Full Text of HB5227 103rd General Assembly
HB5227 103RD GENERAL ASSEMBLY | | | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024 HB5227 Introduced 2/9/2024, by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: | | 20 ILCS 2405/3 | from Ch. 23, par. 3434 | 305 ILCS 5/5-2 | from Ch. 23, par. 5-2 |
| Amends the Rehabilitation of Persons with Disabilities Act. In a provision requiring the Department of Human Services to establish eligibility standards for services provided under the Home Services Program, provides that the standards must provide that a person may not have more than $17,500 (rather than $10,000) in assets to be eligible for services. Provides that the Department may not decrease the asset level below $17,500 (rather than $10,000). Requires the Department to implement a pilot program of no less than 60 months in 3 geographically diverse locations wherein it shall exempt from consideration when determining eligibility for the Home Services Program retirement accounts that the person cannot access without penalty before the age of 59 1/2, and medical savings accounts. Provides that services provided to any individual determined eligible under the pilot program shall be funded solely by the State. Amends the Medical Assistance Article of the Illinois Public Aid Code. In a provision regarding the income eligibility standard under the medical assistance program for persons with disabilities who are employed and for persons with a medically improved disability who are employed, requires the Department of Healthcare and Family Services to set the income eligibility standard at not lower than 450% (rather than 350%) of the federal poverty level. |
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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 Rehabilitation of Persons with Disabilities | 5 | | Act is amended by changing Section 3 as follows: | 6 | | (20 ILCS 2405/3) (from Ch. 23, par. 3434) | 7 | | Sec. 3. Powers and duties. The Department shall have the | 8 | | powers and duties enumerated herein: | 9 | | (a) To cooperate with the federal government in the | 10 | | administration of the provisions of the federal | 11 | | Rehabilitation Act of 1973, as amended by the Workforce | 12 | | Innovation and Opportunity Act, and of the federal Social | 13 | | Security Act to the extent and in the manner provided in | 14 | | these Acts. | 15 | | (b) To prescribe and supervise such courses of | 16 | | vocational training and provide such other services as may | 17 | | be necessary for the vocational rehabilitation of persons | 18 | | with one or more disabilities, including the | 19 | | administrative activities under subsection (e) of this | 20 | | Section; to cooperate with State and local school | 21 | | authorities and other recognized agencies engaged in | 22 | | vocational rehabilitation services; and to cooperate with | 23 | | the Department of Children and Family Services, the |
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| 1 | | Illinois State Board of Education, and others regarding | 2 | | the education of children with one or more disabilities. | 3 | | (c) (Blank). | 4 | | (d) To report in writing, to the Governor, annually on | 5 | | or before the first day of December, and at such other | 6 | | times and in such manner and upon such subjects as the | 7 | | Governor may require. The annual report shall contain (1) | 8 | | information on the programs and activities dedicated to | 9 | | vocational rehabilitation, independent living, and other | 10 | | community services and supports administered by the | 11 | | Director; (2) information on the development of vocational | 12 | | rehabilitation services, independent living services, and | 13 | | supporting services administered by the Director in the | 14 | | State; and (3) information detailing the amounts of money | 15 | | received from federal, State, and other sources, and of | 16 | | the objects and purposes to which the respective items of | 17 | | these several amounts have been devoted. | 18 | | (e) (Blank). | 19 | | (f) To establish a program of services to prevent the | 20 | | unnecessary institutionalization of persons in need of | 21 | | long term care and who meet the criteria for blindness or | 22 | | disability as defined by the Social Security Act, thereby | 23 | | enabling them to remain in their own homes. Such | 24 | | preventive services include any or all of the following: | 25 | | (1) personal assistant services; | 26 | | (2) homemaker services; |
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| 1 | | (3) home-delivered meals; | 2 | | (4) adult day care services; | 3 | | (5) respite care; | 4 | | (6) home modification or assistive equipment; | 5 | | (7) home health services; | 6 | | (8) electronic home response; | 7 | | (9) brain injury behavioral/cognitive services; | 8 | | (10) brain injury habilitation; | 9 | | (11) brain injury pre-vocational services; or | 10 | | (12) brain injury supported employment. | 11 | | The Department shall establish eligibility standards | 12 | | for such services taking into consideration the unique | 13 | | economic and social needs of the population for whom they | 14 | | are to be provided. Such eligibility standards may be | 15 | | based on the recipient's ability to pay for services; | 16 | | provided, however, that any portion of a person's income | 17 | | that is equal to or less than the "protected income" level | 18 | | shall not be considered by the Department in determining | 19 | | eligibility. The "protected income" level shall be | 20 | | determined by the Department, shall never be less than the | 21 | | federal poverty standard, and shall be adjusted each year | 22 | | to reflect changes in the Consumer Price Index For All | 23 | | Urban Consumers as determined by the United States | 24 | | Department of Labor. The standards must provide that a | 25 | | person may not have more than $17,500 $10,000 in assets to | 26 | | be eligible for the services, and the Department may |
