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| [ Introduced ] | [ Engrossed ] | [ House Amendment 001 ] |
90_HB1302ham004
LRB9003882EGmbam01
1 AMENDMENT TO HOUSE BILL 1302
2 AMENDMENT NO. . Amend House Bill 1302, AS AMENDED,
3 by replacing everything after the enacting clause with the
4 following:
5 "Section 1. Short title. This Act may be cited as the
6 Healthy Start Insurance Plan Act.
7 Section 5. Findings and declarations.
8 (a) About 310,000, or nearly 10% of more than 3,000,000
9 children in Illinois, have no health insurance coverage,
10 either through a parent's employment, through the State's
11 Medicaid program, or any other health plan.
12 (b) Parents moving from welfare to work will lose
13 Medicaid coverage for their children and are unlikely to be
14 offered health care coverage in low-skill and service sector
15 jobs. According to the General Accounting Office,
16 lower-income workers are less likely to work for a firm that
17 offers insurance and may find it too costly to purchase where
18 coverage it is available.
19 (c) Numerous states have implemented health insurance
20 programs for insured children in recognizing that access to
21 immunizations, ongoing check-ups, and other health services
22 helps children avoid serious health problems that can lead to
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1 life-long physical and mental disabilities. Preventive care
2 is cost effective and can reduce expensive hospitalization.
3 (d) The State of Illinois may subsidize the cost of
4 health insurance policies offered. While serving as many
5 uninsured children as possible within the limits of
6 appropriations, the General Assembly is not guaranteeing
7 every family an entitlement to a health insurance policy
8 under this Act.
9 Section 10. Definitions.
10 "Board" means the Illinois Comprehensive Health Insurance
11 Board.
12 "Department" means the Department of Human Services.
13 "Eligible child" means a child who has resided in the
14 State of Illinois for 30 days and (i) who is 8 years of age
15 or less in fiscal year 1999, or who is 10 years of age or
16 less in fiscal year 2000, or who is 12 years of age or less
17 in 2001, and who qualifies for enrollment in the Healthy
18 Start Insurance Plan under eligibility criteria set forth
19 under subsection (a) of Section 20 of this Act; or (ii) a
20 child who is 12 years of age or less prior to fiscal year
21 2002 and qualifies for enrollment in the Healthy Start
22 Insurance Plan under subsection (a) of Section 20 of this
23 Act.
24 "Family" means, in the case of a child who is a dependent
25 of another person or couple as defined by the Illinois Income
26 Tax Act, all persons for whom exemption is claimed in the
27 State income tax return of the person or couple whose
28 dependent the eligible child is.
29 "Health insurance coverage" means benefits consisting of
30 health services set forth under Section 15 of this Act,
31 provided under any health insurance plan offered by the
32 Department.
33 "Medical assistance" means the state medical assistance
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1 or medical assistance no grant (MANG) programs provided under
2 Title XIX of the Social Security Act and Article V (Medical
3 Assistance) and VI (General Assistance) of the Illinois
4 Public Aid Code (or any successor program).
5 "Plan market rate" means the costs of Healthy Start
6 Insurance Plan coverage charged by at least 5 of the largest
7 health insurance issuers providing to residents of Illinois
8 health insurance coverage that is substantially similar to
9 the coverage offered by the Plan.
10 "Plan of operation" means the plan of operation of the
11 Healthy Start Insurance Plan, including articles, bylaws, and
12 operating rules, adopted by the Department.
13 All other definitions in Section 2 of the Comprehensive
14 Health Insurance Plan shall apply to this Act, unless
15 otherwise indicated.
