Full Text of SB3133 097th General Assembly
SB3133 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 SB3133 Introduced 2/1/2012, by Sen. Christine Radogno 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. Persons who are under 21 years of age and would
| 3 | | qualify as
disabled as defined under the Federal | 4 | | Supplemental Security Income Program,
provided medical | 5 | | service for such persons would be eligible for Federal
| 6 | | Financial Participation, and provided the Illinois | 7 | | Department determines that:
| 8 | | (a) the person requires a level of care provided by | 9 | | a hospital, skilled
nursing facility, or intermediate | 10 | | care facility, as determined by a physician
licensed to | 11 | | practice medicine in all its branches;
| 12 | | (b) it is appropriate to provide such care outside | 13 | | of an institution, as
determined by a physician | 14 | | licensed to practice medicine in all its branches;
| 15 | | (c) the estimated amount which would be expended | 16 | | for care outside the
institution is not greater than | 17 | | the estimated amount which would be
expended in an | 18 | | institution.
| 19 | | 8. Persons who become ineligible for basic maintenance | 20 | | assistance
under Article IV of this Code in programs | 21 | | administered by the Illinois
Department due to employment | 22 | | earnings and persons in
assistance units comprised of | 23 | | adults and children who become ineligible for
basic | 24 | | maintenance assistance under Article VI of this Code due to
| 25 | | employment earnings. The plan for coverage for this class | 26 | | of persons shall:
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| 1 | | (a) extend the medical assistance coverage for up | 2 | | to 12 months following
termination of basic | 3 | | maintenance assistance; and
| 4 | | (b) offer persons who have initially received 6 | 5 | | months of the
coverage provided in paragraph (a) above, | 6 | | the option of receiving an
additional 6 months of | 7 | | coverage, subject to the following:
| 8 | | (i) such coverage shall be pursuant to | 9 | | provisions of the federal
Social Security Act;
| 10 | | (ii) such coverage shall include all services | 11 | | covered while the person
was eligible for basic | 12 | | maintenance assistance;
| 13 | | (iii) no premium shall be charged for such | 14 | | coverage; and
| 15 | | (iv) such coverage shall be suspended in the | 16 | | event of a person's
failure without good cause to | 17 | | file in a timely fashion reports required for
this | 18 | | coverage under the Social Security Act and | 19 | | coverage shall be reinstated
upon the filing of | 20 | | such reports if the person remains otherwise | 21 | | eligible.
| 22 | | 9. Persons with acquired immunodeficiency syndrome | 23 | | (AIDS) or with
AIDS-related conditions with respect to whom | 24 | | there has been a determination
that but for home or | 25 | | community-based services such individuals would
require | 26 | | the level of care provided in an inpatient hospital, |
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| 1 | | skilled
nursing facility or intermediate care facility the | 2 | | cost of which is
reimbursed under this Article. Assistance | 3 | | shall be provided to such
persons to the maximum extent | 4 | | permitted under Title
XIX of the Federal Social Security | 5 | | Act.
| 6 | | 10. Participants in the long-term care insurance | 7 | | partnership program
established under the Illinois | 8 | | Long-Term Care Partnership Program Act who meet the
| 9 | | qualifications for protection of resources described in | 10 | | Section 15 of that
Act.
| 11 | | 11. Persons with disabilities who are employed and | 12 | | eligible for Medicaid,
pursuant to Section | 13 | | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | 14 | | subject to federal approval, persons with a medically | 15 | | improved disability who are employed and eligible for | 16 | | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | 17 | | the Social Security Act, as
provided by the Illinois | 18 | | Department by rule. In establishing eligibility standards | 19 | | under this paragraph 11, the Department shall, subject to | 20 | | federal approval: | 21 | | (a) set the income eligibility standard at not | 22 | | lower than 350% of the federal poverty level; | 23 | | (b) exempt retirement accounts that the person | 24 | | cannot access without penalty before the age
of 59 1/2, | 25 | | and medical savings accounts established pursuant to | 26 | | 26 U.S.C. 220; |
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| 1 | | (c) allow non-exempt assets up to $25,000 as to | 2 | | those assets accumulated during periods of eligibility | 3 | | under this paragraph 11; and
| 4 | | (d) continue to apply subparagraphs (b) and (c) in | 5 | | determining the eligibility of the person under this | 6 | | Article even if the person loses eligibility under this | 7 | | paragraph 11.