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| 1 | | increase or decrease the asset limitation by rule. The | 2 | | Department may not decrease the asset level below $17,500 | 3 | | $10,000 . Subject to federal approval, the Department shall | 4 | | allow a recipient's spouse, guardian, kin, or siblings to | 5 | | serve as his or her provider of personal care or similar | 6 | | services. The Department shall implement a pilot program | 7 | | of no less than 60 months in 3 geographically diverse | 8 | | locations wherein it shall exempt from consideration when | 9 | | determining eligibility for the Home Services Program | 10 | | retirement accounts that the person cannot access without | 11 | | penalty before the age of 59 1/2, and medical savings | 12 | | accounts established pursuant to 26 U.S.C. 220. Services | 13 | | provided to any individual determined eligible under the | 14 | | pilot program shall be funded solely by the State. | 15 | | The services shall be provided, as established by the | 16 | | Department by rule, to eligible persons to prevent | 17 | | unnecessary or premature institutionalization, to the | 18 | | extent that the cost of the services, together with the | 19 | | other personal maintenance expenses of the persons, are | 20 | | reasonably related to the standards established for care | 21 | | in a group facility appropriate to their condition. These | 22 | | non-institutional services, pilot projects or experimental | 23 | | facilities may be provided as part of or in addition to | 24 | | those authorized by federal law or those funded and | 25 | | administered by the Illinois Department on Aging. The | 26 | | Department shall set rates and fees for services in a fair |
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| 1 | | and equitable manner. Services identical to those offered | 2 | | by the Department on Aging shall be paid at the same rate. | 3 | | Except as otherwise provided in this paragraph, | 4 | | personal assistants shall be paid at a rate negotiated | 5 | | between the State and an exclusive representative of | 6 | | personal assistants under a collective bargaining | 7 | | agreement. In no case shall the Department pay personal | 8 | | assistants an hourly wage that is less than the federal | 9 | | minimum wage. Within 30 days after July 6, 2017 (the | 10 | | effective date of Public Act 100-23), the hourly wage paid | 11 | | to personal assistants and individual maintenance home | 12 | | health workers shall be increased by $0.48 per hour. Wages | 13 | | and other benefits for personal assistants shall not count | 14 | | against benefits that guardians receive as outlined in | 15 | | Article XIa of the Probate Act of 1975. | 16 | | Solely for the purposes of coverage under the Illinois | 17 | | Public Labor Relations Act, personal assistants providing | 18 | | services under the Department's Home Services Program | 19 | | shall be considered to be public employees and the State | 20 | | of Illinois shall be considered to be their employer as of | 21 | | July 16, 2003 (the effective date of Public Act 93-204), | 22 | | but not before. Solely for the purposes of coverage under | 23 | | the Illinois Public Labor Relations Act, home care and | 24 | | home health workers who function as personal assistants | 25 | | and individual maintenance home health workers and who | 26 | | also provide services under the Department's Home Services |
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| 1 | | Program shall be considered to be public employees, no | 2 | | matter whether the State provides such services through | 3 | | direct fee-for-service arrangements, with the assistance | 4 | | of a managed care organization or other intermediary, or | 5 | | otherwise, and the State of Illinois shall be considered | 6 | | to be the employer of those persons as of January 29, 2013 | 7 | | (the effective date of Public Act 97-1158), but not before | 8 | | except as otherwise provided under this subsection (f). | 9 | | The State shall engage in collective bargaining with an | 10 | | exclusive representative of home care and home health | 11 | | workers who function as personal assistants and individual | 12 | | maintenance home health workers working under the Home | 13 | | Services Program concerning their terms and conditions of | 14 | | employment that are within the State's control. Nothing in | 15 | | this paragraph shall be understood to limit the right of | 16 | | the persons receiving services defined in this Section to | 17 | | hire and fire home care and home health workers who | 18 | | function as personal assistants and individual maintenance | 19 | | home health workers working under the Home Services | 20 | | Program or to supervise them within the limitations set by | 21 | | the Home Services Program. The State shall not be | 22 | | considered to be the employer of home care and home health | 23 | | workers who function as personal assistants and individual | 24 | | maintenance home health workers working under the Home | 25 | | Services Program for any purposes not specifically | 26 | | provided in Public Act 93-204 or Public Act 97-1158, |
