Full Text of HB5927 96th General Assembly
HB5927enr 96TH GENERAL ASSEMBLY
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| AN ACT concerning insurance.
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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 Children's Health Insurance Program Act is | 5 |
| amended by changing Section 20 as follows:
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| (215 ILCS 106/20)
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| Sec. 20. Eligibility.
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| (a) To be eligible for this Program, a person must be a | 9 |
| person who
has a child eligible under this Act and who is | 10 |
| eligible under a waiver
of federal requirements pursuant to an | 11 |
| application made pursuant to
subdivision (a)(1) of Section 40 | 12 |
| of this Act or who is a child who:
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| (1) is a child who is not eligible for medical | 14 |
| assistance;
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| (2) is a child whose annual household income, as | 16 |
| determined by the
Department, is above 133% of the federal | 17 |
| poverty level and at or below
200%
of the federal poverty | 18 |
| level;
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| (3) is a resident of the State of Illinois; and
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| (4) is a child who is either a United States citizen or | 21 |
| included in one
of the following categories of | 22 |
| non-citizens:
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| (A) unmarried dependent children of either a |
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| United States Veteran
honorably discharged or a person | 2 |
| on active military duty;
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| (B) refugees under Section 207 of the Immigration | 4 |
| and
Nationality Act;
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| (C) asylees under Section 208 of the Immigration | 6 |
| and
Nationality Act;
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| (D) persons for whom deportation has been withheld | 8 |
| under
Section 243(h) of the Immigration and | 9 |
| Nationality Act;
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| (E) persons granted conditional entry under | 11 |
| Section 203(a)(7) of the
Immigration and Nationality | 12 |
| Act as in effect prior to April 1, 1980;
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| (F) persons lawfully admitted for permanent | 14 |
| residence under
the Immigration and Nationality Act; | 15 |
| and
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| (G) parolees, for at least one year, under Section | 17 |
| 212(d)(5)
of the Immigration and Nationality Act.
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| Those children who are in the categories set forth in | 19 |
| subdivisions
(4)(F) and (4)(G) of this subsection, who enter | 20 |
| the United States on or
after August 22, 1996, shall not be | 21 |
| eligible for 5 years beginning on the
date the child entered | 22 |
| the United States.
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| (b) A child who is determined to be eligible for assistance | 24 |
| may remain
eligible for 12 months, provided the child maintains | 25 |
| his or
her residence in the State, has not yet attained 19 | 26 |
| years of age, and is not
excluded pursuant to subsection (c). A |
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| child who has been determined to
be eligible for assistance | 2 |
| must reapply or otherwise establish eligibility
at least | 3 |
| annually.
An eligible child shall be required, as determined by | 4 |
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Department by rule, to report promptly those changes in | 5 |
| income and other
circumstances that affect eligibility. The | 6 |
| eligibility of a child may be
redetermined based on the | 7 |
| information reported or may be terminated based on
the failure | 8 |
| to report or failure to report accurately. A child's | 9 |
| responsible
relative or caretaker may also be held liable to | 10 |
| the Department for any
payments made by the Department on such | 11 |
| child's behalf that were inappropriate.
An applicant shall be | 12 |
| provided with notice of these obligations.
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| (c) A child shall not be eligible for coverage under this | 14 |
| Program if:
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| (1) the premium required pursuant to
Section 30 of this | 16 |
| Act has not been paid. If the
required premiums are not | 17 |
| paid the liability of the Program
shall be limited to | 18 |
| benefits incurred under the
Program for the time period for | 19 |
| which premiums had been paid. If
the required monthly | 20 |
| premium is not paid, the child shall be ineligible for
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| re-enrollment for a minimum period of 3 months. | 22 |
| Re-enrollment shall be
completed prior to the next covered | 23 |
| medical visit and the first month's
required premium shall | 24 |
| be paid in advance of the next covered medical visit.
The | 25 |
| Department shall promulgate rules regarding grace periods, | 26 |
| notice
requirements, and hearing procedures pursuant to |
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| this subsection;
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| (2) the child is an inmate of a public institution or a | 3 |
| patient in an
institution for mental diseases; or
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| (3) the child is a member of a family that is eligible | 5 |
| for health benefits
covered under the State of Illinois | 6 |
| health benefits plan on the basis of a
member's employment | 7 |
| with a public agency.
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| (Source: P.A. 92-597, eff. 6-28-02; 93-63, eff. 6-30-03.)
