver | 20 | | program operates. | 21 | | (b) Determine the scope, quantity, duration, and | 22 | | quality, and the rate and method of reimbursement, of | 23 | | the medical services to be provided, which may differ | 24 | | from those for other classes of persons eligible for | 25 | | assistance under this Article. | 26 | | (c) Restrict the persons' freedom in choice of |
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| 1 | | providers. | 2 | | In implementing the provisions of Public Act 96-20, the | 3 | | Department is authorized to adopt only those rules necessary, | 4 | | including emergency rules. Nothing in Public Act 96-20 permits | 5 | | the Department to adopt rules or issue a decision that expands | 6 | | eligibility for the FamilyCare Program to a person whose income | 7 | | exceeds 185% of the Federal Poverty Level as determined from | 8 | | time to time by the U.S. Department of Health and Human | 9 | | Services, unless the Department is provided with express | 10 | | statutory authority. | 11 | | The Illinois Department and the Governor shall provide a | 12 | | plan for
coverage of the persons eligible under paragraph 7 as | 13 | | soon as possible after
July 1, 1984.
| 14 | | The eligibility of any such person for medical assistance | 15 | | under this
Article is not affected by the payment of any grant | 16 | | under the Senior
Citizens and Disabled Persons Property Tax | 17 | | Relief Act or any distributions or items of income described | 18 | | under
subparagraph (X) of
paragraph (2) of subsection (a) of | 19 | | Section 203 of the Illinois Income Tax
Act. The Department | 20 | | shall by rule establish the amounts of
assets to be disregarded | 21 | | in determining eligibility for medical assistance,
which shall | 22 | | at a minimum equal the amounts to be disregarded under the
| 23 | | Federal Supplemental Security Income Program. The amount of | 24 | | assets of a
single person to be disregarded
shall not be less | 25 | | than $2,000, and the amount of assets of a married couple
to be | 26 | | disregarded shall not be less than $3,000.
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| 1 | | To the extent permitted under federal law, any person found | 2 | | guilty of a
second violation of Article VIIIA
shall be | 3 | | ineligible for medical assistance under this Article, as | 4 | | provided
in Section 8A-8.
| 5 | | The eligibility of any person for medical assistance under | 6 | | this Article
shall not be affected by the receipt by the person | 7 | | of donations or benefits
from fundraisers held for the person | 8 | | in cases of serious illness,
as long as neither the person nor | 9 | | members of the person's family
have actual control over the | 10 | | donations or benefits or the disbursement
of the donations or | 11 | | benefits.
| 12 | | Notwithstanding any other provision of this Code, if the | 13 | | United States Supreme Court holds Title II, Subtitle A, Section | 14 | | 2001(a) of Public Law 111-148 to be unconstitutional, or if a | 15 | | holding of Public Law 111-148 makes Medicaid eligibility | 16 | | allowed under Section 2001(a) inoperable, the State or a unit | 17 | | of local government shall be prohibited from enrolling | 18 | | individuals in the Medical Assistance Program as the result of | 19 | | federal approval of a State Medicaid waiver on or after the | 20 | | effective date of this amendatory Act of the 97th General | 21 | | Assembly, and any individuals enrolled in the Medical | 22 | | Assistance Program pursuant to eligibility permitted as a | 23 | | result of such a State Medicaid waiver shall become immediately | 24 | | ineligible. | 25 | | Notwithstanding any other provision of this Code, if an Act | 26 | | of Congress that becomes a Public Law eliminates Section |
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| 1 | | 2001(a) of Public Law 111-148, the State or a unit of local | 2 | | government shall be prohibited from enrolling individuals in | 3 | | the Medical Assistance Program as the result of federal | 4 | | approval of a State Medicaid waiver on or after the effective | 5 | | date of this amendatory Act of the 97th General Assembly, and | 6 | | any individuals enrolled in the Medical Assistance Program | 7 | | pursuant to eligibility permitted as a result of such a State | 8 | | Medicaid waiver shall become immediately ineligible. | 9 | | (Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; | 10 | | 96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. | 11 | | 7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, | 12 | | eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; | 13 | | 97-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff. | 14 | | 7-13-12; revised 7-23-12.)
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