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| 1 | | including but not limited to, purposes of vicarious | 2 | | liability in tort and purposes of statutory retirement or | 3 | | health insurance benefits. Home care and home health | 4 | | workers who function as personal assistants and individual | 5 | | maintenance home health workers and who also provide | 6 | | services under the Department's Home Services Program | 7 | | shall not be covered by the State Employees Group | 8 | | Insurance Act of 1971. | 9 | | The Department shall execute, relative to nursing home | 10 | | prescreening, as authorized by Section 4.03 of the | 11 | | Illinois Act on the Aging, written inter-agency agreements | 12 | | with the Department on Aging and the Department of | 13 | | Healthcare and Family Services, to effect the intake | 14 | | procedures and eligibility criteria for those persons who | 15 | | may need long term care. On and after July 1, 1996, all | 16 | | nursing home prescreenings for individuals 18 through 59 | 17 | | years of age shall be conducted by the Department, or a | 18 | | designee of the Department. | 19 | | The Department is authorized to establish a system of | 20 | | recipient cost-sharing for services provided under this | 21 | | Section. The cost-sharing shall be based upon the | 22 | | recipient's ability to pay for services, but in no case | 23 | | shall the recipient's share exceed the actual cost of the | 24 | | services provided. Protected income shall not be | 25 | | considered by the Department in its determination of the | 26 | | recipient's ability to pay a share of the cost of |
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| 1 | | services. The level of cost-sharing shall be adjusted each | 2 | | year to reflect changes in the "protected income" level. | 3 | | The Department shall deduct from the recipient's share of | 4 | | the cost of services any money expended by the recipient | 5 | | for disability-related expenses. | 6 | | To the extent permitted under the federal Social | 7 | | Security Act, the Department, or the Department's | 8 | | authorized representative, may recover the amount of | 9 | | moneys expended for services provided to or in behalf of a | 10 | | person under this Section by a claim against the person's | 11 | | estate or against the estate of the person's surviving | 12 | | spouse, but no recovery may be had until after the death of | 13 | | the surviving spouse, if any, and then only at such time | 14 | | when there is no surviving child who is under age 21 or | 15 | | blind or who has a permanent and total disability. This | 16 | | paragraph, however, shall not bar recovery, at the death | 17 | | of the person, of moneys for services provided to the | 18 | | person or in behalf of the person under this Section to | 19 | | which the person was not entitled; provided that such | 20 | | recovery shall not be enforced against any real estate | 21 | | while it is occupied as a homestead by the surviving | 22 | | spouse or other dependent, if no claims by other creditors | 23 | | have been filed against the estate, or, if such claims | 24 | | have been filed, they remain dormant for failure of | 25 | | prosecution or failure of the claimant to compel | 26 | | administration of the estate for the purpose of payment. |
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| 1 | | This paragraph shall not bar recovery from the estate of a | 2 | | spouse, under Sections 1915 and 1924 of the Social | 3 | | Security Act and Section 5-4 of the Illinois Public Aid | 4 | | Code, who precedes a person receiving services under this | 5 | | Section in death. All moneys for services paid to or in | 6 | | behalf of the person under this Section shall be claimed | 7 | | for recovery from the deceased spouse's estate. | 8 | | "Homestead", as used in this paragraph, means the dwelling | 9 | | house and contiguous real estate occupied by a surviving | 10 | | spouse or relative, as defined by the rules and | 11 | | regulations of the Department of Healthcare and Family | 12 | | Services, regardless of the value of the property. | 13 | | (g) To establish such subdivisions of the Department | 14 | | as shall be desirable and assign to the various | 15 | | subdivisions the responsibilities and duties placed upon | 16 | | the Department by law. | 17 | | (h) To cooperate and enter into any necessary | 18 | | agreements with the Department of Employment Security for | 19 | | the provision of job placement and job referral services | 20 | | to clients of the Department, including job service | 21 | | registration of such clients with Illinois Employment | 22 | | Security offices and making job listings maintained by the | 23 | | Department of Employment Security available to such | 24 | | clients. | 25 | | (i) To possess all powers reasonable and necessary for | 26 | | the exercise and administration of the powers, duties and |
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| 1 | | responsibilities of the Department which are provided for | 2 | | by law. | 3 | | (j) (Blank). | 4 | | (k) (Blank). | 5 | | (l) To establish, operate, and maintain a Statewide | 6 | | Housing Clearinghouse of information on available | 7 | | government subsidized housing accessible to persons with | 8 | | disabilities and available privately owned housing | 9 | | accessible to persons with disabilities. The information | 10 | | shall include, but not be limited to, the location, rental | 11 | | requirements, access features and proximity to public | 12 | | transportation of available housing. The Clearinghouse | 13 | | shall consist of at least a computerized database for the | 14 | | storage and retrieval of information and a separate or | 15 | | shared toll free telephone number for use by those seeking | 16 | | information from the Clearinghouse. Department offices and | 17 | | personnel throughout the State shall also assist in the | 18 | | operation of the Statewide Housing Clearinghouse. | 19 | | Cooperation with local, State, and federal housing | 20 | | managers shall be sought and extended in order to | 21 | | frequently and promptly update the Clearinghouse's | 22 | | information. | 23 | | (m) To assure that the names and case records of | 24 | | persons who received or are receiving services from the | 25 | | Department, including persons receiving vocational | 26 | | rehabilitation, home services, or other services, and |