| 8 | | 12. Subject to federal approval, persons who are | 9 | | eligible for medical
assistance coverage under applicable | 10 | | provisions of the federal Social Security
Act and the | 11 | | federal Breast and Cervical Cancer Prevention and | 12 | | Treatment Act of
2000. Those eligible persons are defined | 13 | | to include, but not be limited to,
the following persons:
| 14 | | (1) persons who have been screened for breast or | 15 | | cervical cancer under
the U.S. Centers for Disease | 16 | | Control and Prevention Breast and Cervical Cancer
| 17 | | Program established under Title XV of the federal | 18 | | Public Health Services Act in
accordance with the | 19 | | requirements of Section 1504 of that Act as | 20 | | administered by
the Illinois Department of Public | 21 | | Health; and
| 22 | | (2) persons whose screenings under the above | 23 | | program were funded in whole
or in part by funds | 24 | | appropriated to the Illinois Department of Public | 25 | | Health
for breast or cervical cancer screening.
| 26 | | "Medical assistance" under this paragraph 12 shall be |
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| 1 | | identical to the benefits
provided under the State's | 2 | | approved plan under Title XIX of the Social Security
Act. | 3 | | The Department must request federal approval of the | 4 | | coverage under this
paragraph 12 within 30 days after the | 5 | | effective date of this amendatory Act of
the 92nd General | 6 | | Assembly.
| 7 | | In addition to the persons who are eligible for medical | 8 | | assistance pursuant to subparagraphs (1) and (2) of this | 9 | | paragraph 12, and to be paid from funds appropriated to the | 10 | | Department for its medical programs, any uninsured person | 11 | | as defined by the Department in rules residing in Illinois | 12 | | who is younger than 65 years of age, who has been screened | 13 | | for breast and cervical cancer in accordance with standards | 14 | | and procedures adopted by the Department of Public Health | 15 | | for screening, and who is referred to the Department by the | 16 | | Department of Public Health as being in need of treatment | 17 | | for breast or cervical cancer is eligible for medical | 18 | | assistance benefits that are consistent with the benefits | 19 | | provided to those persons described in subparagraphs (1) | 20 | | and (2). Medical assistance coverage for the persons who | 21 | | are eligible under the preceding sentence is not dependent | 22 | | on federal approval, but federal moneys may be used to pay | 23 | | for services provided under that coverage upon federal | 24 | | approval. | 25 | | 13. Subject to appropriation and to federal approval, | 26 | | persons living with HIV/AIDS who are not otherwise eligible |
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| 1 | | under this Article and who qualify for services covered | 2 | | under Section 5-5.04 as provided by the Illinois Department | 3 | | by rule.
| 4 | | 14. Subject to the availability of funds for this | 5 | | purpose, the Department may provide coverage under this | 6 | | Article to persons who reside in Illinois who are not | 7 | | eligible under any of the preceding paragraphs and who meet | 8 | | the income guidelines of paragraph 2(a) of this Section and | 9 | | (i) have an application for asylum pending before the | 10 | | federal Department of Homeland Security or on appeal before | 11 | | a court of competent jurisdiction and are represented | 12 | | either by counsel or by an advocate accredited by the | 13 | | federal Department of Homeland Security and employed by a | 14 | | not-for-profit organization in regard to that application | 15 | | or appeal, or (ii) are receiving services through a | 16 | | federally funded torture treatment center. Medical | 17 | | coverage under this paragraph 14 may be provided for up to | 18 | | 24 continuous months from the initial eligibility date so | 19 | | long as an individual continues to satisfy the criteria of | 20 | | this paragraph 14. If an individual has an appeal pending | 21 | | regarding an application for asylum before the Department | 22 | | of Homeland Security, eligibility under this paragraph 14 | 23 | | may be extended until a final decision is rendered on the | 24 | | appeal. The Department may adopt rules governing the | 25 | | implementation of this paragraph 14.