16 Section 15. Health services covered.
17 (a) The Healthy Start Insurance Plan (called "Healthy
18 Start Plan") is established to promote access to certain
19 health care services to assure healthy children. The
20 following health insurance coverage shall be offered to
21 children who are enrolled in the Healthy Start Plan, subject
22 to such separate co-payments, exclusions, and other
23 limitations on benefits as the Department shall establish and
24 approve:
25 (1) Well-child examinations, including
26 immunizations;
27 (2) Out-patient medical care, including laboratory
28 and x-ray services;
29 (3) Emergency room care;
30 (4) Prescription medications;
31 (5) Hearing and vision services;
32 (6) Dental care, including preventive and
33 restorative care, but excluding orthodontic care;
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1 (7) Home health care;
2 (8) Allied health services, including physical,
3 occupational, and speech therapy, audiology, social work,
4 and nutritional services;
5 (9) Out-patient mental health services; and
6 (10) Out-patient substance abuse treatment
7 services.
8 (b) Health insurance coverage under the Healthy Start
9 Plan shall be secondary to an insurance policy or benefit
10 program under which an eligible child may otherwise have
11 health insurance coverage.
12 Section 20. Eligibility for enrollment.
13 (a) A family may enroll an eligible child or children in
14 the Healthy Start Plan, within the limits of available
15 appropriations, if the following criteria are met:
16 (1) The child's family has gross family income
17 equal to or less than 250% of the federal poverty level
18 and is not eligible for medical assistance and is not
19 otherwise insured for a particular health service covered
20 under the Healthy Start Plan;
21 (2) The child's family pays an annual premium as
22 defined in Section 25; and
23 (3) The eligible child and his or her family meet
24 all other guidelines and requirements of the Department.
25 (b) The Department may use Social Security numbers of
26 individuals as identifiers for purposes of administering the
27 Healthy Start Plan and may conduct data matches to verify
28 income. Applicants may be required to submit evidence of
29 family income to verify income eligibility for the Healthy
30 Start Plan.
31 (c) The period of a child's eligibility for the Healthy
32 Start Plan shall terminate on the last day of the month in
33 which the child's birthday occurs at the age that he or she
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1 is no longer an "eligible child" pursuant to Section 10 of
2 this Act.
3 Section 25. Premiums.
4 (a) The following annual premiums shall be required as a
5 condition of enrollment in the Healthy Start Plan, provided
6 that total premium costs shall not exceed 5% of family gross
7 income:
8 (1) Families with gross income equal to or less
9 than 100% of the federal poverty level shall pay a
10 premium that is no more than 5% of the Plan market rate.
11 (2) Families with gross income of more than 100%,
12 but less than 133%, of the federal poverty level shall
13 pay a premium that is no more than 10% of the Plan market
14 rate.
15 (3) Families with gross income of at least 133%,
16 but less than 185%, of the federal poverty level shall
17 pay a premium that is no more than 20% of the Plan market
18 rate.
19 (4) Families with gross income of at least 185%,
20 but less than 200%, of the federal poverty level shall
21 pay a premium that is no more than 40% of the Plan market
22 rate.
23 (5) Families with gross income of at least 200%,
24 but less than 230%, of the federal poverty level shall
25 pay a premium that is no more than 60% of the Plan market
26 rate.
27 (6) Families with gross income of at least 230%,
28 but less than 250%, of the federal poverty level shall
29 pay a premium that is no more than 75% of the Plan market
30 rate.
31 (b) Total premium costs shall not exceed 5% of family
32 net income.
33 (c) An eligible child whose family has gross family
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1 income greater than 250% of the federal poverty level may
2 enroll in the Plan if coverage is provided under guidelines
3 and requirements of the Department. Families enrolling under
4 this subsection may be required to pay the full cost of
5 health insurance coverage as determined by the Department.
6 (d) An eligible child who is 18 years of age or less
7 prior to fiscal year 2002 and whose gross family income is
8 less than 250% of the federal poverty level shall be
9 permitted to enroll in the Plan but shall be required to pay
10 the full cost of health insurance coverage as determined by
11 the Department.
12 (e) The Department may establish family premium rates
13 for families who enroll in the Plan with 2 or more eligible
14 children.