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| 1 | | those attending one of the Department's schools or other | 2 | | supervised facility shall be confidential and not be open | 3 | | to the general public. Those case records and reports or | 4 | | the information contained in those records and reports | 5 | | shall be disclosed by the Director only to proper law | 6 | | enforcement officials, individuals authorized by a court, | 7 | | the General Assembly or any committee or commission of the | 8 | | General Assembly, and other persons and for reasons as the | 9 | | Director designates by rule. Disclosure by the Director | 10 | | may be only in accordance with other applicable law. | 11 | | (Source: P.A. 102-264, eff. 8-6-21; 102-826, eff. 5-13-22; | 12 | | 103-479, eff. 1-1-24 .) | 13 | | Section 10. The Illinois Public Aid Code is amended by | 14 | | changing Section 5-2 as follows: | 15 | | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2) | 16 | | Sec. 5-2. Classes of persons eligible. Medical assistance | 17 | | under this Article shall be available to any of the following | 18 | | classes of persons in respect to whom a plan for coverage has | 19 | | been submitted to the Governor by the Illinois Department and | 20 | | approved by him. If changes made in this Section 5-2 require | 21 | | federal approval, they shall not take effect until such | 22 | | approval has been received: | 23 | | 1. Recipients of basic maintenance grants under | 24 | | Articles III and IV. |
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| 1 | | 2. Beginning January 1, 2014, persons otherwise | 2 | | eligible for basic maintenance under Article III, | 3 | | excluding any eligibility requirements that are | 4 | | inconsistent with any federal law or federal regulation, | 5 | | as interpreted by the U.S. Department of Health and Human | 6 | | Services, but who fail to qualify thereunder on the basis | 7 | | of need, and who have insufficient income and resources to | 8 | | meet the costs of necessary medical care, including, but | 9 | | not limited to, the following: | 10 | | (a) All persons otherwise eligible for basic | 11 | | maintenance under Article III but who fail to qualify | 12 | | under that Article on the basis of need and who meet | 13 | | either of the following requirements: | 14 | | (i) their income, as determined by the | 15 | | Illinois Department in accordance with any federal | 16 | | requirements, is equal to or less than 100% of the | 17 | | federal poverty level; or | 18 | | (ii) their income, after the deduction of | 19 | | costs incurred for medical care and for other | 20 | | types of remedial care, is equal to or less than | 21 | | 100% of the federal poverty level. | 22 | | (b) (Blank). | 23 | | 3. (Blank). | 24 | | 4. Persons not eligible under any of the preceding | 25 | | paragraphs who fall sick, are injured, or die, not having | 26 | | sufficient money, property or other resources to meet the |
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| 1 | | costs of necessary medical care or funeral and burial | 2 | | expenses. | 3 | | 5.(a) Beginning January 1, 2020, individuals during | 4 | | pregnancy and during the 12-month period beginning on the | 5 | | last day of the pregnancy, together with their infants, | 6 | | whose income is at or below 200% of the federal poverty | 7 | | level. Until September 30, 2019, or sooner if the | 8 | | maintenance of effort requirements under the Patient | 9 | | Protection and Affordable Care Act are eliminated or may | 10 | | be waived before then, individuals during pregnancy and | 11 | | during the 12-month period beginning on the last day of | 12 | | the pregnancy, whose countable monthly income, after the | 13 | | deduction of costs incurred for medical care and for other | 14 | | types of remedial care as specified in administrative | 15 | | rule, is equal to or less than the Medical Assistance-No | 16 | | Grant(C) (MANG(C)) Income Standard in effect on April 1, | 17 | | 2013 as set forth in administrative rule. | 18 | | (b) The plan for coverage shall provide ambulatory | 19 | | prenatal care to pregnant individuals during a presumptive | 20 | | eligibility period and establish an income eligibility | 21 | | standard that is equal to 200% of the federal poverty | 22 | | level, provided that costs incurred for medical care are | 23 | | not taken into account in determining such income | 24 | | eligibility. | 25 | | (c) The Illinois Department may conduct a | 26 | | demonstration in at least one county that will provide |
