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90_SB0514
New Act
Creates the Healthy Kids Plan Act. Provides for voluntary
enrollment in the Healthy Kids Plan to provide health care
services for children not eligible for medical assistance and
not otherwise insured. Provides for enrollment fees.
Provides for administration of the Plan by the Department of
Public Aid in cooperation with the Department of Public
Health and the Department of Human Services as successor to
the Department of Alcoholism and Substance Abuse.
LRB9001157SMdvB
LRB9001157SMdvB
1 AN ACT concerning health care.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the
5 Healthy Kids Plan Act.
6 Section 5. Definitions. As used in this Act, unless the
7 context clearly requires otherwise:
8 "Covered health services" means the following:
9 (1) Well-child examinations, including
10 immunizations.
11 (2) Outpatient medical care.
12 (3) Emergency room care.
13 (4) Prescription medications.
14 (5) Hearing and vision services.
15 (6) Dental care.
16 (7) Case management.
17 (8) Home visiting.
18 (9) Allied health services including early
19 intervention; physical, occupational, and speech therapy;
20 audiology; social work and nutritional services; and
21 parent/caregiver training.
22 (10) Outpatient mental health services.
23 (11) Outpatient substance abuse treatment services.
24 "Director" means the Director of Public Aid.
25 "Eligible providers" means those health care providers
26 who provide covered health services to recipients of medical
27 assistance under the Illinois Public Aid Code under rules
28 established by the Director for that program.
29 "Family" means, in the case of a child who is a dependent
30 of another person or couple as defined by the Illinois Income
31 Tax Act, all those persons for whom exemption is claimed in
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1 the State income tax return of the person or couple whose
2 dependent the eligible child is.
3 "Net income" and "net family income" shall be defined by
4 the Illinois Department of Public Aid.
5 "Plan" means the Healthy Kids Plan established under this
6 Act.
7 Section 10. Plan established; administration.
8 (a) The Healthy Kids Plan is established to promote
9 access to appropriate health care services to assure healthy
10 children.
11 (b) The Plan shall be administered by the Illinois
12 Department of Public Aid in cooperation with the Departments
13 of Insurance, Human Services as the successor to the
14 Department of Alcoholism and Substance Abuse, and Public
15 Health. The Director shall establish an office for the
16 statewide administration of the Plan.
17 (c) The Plan shall be used to provide covered health
18 services for eligible children. Payment for these services
19 shall be made to all eligible providers.
20 (d) The Director shall adopt rules to administer this
21 Act.
22 (e) The Director shall establish marketing efforts to
23 encourage the families of potentially eligible children to
24 receive information about the program and about other medical
25 care programs administered or supervised by the Departments
26 of Public Aid, Human Services as the successor to the
27 Department of Alcoholism and Substance Abuse, and Public
28 Health. A toll-free telephone number shall be used to
29 provide information about medical programs and to promote
30 access to the covered services.
31 (f) The Director shall submit a report to the General
32 Assembly, no later than April 1, 1998, containing (i) a plan
33 for implementing the Healthy Kids Plan beginning July 1,
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1 1998, and (ii) amounts necessary to be appropriated to
2 implement the Plan. The implementation plan shall include a
3 schedule for implementing the covered health services so that
4 implementation of the Plan shall begin July 1, 1998.
5 Beginning April 1, 1998, the Director shall make a
6 quarterly assessment comparing the expected expenditures for
7 the covered health services and the appropriation for that
8 coverage.
9 Section 15. Eligible children.
10 (a) A child 9 years old or less is eligible to
11 participate in the Plan if he or she meets the following
12 criteria:
13 (1) The child's family has net family income equal
14 to or less than 250% of the federal poverty level and is
15 not eligible for medical assistance under Section 5-5 of
16 the Illinois Public Aid Code and is not otherwise insured
17 for a particular covered health service.
18 (2) The child's family pays an annual enrollment
19 fee as defined in this Act and pursuant to rules and
20 regulations of the Department.
21 The period of a child's eligibility extends through the
22 last day of the month in which the child's 10th birthday
23 occurs. Children who initially enroll in the Plan under the
24 eligibility criteria in this subsection shall remain eligible
25 for the Plan, regardless of age or place of residence, so
26 long as all other eligibility requirements are met and
27 continuous enrollment in the Plan is maintained.
28 (b) Any child 9 years old or less whose family has net
29 family income greater than 250% of the federal poverty level
30 may enroll in the Plan if coverage is provided under rules
31 and regulations of the Department. Families enrolling under
32 this subsection (b) may be required to pay the full cost of
33 coverage as determined by the Department.
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1 Section 20. Application.
2 (a) Application forms and other information concerning
3 the Plan shall be made available to county departments of
4 public aid, eligible providers, local human services
5 agencies, school districts, public and private elementary
6 schools in which 25% or more of the students receive free or
7 reduced price lunches, community health offices, and Women,
8 Infants and Children (WIC) program sites. These sites may
9 accept applications, collect the enrollment fee or initial
10 premium fee, and forward the forms and fees to the Department
11 of Public Aid.