| 26 | | 15. Family Care Eligibility. |
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| 1 | | (a) Through December 31, 2013, a caretaker | 2 | | relative who is 19 years of age or older when countable | 3 | | income is at or below 185% of the Federal Poverty Level | 4 | | Guidelines, as published annually in the Federal | 5 | | Register, for the appropriate family size. Beginning | 6 | | January 1, 2014, a caretaker relative who is 19 years | 7 | | of age or older when countable income is at or below | 8 | | 133% of the Federal Poverty Level Guidelines, as | 9 | | published annually in the Federal Register, for the | 10 | | appropriate family size. A person may not spend down to | 11 | | become eligible under this paragraph 15. | 12 | | (b) Eligibility shall be reviewed annually. | 13 | | (c) Caretaker relatives enrolled under this | 14 | | paragraph 15 in families with countable income above | 15 | | 150% and at or below 185% of the Federal Poverty Level | 16 | | Guidelines shall be counted as family members and pay | 17 | | premiums as established under the Children's Health | 18 | | Insurance Program Act. | 19 | | (d) Premiums shall be billed by and payable to the | 20 | | Department or its authorized agent, on a monthly basis. | 21 | | (e) The premium due date is the last day of the | 22 | | month preceding the month of coverage. | 23 | | (f) Individuals shall have a grace period through | 24 | | 60 days of coverage to pay the premium. | 25 | | (g) Failure to pay the full monthly premium by the | 26 | | last day of the grace period shall result in |
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| 1 | | termination of coverage. | 2 | | (h) Partial premium payments shall not be | 3 | | refunded. | 4 | | (i) Following termination of an individual's | 5 | | coverage under this paragraph 15, the following action | 6 | | is required before the individual can be re-enrolled: | 7 | | (1) A new application must be completed and the | 8 | | individual must be determined otherwise eligible. | 9 | | (2) There must be full payment of premiums due | 10 | | under this Code, the Children's Health Insurance | 11 | | Program Act, the Covering ALL KIDS Health | 12 | | Insurance Act, or any other healthcare program | 13 | | administered by the Department for periods in | 14 | | which a premium was owed and not paid for the | 15 | | individual. | 16 | | (3) The first month's premium must be paid if | 17 | | there was an unpaid premium on the date the | 18 | | individual's previous coverage was canceled. | 19 | | The Department is authorized to implement the | 20 | | provisions of this amendatory Act of the 95th General | 21 | | Assembly by adopting the medical assistance rules in effect | 22 | | as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | 23 | | 89 Ill. Admin. Code 120.32 along with only those changes | 24 | | necessary to conform to federal Medicaid requirements, | 25 | | federal laws, and federal regulations, including but not | 26 | | limited to Section 1931 of the Social Security Act (42 |
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| 1 | | U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | 2 | | of Health and Human Services, and the countable income | 3 | | eligibility standard authorized by this paragraph 15. The | 4 | | Department may not otherwise adopt any rule to implement | 5 | | this increase except as authorized by law, to meet the | 6 | | eligibility standards authorized by the federal government | 7 | | in the Medicaid State Plan or the Title XXI Plan, or to | 8 | | meet an order from the federal government or any court. | 9 | | 16. Subject to appropriation, uninsured persons who | 10 | | are not otherwise eligible under this Section who have been | 11 | | certified and referred by the Department of Public Health | 12 | | as having been screened and found to need diagnostic | 13 | | evaluation or treatment, or both diagnostic evaluation and | 14 | | treatment, for prostate or testicular cancer. For the | 15 | | purposes of this paragraph 16, uninsured persons are those | 16 | | who do not have creditable coverage, as defined under the | 17 | | Health Insurance Portability and Accountability Act, or | 18 | | have otherwise exhausted any insurance benefits they may | 19 | | have had, for prostate or testicular cancer diagnostic | 20 | | evaluation or treatment, or both diagnostic evaluation and | 21 | | treatment.