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| Section 10. The Covering ALL KIDS Health Insurance Act is | 10 |
| amended by changing Section 20 as follows: | 11 |
| (215 ILCS 170/20) | 12 |
| (Section scheduled to be repealed on July 1, 2011)
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| Sec. 20. Eligibility. | 14 |
| (a) To be eligible for the Program, a person must be a | 15 |
| child:
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| (1) who is a resident of the State of Illinois; and
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| (2) who is ineligible for medical assistance under the | 18 |
| Illinois Public Aid Code or benefits under the Children's | 19 |
| Health Insurance Program Act; and
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| (3) either (i) who has been without health insurance | 21 |
| coverage for a period set forth by the Department in rules, | 22 |
| but not less than 6 months during the first month of | 23 |
| operation of the Program, 7 months during the second month | 24 |
| of operation, 8 months during the third month of operation, |
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| 9 months during the fourth month of operation, 10 months | 2 |
| during the fifth month of operation, 11 months during the | 3 |
| sixth month of operation, and 12 months thereafter, (ii) | 4 |
| whose parent has lost employment that made available | 5 |
| affordable dependent health insurance coverage, until such | 6 |
| time as affordable employer-sponsored dependent health | 7 |
| insurance coverage is again available for the child as set | 8 |
| forth by the Department in rules, (iii) who is a newborn | 9 |
| whose responsible relative does not have available | 10 |
| affordable private or employer-sponsored health insurance, | 11 |
| or (iv) who, within one year of applying for coverage under | 12 |
| this Act, lost medical benefits under the Illinois Public | 13 |
| Aid Code or the Children's Health Insurance Program Act. | 14 |
| An entity that provides health insurance coverage (as | 15 |
| defined in Section 2 of the Comprehensive Health Insurance Plan | 16 |
| Act) to Illinois residents shall provide health insurance data | 17 |
| match to the Department of Healthcare and Family Services for | 18 |
| the purpose of determining eligibility for the Program under | 19 |
| this Act. | 20 |
| The Department of Healthcare and Family Services, in | 21 |
| collaboration with the Department of Financial and | 22 |
| Professional Regulation, Division of Insurance, shall adopt | 23 |
| rules governing the exchange of information under this Section. | 24 |
| The rules shall be consistent with all laws relating to the | 25 |
| confidentiality or privacy of personal information or medical | 26 |
| records, including provisions under the Federal Health |
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| Insurance Portability and Accountability Act (HIPAA). | 2 |
| (b) The Department shall monitor the availability and | 3 |
| retention of employer-sponsored dependent health insurance | 4 |
| coverage and shall modify the period described in subdivision | 5 |
| (a)(3) if necessary to promote retention of private or | 6 |
| employer-sponsored health insurance and timely access to | 7 |
| healthcare services, but at no time shall the period described | 8 |
| in subdivision (a)(3) be less than 6 months.
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| (c) The Department, at its discretion, may take into | 10 |
| account the affordability of dependent health insurance when | 11 |
| determining whether employer-sponsored dependent health | 12 |
| insurance coverage is available upon reemployment of a child's | 13 |
| parent as provided in subdivision (a)(3). | 14 |
| (d) A child who is determined to be eligible for the | 15 |
| Program shall remain eligible for 12 months, provided that the | 16 |
| child maintains his or her residence in this State, has not yet | 17 |
| attained 19 years of age, and is not excluded under subsection | 18 |
| (e). | 19 |
| (e) A child is not eligible for coverage under the Program | 20 |
| if: | 21 |
| (1) the premium required under Section 40 has not been | 22 |
| timely paid; if the required premiums are not paid, the | 23 |
| liability of the Program shall be limited to benefits | 24 |
| incurred under the Program for the time period for which | 25 |
| premiums have been paid; if the required monthly premium is | 26 |
| not paid, the child is ineligible for re-enrollment for a |
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| minimum period of 3 months; re-enrollment shall be | 2 |
| completed before the next covered medical visit, and the | 3 |
| first month's required premium shall be paid in advance of | 4 |
| the next covered medical visit; or | 5 |
| (2) the child is an inmate of a public institution or | 6 |
| an institution for mental diseases.
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| (f) The Department shall adopt eligibility rules, | 8 |
| including, but not limited to: rules regarding annual renewals | 9 |
| of eligibility for the Program; rules providing for | 10 |
| re-enrollment, grace periods, notice requirements, and hearing | 11 |
| procedures under subdivision (e)(1) of this Section; and rules | 12 |
| regarding what constitutes availability and affordability of | 13 |
| private or employer-sponsored health insurance, with | 14 |
| consideration of such factors as the percentage of income | 15 |
| needed to purchase children or family health insurance, the | 16 |
| availability of employer subsidies, and other relevant | 17 |
| factors.
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| (Source: P.A. 94-693, eff. 7-1-06 .)
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