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| 1 | | medical assistance to pregnant individuals together with | 2 | | their infants and children up to one year of age, where the | 3 | | income eligibility standard is set up to 185% of the | 4 | | nonfarm income official poverty line, as defined by the | 5 | | federal Office of Management and Budget. The Illinois | 6 | | Department shall seek and obtain necessary authorization | 7 | | provided under federal law to implement such a | 8 | | demonstration. Such demonstration may establish resource | 9 | | standards that are not more restrictive than those | 10 | | established under Article IV of this Code. | 11 | | 6. (a) Subject to federal approval, children younger | 12 | | than age 19 when countable income is at or below 313% of | 13 | | the federal poverty level, as determined by the Department | 14 | | and in accordance with all applicable federal | 15 | | requirements. The Department is authorized to adopt | 16 | | emergency rules to implement the changes made to this | 17 | | paragraph by Public Act 102-43. Until September 30, 2019, | 18 | | or sooner if the maintenance of effort requirements under | 19 | | the Patient Protection and Affordable Care Act are | 20 | | eliminated or may be waived before then, children younger | 21 | | than age 19 whose countable monthly income, after the | 22 | | deduction of costs incurred for medical care and for other | 23 | | types of remedial care as specified in administrative | 24 | | rule, is equal to or less than the Medical Assistance-No | 25 | | Grant(C) (MANG(C)) Income Standard in effect on April 1, | 26 | | 2013 as set forth in administrative rule. |
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| 1 | | (b) Children and youth who are under temporary custody | 2 | | or guardianship of the Department of Children and Family | 3 | | Services or who receive financial assistance in support of | 4 | | an adoption or guardianship placement from the Department | 5 | | of Children and Family Services. | 6 | | 7. (Blank). | 7 | | 8. As required under federal law, persons who are | 8 | | eligible for Transitional Medical Assistance as a result | 9 | | of an increase in earnings or child or spousal support | 10 | | received. The plan for coverage for this class of persons | 11 | | shall: | 12 | | (a) extend the medical assistance coverage to the | 13 | | extent required by federal law; and | 14 | | (b) offer persons who have initially received 6 | 15 | | months of the coverage provided in paragraph (a) | 16 | | above, the option of receiving an additional 6 months | 17 | | of 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 under Illinois' State Medicaid Plan; | 22 | | (iii) no premium shall be charged for such | 23 | | coverage; and | 24 | | (iv) such coverage shall be suspended in the | 25 | | event of a person's failure without good cause to | 26 | | file in a timely fashion reports required for this |
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| 1 | | coverage under the Social Security Act and | 2 | | coverage shall be reinstated upon the filing of | 3 | | such reports if the person remains otherwise | 4 | | eligible. | 5 | | 9. Persons with acquired immunodeficiency syndrome | 6 | | (AIDS) or with AIDS-related conditions with respect to | 7 | | whom there has been a determination that but for home or | 8 | | community-based services such individuals would require | 9 | | the level of care provided in an inpatient hospital, | 10 | | skilled nursing facility or intermediate care facility the | 11 | | cost of which is reimbursed under this Article. Assistance | 12 | | shall be provided to such persons to the maximum extent | 13 | | permitted under Title XIX of the Federal Social Security | 14 | | Act. | 15 | | 10. Participants in the long-term care insurance | 16 | | partnership program established under the Illinois | 17 | | Long-Term Care Partnership Program Act who meet the | 18 | | qualifications for protection of resources described in | 19 | | Section 15 of that Act. | 20 | | 11. Persons with disabilities who are employed and | 21 | | eligible for Medicaid, pursuant to Section | 22 | | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | 23 | | subject to federal approval, persons with a medically | 24 | | improved disability who are employed and eligible for | 25 | | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | 26 | | the Social Security Act, as provided by the Illinois |
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| 1 | | Department by rule. In establishing eligibility standards | 2 | | under this paragraph 11, the Department shall, subject to | 3 | | federal approval: | 4 | | (a) set the income eligibility standard at not | 5 | | lower than 450% 350% of the federal poverty level; | 6 | | (b) exempt retirement accounts that the person | 7 | | cannot access without penalty before the age of 59 | 8 | | 1/2, and medical savings accounts established pursuant | 9 | | to 26 U.S.C. 220; | 10 | | (c) allow non-exempt assets up to $25,000 as to | 11 | | those assets accumulated during periods of eligibility | 12 | | under this paragraph 11; and | 13 | | (d) continue to apply subparagraphs (b) and (c) in | 14 | | determining the eligibility of the person under this | 15 | | Article even if the person loses eligibility under | 16 | | this paragraph 11. | 17 | | 12. Subject to federal approval, persons who are | 18 | | eligible for medical assistance coverage under applicable | 19 | | provisions of the federal Social Security Act and the | 20 | | federal Breast and Cervical Cancer Prevention and | 21 | | Treatment Act of 2000. Those eligible persons are defined | 22 | | to include, but not be limited to, the following persons: | 23 | | (1) persons who have been screened for breast or | 24 | | cervical cancer under the U.S. Centers for Disease | 25 | | Control and Prevention Breast and Cervical Cancer | 26 | | Program established under Title XV of the federal |