15 Section 30. Administration.
16 (a) The Healthy Start Plan shall be administered by the
17 Department. The Department may adopt rules, policies, and
18 procedures as may be necessary or convenient for the
19 implementation of this Act and the operation of the Healthy
20 Start Plan.
21 (b) In its plan of operation for the Healthy Start Plan,
22 the Department shall:
23 (1) establish procedures for selecting an
24 administrator for the Healthy Start Plan that is in
25 conformance with Section 5 of the Comprehensive Health
26 Insurance Plan;
27 (2) create a Healthy Start Plan Fund, under
28 management of the Department, to fund administrative
29 expenses;
30 (3) establish procedures for the handling and
31 accounting of assets and moneys of the Healthy Start
32 Plan;
33 (4) establish procedures to (i) distribute
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1 application forms and other information concerning the
2 Healthy Start Plan to, and accept completed applications
3 from, public health and health agencies and human
4 services agencies and schools and (ii) maintain public
5 awareness of the Healthy Start Plan and other publicly
6 subsidized medical assistance programs among families of
7 potentially eligible children;
8 (5) develop procedures for joint applications and
9 eligibility determination procedures, wherever possible,
10 for enrollment of eligible children in the Healthy Start
11 Plan and for medical assistance under the Illinois Public
12 Aid Code (or any other successor program);
13 (6) determine qualifications and payment schedules
14 for the providers who are eligible to provide and receive
15 payment for health services included under Section 15 of
16 this Act;
17 (7) establish procedures for the redetermination of
18 eligibility under the Healthy Start Plan and the
19 reporting of changes in family income and for the
20 disenrollment of eligible children from the Healthy Start
21 Plan for failure of their families to pay a premium
22 required under this Act;
23 (8) establish procedures under which applicants and
24 participants may have grievances reviewed by a grievance
25 committee appointed by the Department, and in conformance
26 with grievance procedures established for other plans
27 administered by the Department; and
28 (9) provide for other matters as may be necessary
29 and proper for the execution of its powers, duties and
30 obligations under the Healthy Start Plan.
31 (c) The Department shall submit a report to the General
32 Assembly, no later than April 1, 1998, containing:
33 (1) a plan for implementation of the Healthy Start
34 Plan beginning January 1, 1999;
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1 (2) the rules, policies, and procedures that were
2 adopted by the Department for implementation of the
3 Healthy Start Plan; and
4 (3) amounts necessary to be appropriated by the
5 General Assembly in order to subsidize the premiums paid
6 by families of eligible children to implement the Healthy
7 Start Plan.
8 (d) The Department of Human Services may enter into an
9 intergovernmental agreement under which it delegates any or
10 all of its powers and duties under this Act to the Board or
11 the Department of Public Aid.
12 Section 35. Federal waivers. The Department shall work
13 with the appropriate State agencies to apply for any federal
14 waivers necessary to implement the Healthy Start Plan,
15 including those to allow enrollees in State health care
16 programs to assign the federal health insurance credit
17 component of the earned income tax credit to the State of
18 Illinois.
19 Section 40. Exclusion of persons or medical conditions
20 prohibited.
21 (a) No employer, association, or any other group that
22 makes health insurance available to its employees or members
23 shall refer any previously covered individual employee,
24 member, or dependent thereof to the Healthy Start Plan or
25 arrange for any individual employee, member, or dependent
26 thereof to apply for the Healthy Start Plan for the purpose
27 of the selecting out of these persons from a health insurance
28 policy, plan, or arrangement.
29 (b) It shall constitute unfair competition for purposes
30 of Article XXVI of the Illinois Insurance Code for any
31 insurer, insurance producer, or administrator to refer any
32 individual employee, member, or the dependent thereof to the
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1 Healthy Start Plan or arrange for any individual employee,
2 member, or dependent thereof to apply for the Healthy Start
3 Plan for the purpose of the selecting out or otherwise
4 excluding those persons or medical conditions that were
5 previously covered by that employer or association from a
6 group health insurance policy, plan, or arrangement provided
7 other employees or members.
8 Section 99. Effective date. This Act takes effect upon
9 becoming law.".