Full Text of HB5891 96th General Assembly
HB5891enr 96TH GENERAL ASSEMBLY
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Public Aid Code is amended by | 5 |
| changing Section 5-2 as follows:
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| (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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| Sec. 5-2. Classes of Persons Eligible. Medical assistance | 8 |
| under this
Article shall be available to any of the following | 9 |
| classes of persons in
respect to whom a plan for coverage has | 10 |
| been submitted to the Governor
by the Illinois Department and | 11 |
| approved by him:
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| 1. Recipients of basic maintenance grants under | 13 |
| Articles III and IV.
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| 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
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| necessary medical care, including but not limited to the | 23 |
| following:
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| (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:
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| (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
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| 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
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| 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
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| (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
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| 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
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| 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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| subparagraph (a).
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| (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
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| permitted by federal law.
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| 3. Persons who would otherwise qualify for Aid to the | 10 |
| Medically
Indigent under Article VII.
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| 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
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| expenses.
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| 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
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| the maximum extent possible under Title XIX of the
Federal | 23 |
| Social Security Act.
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| (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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| ambulatory prenatal care to pregnant women during a
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| 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
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| 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
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| eligibility.
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| (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
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| 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.
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| 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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| Federal Social Security Act.
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| 7. Persons who are under 21 years of age and would
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| 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
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| Financial Participation, and provided the Illinois | 7 |
| Department determines that:
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| (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;
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| (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;
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| (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.
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| 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
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| employment earnings. The plan for coverage for this class | 26 |
| of persons shall:
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| (a) extend the medical assistance coverage for up | 2 |
| to 12 months following
termination of basic | 3 |
| maintenance assistance; and
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| (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:
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| (i) such coverage shall be pursuant to | 9 |
| provisions of the federal
Social Security Act;
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| (ii) such coverage shall include all services | 11 |
| covered while the person
was eligible for basic | 12 |
| maintenance assistance;
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| (iii) no premium shall be charged for such | 14 |
| coverage; and
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| (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.
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| 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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| 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.
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| 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
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| qualifications for protection of resources described in | 10 |
| Section 15 of that
Act.
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| 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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| (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
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| (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.
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| 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:
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| (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
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| 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
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| (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.
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| "Medical assistance" under this paragraph 12 shall be |
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| 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.
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| 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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| under this Article and who qualify for services covered | 2 |
| under Section 5-5.04 as provided by the Illinois Department | 3 |
| by rule.
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| 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.
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| 15. Family Care Eligibility. |
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| (a) A caretaker relative who is 19 years of age or | 2 |
| older when countable income is at or below 185% of the | 3 |
| Federal Poverty Level Guidelines, as published | 4 |
| annually in the Federal Register, for the appropriate | 5 |
| family size. A person may not spend down to become | 6 |
| eligible under this paragraph 15. | 7 |
| (b) Eligibility shall be reviewed annually. | 8 |
| (c) Caretaker relatives enrolled under this | 9 |
| paragraph 15 in families with countable income above | 10 |
| 150% and at or below 185% of the Federal Poverty Level | 11 |
| Guidelines shall be counted as family members and pay | 12 |
| premiums as established under the Children's Health | 13 |
| Insurance Program Act. | 14 |
| (d) Premiums shall be billed by and payable to the | 15 |
| Department or its authorized agent, on a monthly basis. | 16 |
| (e) The premium due date is the last day of the | 17 |
| month preceding the month of coverage. | 18 |
| (f) Individuals shall have a grace period through | 19 |
| the month of coverage to pay the premium. | 20 |
| (g) Failure to pay the full monthly premium by the | 21 |
| last day of the grace period shall result in | 22 |
| termination of coverage. | 23 |
| (h) Partial premium payments shall not be | 24 |
| refunded. | 25 |
| (i) Following termination of an individual's | 26 |
| coverage under this paragraph 15, the following action |
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| is required before the individual can be re-enrolled: | 2 |
| (1) A new application must be completed and the | 3 |
| individual must be determined otherwise eligible. | 4 |
| (2) There must be full payment of premiums due | 5 |
| under this Code, the Children's Health Insurance | 6 |
| Program Act, the Covering ALL KIDS Health | 7 |
| Insurance Act, or any other healthcare program | 8 |
| administered by the Department for periods in | 9 |
| which a premium was owed and not paid for the | 10 |
| individual. | 11 |
| (3) The first month's premium must be paid if | 12 |
| there was an unpaid premium on the date the | 13 |
| individual's previous coverage was canceled. | 14 |
| The Department is authorized to implement the | 15 |
| provisions of this amendatory Act of the 95th General | 16 |
| Assembly by adopting the medical assistance rules in effect | 17 |
| as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | 18 |
| 89 Ill. Admin. Code 120.32 along with only those changes | 19 |
| necessary to conform to federal Medicaid requirements, | 20 |
| federal laws, and federal regulations, including but not | 21 |
| limited to Section 1931 of the Social Security Act (42 | 22 |
| U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | 23 |
| of Health and Human Services, and the countable income | 24 |
| eligibility standard authorized by this paragraph 15. The | 25 |
| Department may not otherwise adopt any rule to implement | 26 |
| this increase except as authorized by law, to meet the |
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| eligibility standards authorized by the federal government | 2 |
| in the Medicaid State Plan or the Title XXI Plan, or to | 3 |
| meet an order from the federal government or any court. | 4 |
| 16. 15. Subject to appropriation, uninsured persons | 5 |
| who are not otherwise eligible under this Section who have | 6 |
| been certified and referred by the Department of Public | 7 |
| Health as having been screened and found to need diagnostic | 8 |
| evaluation or treatment, or both diagnostic evaluation and | 9 |
| treatment, for prostate or testicular cancer. For the | 10 |
| purposes of this paragraph 16 15 , uninsured persons are | 11 |
| those who do not have creditable coverage, as defined under | 12 |
| the Health Insurance Portability and Accountability Act, | 13 |
| or have otherwise exhausted any insurance benefits they may | 14 |
| have had, for prostate or testicular cancer diagnostic | 15 |
| evaluation or treatment, or both diagnostic evaluation and | 16 |
| treatment.