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| 1 | | Public Health Service Act in accordance with the | 2 | | requirements of Section 1504 of that Act as | 3 | | administered by the Illinois Department of Public | 4 | | Health; and | 5 | | (2) persons whose screenings under the above | 6 | | program were funded in whole or in part by funds | 7 | | appropriated to the Illinois Department of Public | 8 | | Health for breast or cervical cancer screening. | 9 | | "Medical assistance" under this paragraph 12 shall be | 10 | | identical to the benefits provided under the State's | 11 | | approved plan under Title XIX of the Social Security Act. | 12 | | The Department must request federal approval of the | 13 | | coverage under this paragraph 12 within 30 days after July | 14 | | 3, 2001 (the effective date of Public Act 92-47). | 15 | | In addition to the persons who are eligible for | 16 | | medical assistance pursuant to subparagraphs (1) and (2) | 17 | | of this paragraph 12, and to be paid from funds | 18 | | appropriated to the Department for its medical programs, | 19 | | any uninsured person as defined by the Department in rules | 20 | | residing in Illinois who is younger than 65 years of age, | 21 | | who has been screened for breast and cervical cancer in | 22 | | accordance with standards and procedures adopted by the | 23 | | Department of Public Health for screening, and who is | 24 | | referred to the Department by the Department of Public | 25 | | Health as being in need of treatment for breast or | 26 | | cervical cancer is eligible for medical assistance |
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| 1 | | benefits that are consistent with the benefits provided to | 2 | | those persons described in subparagraphs (1) and (2). | 3 | | Medical assistance coverage for the persons who are | 4 | | eligible under the preceding sentence is not dependent on | 5 | | federal approval, but federal moneys may be used to pay | 6 | | for services provided under that coverage upon federal | 7 | | approval. | 8 | | 13. Subject to appropriation and to federal approval, | 9 | | persons living with HIV/AIDS who are not otherwise | 10 | | eligible under this Article and who qualify for services | 11 | | covered under Section 5-5.04 as provided by the Illinois | 12 | | Department by rule. | 13 | | 14. Subject to the availability of funds for this | 14 | | purpose, the Department may provide coverage under this | 15 | | Article to persons who reside in Illinois who are not | 16 | | eligible under any of the preceding paragraphs and who | 17 | | meet the income guidelines of paragraph 2(a) of this | 18 | | Section and (i) have an application for asylum pending | 19 | | before the federal Department of Homeland Security or on | 20 | | appeal before a court of competent jurisdiction and are | 21 | | represented either by counsel or by an advocate accredited | 22 | | by the federal Department of Homeland Security and | 23 | | employed by a not-for-profit organization in regard to | 24 | | that application or appeal, or (ii) are receiving services | 25 | | through a federally funded torture treatment center. | 26 | | Medical coverage under this paragraph 14 may be provided |
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| 1 | | for up to 24 continuous months from the initial | 2 | | eligibility date so long as an individual continues to | 3 | | satisfy the criteria of this paragraph 14. If an | 4 | | individual has an appeal pending regarding an application | 5 | | for asylum before the Department of Homeland Security, | 6 | | eligibility under this paragraph 14 may be extended until | 7 | | a final decision is rendered on the appeal. The Department | 8 | | may adopt rules governing the implementation of this | 9 | | paragraph 14. | 10 | | 15. Family Care Eligibility. | 11 | | (a) On and after July 1, 2012, a parent or other | 12 | | caretaker relative who is 19 years of age or older when | 13 | | countable income is at or below 133% of the federal | 14 | | poverty level. A person may not spend down to become | 15 | | eligible under this paragraph 15. | 16 | | (b) Eligibility shall be reviewed annually. | 17 | | (c) (Blank). | 18 | | (d) (Blank). | 19 | | (e) (Blank). | 20 | | (f) (Blank). | 21 | | (g) (Blank). | 22 | | (h) (Blank). | 23 | | (i) Following termination of an individual's | 24 | | coverage under this paragraph 15, the individual must | 25 | | be determined eligible before the person can be | 26 | | re-enrolled. |
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| 1 | | 16. Subject to appropriation, uninsured persons who | 2 | | are not otherwise eligible under this Section who have | 3 | | been certified and referred by the Department of Public | 4 | | Health as having been screened and found to need | 5 | | diagnostic evaluation or treatment, or both diagnostic | 6 | | evaluation and treatment, for prostate or testicular | 7 | | cancer. For the purposes of this paragraph 16, uninsured | 8 | | persons are those who do not have creditable coverage, as | 9 | | defined under the Health Insurance Portability and | 10 | | Accountability Act, or have otherwise exhausted any | 11 | | insurance benefits they may have had, for prostate or | 12 | | testicular cancer diagnostic evaluation or treatment, or | 13 | | both diagnostic evaluation and treatment. To be eligible, | 14 | | a person must furnish a Social Security number. A person's | 15 | | assets are exempt from consideration in determining | 16 | | eligibility under this paragraph 16. Such persons shall be | 17 | | eligible for medical assistance under this paragraph 16 | 18 | | for so long as they need treatment for the cancer. A person | 19 | | shall be considered to need treatment if, in the opinion | 20 | | of the person's treating physician, the person requires | 21 | | therapy directed toward cure or palliation of prostate or | 22 | | testicular cancer, including recurrent metastatic cancer | 23 | | that is a known or presumed complication of prostate or | 24 | | testicular cancer and complications resulting from the | 25 | | treatment modalities themselves. Persons who require only | 26 | | routine monitoring services are not considered to need |
