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91_HB4127 LRB9113047DJcd 1 AN ACT to amend the Illinois Public Aid Code by changing 2 Section 5-2. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Illinois Public Aid Code is amended by 6 changing Section 5-2 as follows: 7 (305 ILCS 5/5-2) (from Ch. 23, par. 5-2) 8 Sec. 5-2. Classes of Persons Eligible. Medical 9 assistance under this Article shall be available to any of 10 the following classes of persons in respect to whom a plan 11 for coverage has been submitted to the Governor by the 12 Illinois Department and approved by him: 13 1. Recipients of basic maintenance grants under Articles 14 III and IV. 15 2. Persons otherwise eligible for basic maintenance 16 under Articles III and IV but who fail to qualify thereunder 17 on the basis of need, and who have insufficient income and 18 resources to meet the costs of necessary medical care, 19 including but not limited to, all persons who would be 20 determined eligible for such basic maintenance under Article 21 IV by disregarding the maximum earned income permitted by 22 federal law. Notwithstanding any other provision of this 23 Code, a person described in this paragraph 2 who is aged, 24 blind, or disabled as defined in Section 3-1 shall not be 25 required to incur any minimum amount of medical care costs 26 (including costs of prescription medications) or be otherwise 27 subject to any "spend-down" requirement based on the amount 28 of the person's income and medical care costs before being 29 determined eligible for medical assistance under this 30 Article. 31 3. Persons who would otherwise qualify for Aid to the -2- LRB9113047DJcd 1 Medically Indigent under Article VII. 2 4. Persons not eligible under any of the preceding 3 paragraphs who fall sick, are injured, or die, not having 4 sufficient money, property or other resources to meet the 5 costs of necessary medical care or funeral and burial 6 expenses. 7 5. (a) Women during pregnancy, after the fact of 8 pregnancy has been determined by medical diagnosis, and 9 during the 60-day period beginning on the last day of the 10 pregnancy, together with their infants and children born 11 after September 30, 1983, whose income and resources are 12 insufficient to meet the costs of necessary medical care 13 to the maximum extent possible under Title XIX of the 14 Federal Social Security Act. 15 (b) The Illinois Department and the Governor shall 16 provide a plan for coverage of the persons eligible under 17 paragraph 5(a) by April 1, 1990. Such plan shall provide 18 ambulatory prenatal care to pregnant women during a 19 presumptive eligibility period and establish an income 20 eligibility standard that is equal to 133% of the nonfarm 21 income official poverty line, as defined by the federal 22 Office of Management and Budget and revised annually in 23 accordance with Section 673(2) of the Omnibus Budget 24 Reconciliation Act of 1981, applicable to families of the 25 same size, provided that costs incurred for medical care 26 are not taken into account in determining such income 27 eligibility. 28 (c) The Illinois Department may conduct a 29 demonstration in at least one county that will provide 30 medical assistance to pregnant women, together with their 31 infants and children up to one year of age, where the 32 income eligibility standard is set up to 185% of the 33 nonfarm income official poverty line, as defined by the 34 federal Office of Management and Budget. The Illinois -3- LRB9113047DJcd 1 Department shall seek and obtain necessary authorization 2 provided under federal law to implement such a 3 demonstration. Such demonstration may establish resource 4 standards that are not more restrictive than those 5 established under Article IV of this Code. 6 6. Persons under the age of 18 who fail to qualify as 7 dependent under Article IV and who have insufficient income 8 and resources to meet the costs of necessary medical care to 9 the maximum extent permitted under Title XIX of the Federal 10 Social Security Act. 11 7. Persons who are 18 years of age or younger and would 12 qualify as disabled as defined under the Federal Supplemental 13 Security Income Program, provided medical service for such 14 persons would be eligible for Federal Financial 15 Participation, and provided the Illinois Department 16 determines that: 17 (a) the person requires a level of care provided by 18 a hospital, skilled nursing facility, or intermediate 19 care facility, as determined by a physician licensed to 20 practice medicine in all its branches; 21 (b) it is appropriate to provide such care outside 22 of an institution, as determined by a physician licensed 23 to practice medicine in all its branches; 24 (c) the estimated amount which would be expended 25 for care outside the institution is not greater than the 26 estimated amount which would be expended in an 27 institution. 28 8. Persons who become ineligible for basic maintenance 29 assistance under Article IV of this Code in programs 30 administered by the Illinois Department due to employment 31 earnings and persons in assistance units comprised of adults 32 and children who become ineligible for basic maintenance 33 assistance under Article VI of this Code due to employment 34 earnings. The plan for coverage for this class of persons -4- LRB9113047DJcd 1 shall: 2 (a) extend the medical assistance coverage for up 3 to 12 months following termination of basic maintenance 4 assistance; and 5 (b) offer persons who have initially received 6 6 months of the coverage provided in paragraph (a) above, 7 the option of receiving an additional 6 months of 8 coverage, subject to the following: 9 (i) such coverage shall be pursuant to 10 provisions of the federal Social Security Act; 11 (ii) such coverage shall include all services 12 covered while the person was eligible for basic 13 maintenance assistance; 14 (iii) no premium shall be charged for such 15 coverage; and 16 (iv) such coverage shall be suspended in the 17 event of a person's failure without good cause to 18 file in a timely fashion reports required for this 19 coverage under the Social Security Act and coverage 20 shall be reinstated upon the filing of such reports 21 if the person remains otherwise eligible. 22 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 the 26 level of care provided in an inpatient hospital, skilled 27 nursing facility or intermediate care facility the cost of 28 which is reimbursed under this Article. Assistance shall be 29 provided to such persons to the maximum extent permitted 30 under Title XIX of the Federal Social Security Act. 31 10. Participants in the long-term care insurance 32 partnership program established under the Partnership for 33 Long-Term Care Act who meet the qualifications for protection 34 of resources described in Section 25 of that Act. -5- LRB9113047DJcd 1 The Illinois Department and the Governor shall provide a 2 plan for coverage of the persons eligible under paragraph 7 3 as soon as possible after July 1, 1984. 4 The eligibility of any such person for medical assistance 5 under this Article is not affected by the payment of any 6 grant under the Senior Citizens and Disabled Persons Property 7 Tax Relief and Pharmaceutical Assistance Act or any 8 distributions or items of income described under subparagraph 9 (X) of paragraph (2) of subsection (a) of Section 203 of the 10 Illinois Income Tax Act. The Department shall by rule 11 establish the amounts of assets to be disregarded in 12 determining eligibility for medical assistance, which shall 13 at a minimum equal the amounts to be disregarded under the 14 Federal Supplemental Security Income Program. The amount of 15 assets of a single person to be disregarded shall not be less 16 than $2,000, and the amount of assets of a married couple to 17 be disregarded shall not be less than $3,000. 18 To the extent permitted under federal law, any person 19 found guilty of a second violation of Article VIIIA shall be 20 ineligible for medical assistance under this Article, as 21 provided in Section 8A-8. 22 The eligibility of any person for medical assistance 23 under this Article shall not be affected by the receipt by 24 the person of donations or benefits from fundraisers held for 25 the person in cases of serious illness, as long as neither 26 the person nor members of the person's family have actual 27 control over the donations or benefits or the disbursement of 28 the donations or benefits. 29 (Source: P.A. 91-676, eff. 12-23-99.) 30 Section 99. Effective date. This Act takes effect on 31 July 1, 2000.