12 The Department of Public Aid may use individuals' Social
13 Security numbers as identifiers for purposes of administering
14 the Plan and may conduct data matches to verify income.
15 Applicants shall submit evidence of family income (both
16 earned and unearned) to be used to verify income eligibility.
17 Applicants shall report the most recent financial situation
18 of the family if it has changed from the period of time
19 covered by the federal income tax form. The report may be in
20 the form of a percentage increase or decrease.
21 Benefits under the Plan are secondary to a plan of
22 insurance or benefit program under which an eligible person
23 may have coverage. The Department of Public Aid shall
24 annually redetermine eligibility for enrollment in the Plan
25 and shall identify eligible children who may have coverage or
26 benefits under the other plans of insurance or who become
27 eligible for medical assistance under the Illinois Public Aid
28 Code.
29 (b) The Director shall establish procedures to
30 accomplish the following:
31 (1) Require families of children enrolled in the
32 Plan to report changes in income.
33 (2) Disenroll children from the Plan for failure of
34 their families to pay an enrollment fee required under
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1 this Section.
2 Section 25. Enrollment fee. The following annual
3 payments shall be required as a condition of enrollment in
4 the Plan in the first year during which benefits are
5 available and until the Department adopts rules establishing
6 fees:
7 (1) Families with net income equal to or less than 100%
8 of the federal poverty level shall pay an annual fee of $25
9 per child, but not more than $100 per family.
10 (2) Families with net income of more than 100% but less
11 than 185% of the federal poverty level shall pay an annual
12 fee of $60 per child.
13 (3) Families with net income of at least 185% but less
14 than 208% of the federal poverty level shall pay an annual
15 fee of $160 per child.
16 (4) Families with net income of at least 208% but less
17 than 230% of the federal poverty level shall pay an annual
18 fee of $260 per child.
19 (5) Families with net income of at least 230% but less
20 than 250% of the federal poverty level shall pay an annual
21 fee of $360 per child.
22 (6) Families with net income equal to or greater than
23 250% of the federal poverty level, if covered under rules and
24 regulations of the Department, may be required to pay the
25 actual cost of coverage, including administrative costs.
26 Section 30. Federal waivers. The Director shall apply
27 for all federal waivers necessary to implement the Plan,
28 including those to allow enrollees in State health care
29 programs to assign the federal health insurance credit
30 component of the earned income tax credit to the State of
31 Illinois.
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1 Section 35. Provider reimbursement. Eligible providers
2 shall be reimbursed under the Plan at the same rates and on
3 the same conditions established for medical assistance under
4 the Illinois Public Aid Code.
5 Section 40. Coordination of Medicaid and Plan. The
6 Director shall develop and implement a plan to combine
7 Illinois Public Aid Code medical assistance and Healthy Kids
8 Plan application and eligibility procedures. The Director
9 shall report to the General Assembly by April 1, 1999, on
10 progress in implementing the plan under this Section.
11 Section 45. Appeals. The family of a child whose
12 application to enroll in the Plan is denied, or whose
13 eligibility to participate in the Plan is suspended or
14 terminated, or whose conditions of participation in the Plan
15 are changed (such as by a change in premium or a change in
16 covered health services) shall have the same rights to notice
17 and appeal as are afforded an applicant for or recipient of
18 medical assistance under the Illinois Public Aid Code.
19 Section 50. Healthy Kids Advisory Board. There is
20 created a Healthy Kids Advisory Board ("the Board"). The
21 Board has the authority to advise the Director on all matters
22 affecting the implementation and administration of the Plan.
23 The Board shall consist of 9 voting members appointed by the
24 Governor, at least 3 of whom shall have expertise in health
25 insurance, 3 of whom shall have expertise in child health
26 issues, and 3 of whom shall represent the interests of the
27 public. The State Superintendent of Education (or his or her
28 designee) and the Directors of Public Aid, Public Health,
29 Insurance, Children and Family Services, and Human Services
30 as the successor to the Departments of Alcoholism and
31 Substance Abuse and Mental Health and Developmental
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1 Disabilities shall serve as ex officio, non-voting members.
2 The Governor shall select the Board chairman from among the
3 appointed members.
4 Terms of the initial appointed Board members shall
5 commence on January 1, 1998. The initial appointed members
6 shall by lot be divided into 3 groups; 3 of those members
7 shall serve for terms of one year, 3 for terms of 2 years,
8 and 3 for terms of 3 years. All subsequent appointed members
9 shall serve for terms of 3 years.
10 A vacancy in the appointed membership of the Board
11 occurring for any reason other than the expiration of a term
12 shall be filled for the unexpired term in the same manner as
13 the original appointment. An appointed member of the Board
14 may be removed by the Governor for neglect of duty or for
15 misfeasance, malfeasance, or nonfeasance in office.
16 Appointed Board members shall continue to serve until their
17 successors are appointed.
18 Board members shall receive no compensation but shall be
19 reimbursed for their actual expenses incurred in performing
20 their duties.
21 The Board shall meet at least quarterly. A majority of
22 the appointed Board members shall constitute a quorum for
23 conducting the Board's business.