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| 1 | | treatment. "Medical assistance" under this paragraph 16 | 2 | | shall be identical to the benefits provided under the | 3 | | State's approved plan under Title XIX of the Social | 4 | | Security Act. Notwithstanding any other provision of law, | 5 | | the Department (i) does not have a claim against the | 6 | | estate of a deceased recipient of services under this | 7 | | paragraph 16 and (ii) does not have a lien against any | 8 | | homestead property or other legal or equitable real | 9 | | property interest owned by a recipient of services under | 10 | | this paragraph 16. | 11 | | 17. Persons who, pursuant to a waiver approved by the | 12 | | Secretary of the U.S. Department of Health and Human | 13 | | Services, are eligible for medical assistance under Title | 14 | | XIX or XXI of the federal Social Security Act. | 15 | | Notwithstanding any other provision of this Code and | 16 | | consistent with the terms of the approved waiver, the | 17 | | Illinois Department, may by rule: | 18 | | (a) Limit the geographic areas in which the waiver | 19 | | program operates. | 20 | | (b) Determine the scope, quantity, duration, and | 21 | | quality, and the rate and method of reimbursement, of | 22 | | the medical services to be provided, which may differ | 23 | | from those for other classes of persons eligible for | 24 | | assistance under this Article. | 25 | | (c) Restrict the persons' freedom in choice of | 26 | | providers. |
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| 1 | | 18. Beginning January 1, 2014, persons aged 19 or | 2 | | older, but younger than 65, who are not otherwise eligible | 3 | | for medical assistance under this Section 5-2, who qualify | 4 | | for medical assistance pursuant to 42 U.S.C. | 5 | | 1396a(a)(10)(A)(i)(VIII) and applicable federal | 6 | | regulations, and who have income at or below 133% of the | 7 | | federal poverty level plus 5% for the applicable family | 8 | | size as determined pursuant to 42 U.S.C. 1396a(e)(14) and | 9 | | applicable federal regulations. Persons eligible for | 10 | | medical assistance under this paragraph 18 shall receive | 11 | | coverage for the Health Benefits Service Package as that | 12 | | term is defined in subsection (m) of Section 5-1.1 of this | 13 | | Code. If Illinois' federal medical assistance percentage | 14 | | (FMAP) is reduced below 90% for persons eligible for | 15 | | medical assistance under this paragraph 18, eligibility | 16 | | under this paragraph 18 shall cease no later than the end | 17 | | of the third month following the month in which the | 18 | | reduction in FMAP takes effect. | 19 | | 19. Beginning January 1, 2014, as required under 42 | 20 | | U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18 | 21 | | and younger than age 26 who are not otherwise eligible for | 22 | | medical assistance under paragraphs (1) through (17) of | 23 | | this Section who (i) were in foster care under the | 24 | | responsibility of the State on the date of attaining age | 25 | | 18 or on the date of attaining age 21 when a court has | 26 | | continued wardship for good cause as provided in Section |
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| 1 | | 2-31 of the Juvenile Court Act of 1987 and (ii) received | 2 | | medical assistance under the Illinois Title XIX State Plan | 3 | | or waiver of such plan while in foster care. | 4 | | 20. Beginning January 1, 2018, persons who are | 5 | | foreign-born victims of human trafficking, torture, or | 6 | | other serious crimes as defined in Section 2-19 of this | 7 | | Code and their derivative family members if such persons: | 8 | | (i) reside in Illinois; (ii) are not eligible under any of | 9 | | the preceding paragraphs; (iii) meet the income guidelines | 10 | | of subparagraph (a) of paragraph 2; and (iv) meet the | 11 | | nonfinancial eligibility requirements of Sections 16-2, | 12 | | 16-3, and 16-5 of this Code. The Department may extend | 13 | | medical assistance for persons who are foreign-born | 14 | | victims of human trafficking, torture, or other serious | 15 | | crimes whose medical assistance would be terminated | 16 | | pursuant to subsection (b) of Section 16-5 if the | 17 | | Department determines that the person, during the year of | 18 | | initial eligibility (1) experienced a health crisis, (2) | 19 | | has been unable, after reasonable attempts, to obtain | 20 | | necessary information from a third party, or (3) has other | 21 | | extenuating circumstances that prevented the person from | 22 | | completing his or her application for status. The | 23 | | Department may adopt any rules necessary to implement the | 24 | | provisions of this paragraph. | 25 | | 21. Persons who are not otherwise eligible for medical | 26 | | assistance under this Section who may qualify for medical |