To be eligible, a person must furnish a Social | 22 | | Security number.
A person's assets are exempt from | 23 | | consideration in determining eligibility under this | 24 | | paragraph 16.
Such persons shall be eligible for medical | 25 | | assistance under this paragraph 16 for so long as they need | 26 | | treatment for the cancer. A person shall be considered to |
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| 1 | | need treatment if, in the opinion of the person's treating | 2 | | physician, the person requires therapy directed toward | 3 | | cure or palliation of prostate or testicular cancer, | 4 | | including recurrent metastatic cancer that is a known or | 5 | | presumed complication of prostate or testicular cancer and | 6 | | complications resulting from the treatment modalities | 7 | | themselves. Persons who require only routine monitoring | 8 | | services are not considered to need treatment.
"Medical | 9 | | assistance" under this paragraph 16 shall be identical to | 10 | | the benefits provided under the State's approved plan under | 11 | | Title XIX of the Social Security Act.
Notwithstanding any | 12 | | other provision of law, the Department (i) does not have a | 13 | | claim against the estate of a deceased recipient of | 14 | | services under this paragraph 16 and (ii) does not have a | 15 | | lien against any homestead property or other legal or | 16 | | equitable real property interest owned by a recipient of | 17 | | services under this paragraph 16. | 18 | | In implementing the provisions of Public Act 96-20, the | 19 | | Department is authorized to adopt only those rules necessary, | 20 | | including emergency rules. Nothing in Public Act 96-20 permits | 21 | | the Department to adopt rules or issue a decision that expands | 22 | | eligibility for the FamilyCare Program to a person whose income | 23 | | exceeds 185% of the Federal Poverty Level as determined from | 24 | | time to time by the U.S. Department of Health and Human | 25 | | Services, unless the Department is provided with express | 26 | | statutory authority. |
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| 1 | | The Illinois Department and the Governor shall provide a | 2 | | plan for
coverage of the persons eligible under paragraph 7 as | 3 | | soon as possible after
July 1, 1984.
| 4 | | The eligibility of any such person for medical assistance | 5 | | under this
Article is not affected by the payment of any grant | 6 | | under the Senior
Citizens and Disabled Persons Property Tax | 7 | | Relief and Pharmaceutical
Assistance Act or any distributions | 8 | | or items of income described under
subparagraph (X) of
| 9 | | paragraph (2) of subsection (a) of Section 203 of the Illinois | 10 | | Income Tax
Act. The Department shall by rule establish the | 11 | | amounts of
assets to be disregarded in determining eligibility | 12 | | for medical assistance,
which shall at a minimum equal the | 13 | | amounts to be disregarded under the
Federal Supplemental | 14 | | Security Income Program. The amount of assets of a
single | 15 | | person to be disregarded
shall not be less than $2,000, and the | 16 | | amount of assets of a married couple
to be disregarded shall | 17 | | not be less than $3,000.
| 18 | | To the extent permitted under federal law, any person found | 19 | | guilty of a
second violation of Article VIIIA
shall be | 20 | | ineligible for medical assistance under this Article, as | 21 | | provided
in Section 8A-8.
| 22 | | The eligibility of any person for medical assistance under | 23 | | this Article
shall not be affected by the receipt by the person | 24 | | of donations or benefits
from fundraisers held for the person | 25 | | in cases of serious illness,
as long as neither the person nor | 26 | | members of the person's family
have actual control over the |
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| 1 | | donations or benefits or the disbursement
of the donations or | 2 | | benefits.
| 3 | | (Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; | 4 | | 96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. | 5 | | 7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, | 6 | | eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; | 7 | | revised 10-4-11.)
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