To be eligible, a person must furnish a Social | 17 |
| Security number.
A person's assets are exempt from | 18 |
| consideration in determining eligibility under this | 19 |
| paragraph 16 15 .
Such persons shall be eligible for medical | 20 |
| assistance under this paragraph 16 15 for so long as they | 21 |
| need treatment for the cancer. A person shall be considered | 22 |
| to need treatment if, in the opinion of the person's | 23 |
| treating physician, the person requires therapy directed | 24 |
| toward cure or palliation of prostate or testicular cancer, | 25 |
| including recurrent metastatic cancer that is a known or | 26 |
| presumed complication of prostate or testicular cancer and |
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| complications resulting from the treatment modalities | 2 |
| themselves. Persons who require only routine monitoring | 3 |
| services are not considered to need treatment.
"Medical | 4 |
| assistance" under this paragraph 16 15 shall be identical | 5 |
| to the benefits provided under the State's approved plan | 6 |
| under Title XIX of the Social Security Act.
Notwithstanding | 7 |
| any other provision of law, the Department (i) does not | 8 |
| have a claim against the estate of a deceased recipient of | 9 |
| services under this paragraph 16 15 and (ii) does not have | 10 |
| a lien against any homestead property or other legal or | 11 |
| equitable real property interest owned by a recipient of | 12 |
| services under this paragraph 16 15 . | 13 |
| In implementing the provisions of Public Act 96-20 this | 14 |
| amendatory Act of the 96th General Assembly , the Department is | 15 |
| authorized to adopt only those rules necessary, including | 16 |
| emergency rules. Nothing in Public Act 96-20 this amendatory | 17 |
| Act of the 96th General Assembly permits the Department to | 18 |
| adopt rules or issue a decision that expands eligibility for | 19 |
| the FamilyCare Program to a person whose income exceeds 185% of | 20 |
| the Federal Poverty Level as determined from time to time by | 21 |
| the U.S. Department of Health and Human Services, unless the | 22 |
| Department is provided with express statutory authority. | 23 |
| The Illinois Department and the Governor shall provide a | 24 |
| plan for
coverage of the persons eligible under paragraph 7 as | 25 |
| soon as possible after
July 1, 1984.
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| The eligibility of any such person for medical assistance |
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| under this
Article is not affected by the payment of any grant | 2 |
| under the Senior
Citizens and Disabled Persons Property Tax | 3 |
| Relief and Pharmaceutical
Assistance Act or any distributions | 4 |
| or items of income described under
subparagraph (X) of
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| paragraph (2) of subsection (a) of Section 203 of the Illinois | 6 |
| Income Tax
Act. The Department shall by rule establish the | 7 |
| amounts of
assets to be disregarded in determining eligibility | 8 |
| for medical assistance,
which shall at a minimum equal the | 9 |
| amounts to be disregarded under the
Federal Supplemental | 10 |
| Security Income Program. The amount of assets of a
single | 11 |
| person to be disregarded
shall not be less than $2,000, and the | 12 |
| amount of assets of a married couple
to be disregarded shall | 13 |
| not be less than $3,000.
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| To the extent permitted under federal law, any person found | 15 |
| guilty of a
second violation of Article VIIIA
shall be | 16 |
| ineligible for medical assistance under this Article, as | 17 |
| provided
in Section 8A-8.
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| The eligibility of any person for medical assistance under | 19 |
| this Article
shall not be affected by the receipt by the person | 20 |
| of donations or benefits
from fundraisers held for the person | 21 |
| in cases of serious illness,
as long as neither the person nor | 22 |
| members of the person's family
have actual control over the | 23 |
| donations or benefits or the disbursement
of the donations or | 24 |
| benefits.
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| (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; | 26 |
| 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. |
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| 8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
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| Section 99. Effective date. This Act takes effect upon | 3 |
| becoming law.
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