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| 1 | | assistance pursuant to 42 U.S.C. | 2 | | 1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the | 3 | | duration of any federal or State declared emergency due to | 4 | | COVID-19. Medical assistance to persons eligible for | 5 | | medical assistance solely pursuant to this paragraph 21 | 6 | | shall be limited to any in vitro diagnostic product (and | 7 | | the administration of such product) described in 42 U.S.C. | 8 | | 1396d(a)(3)(B) on or after March 18, 2020, any visit | 9 | | described in 42 U.S.C. 1396o(a)(2)(G), or any other | 10 | | medical assistance that may be federally authorized for | 11 | | this class of persons. The Department may also cover | 12 | | treatment of COVID-19 for this class of persons, or any | 13 | | similar category of uninsured individuals, to the extent | 14 | | authorized under a federally approved 1115 Waiver or other | 15 | | federal authority. Notwithstanding the provisions of | 16 | | Section 1-11 of this Code, due to the nature of the | 17 | | COVID-19 public health emergency, the Department may cover | 18 | | and provide the medical assistance described in this | 19 | | paragraph 21 to noncitizens who would otherwise meet the | 20 | | eligibility requirements for the class of persons | 21 | | described in this paragraph 21 for the duration of the | 22 | | State emergency period. | 23 | | In implementing the provisions of Public Act 96-20, the | 24 | | Department is authorized to adopt only those rules necessary, | 25 | | including emergency rules. Nothing in Public Act 96-20 permits | 26 | | the Department to adopt rules or issue a decision that expands |
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| 1 | | eligibility for the FamilyCare Program to a person whose | 2 | | income exceeds 185% of the Federal Poverty Level as determined | 3 | | from time to time by the U.S. Department of Health and Human | 4 | | Services, unless the Department is provided with express | 5 | | statutory authority. | 6 | | The eligibility of any such person for medical assistance | 7 | | under this Article is not affected by the payment of any grant | 8 | | under the Senior Citizens and Persons with Disabilities | 9 | | Property Tax Relief Act or any distributions or items of | 10 | | income described under subparagraph (X) of paragraph (2) of | 11 | | subsection (a) of Section 203 of the Illinois Income Tax Act. | 12 | | The Department shall by rule establish the amounts of | 13 | | assets to be disregarded in determining eligibility for | 14 | | medical assistance, which shall at a minimum equal the amounts | 15 | | to be disregarded under the Federal Supplemental Security | 16 | | Income Program. The amount of assets of a single person to be | 17 | | disregarded shall not be less than $2,000, and the amount of | 18 | | assets of a married couple to be disregarded shall not be less | 19 | | than $3,000. | 20 | | To the extent permitted under federal law, any person | 21 | | found guilty of a second violation of Article VIIIA shall be | 22 | | ineligible for medical assistance under this Article, as | 23 | | provided in Section 8A-8. | 24 | | The eligibility of any person for medical assistance under | 25 | | this Article shall not be affected by the receipt by the person | 26 | | of donations or benefits from fundraisers held for the person |
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| 1 | | in cases of serious illness, as long as neither the person nor | 2 | | members of the person's family have actual control over the | 3 | | donations or benefits or the disbursement of the donations or | 4 | | benefits. | 5 | | Notwithstanding any other provision of this Code, if the | 6 | | United States Supreme Court holds Title II, Subtitle A, | 7 | | Section 2001(a) of Public Law 111-148 to be unconstitutional, | 8 | | or if a holding of Public Law 111-148 makes Medicaid | 9 | | eligibility allowed under Section 2001(a) inoperable, the | 10 | | State or a unit of local government shall be prohibited from | 11 | | enrolling individuals in the Medical Assistance Program as the | 12 | | result of federal approval of a State Medicaid waiver on or | 13 | | after June 14, 2012 (the effective date of Public Act 97-687), | 14 | | and any individuals enrolled in the Medical Assistance Program | 15 | | pursuant to eligibility permitted as a result of such a State | 16 | | Medicaid waiver shall become immediately ineligible. | 17 | | Notwithstanding any other provision of this Code, if an | 18 | | Act of Congress that becomes a Public Law eliminates Section | 19 | | 2001(a) of Public Law 111-148, the State or a unit of local | 20 | | government shall be prohibited from enrolling individuals in | 21 | | the Medical Assistance Program as the result of federal | 22 | | approval of a State Medicaid waiver on or after June 14, 2012 | 23 | | (the effective date of Public Act 97-687), and any individuals | 24 | | enrolled in the Medical Assistance Program pursuant to | 25 | | eligibility permitted as a result of such a State Medicaid | 26 | | waiver shall become immediately ineligible. |
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| 1 | | Effective October 1, 2013, the determination of | 2 | | eligibility of persons who qualify under paragraphs 5, 6, 8, | 3 | | 15, 17, and 18 of this Section shall comply with the | 4 | | requirements of 42 U.S.C. 1396a(e)(14) and applicable federal | 5 | | regulations. | 6 | | The Department of Healthcare and Family Services, the | 7 | | Department of Human Services, and the Illinois health | 8 | | insurance marketplace shall work cooperatively to assist | 9 | | persons who would otherwise lose health benefits as a result | 10 | | of changes made under Public Act 98-104 to transition to other | 11 | | health insurance coverage. | 12 | | (Source: P.A. 101-10, eff. 6-5-19; 101-649, eff. 7-7-20; | 13 | | 102-43, eff. 7-6-21; 102-558, eff. 8-20-21; 102-665, eff. | 14 | | 10-8-21; 102-813, eff. 5-13-22.) |
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