State of Illinois
92nd General Assembly

   [ Search ]   [ PDF text ]   [ Legislation ]   
[ Home ]   [ Back ]   [ Bottom ]

[ House Amendment 001 ]



 1        AN ACT concerning insurance.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 5.  The Children's Health Insurance  Program  Act
 5    is amended by changing Sections 20, 25, and 97 as follows:

 6        (215 ILCS 106/20)
 7        (Section scheduled to be repealed on July 1, 2002)
 8        Sec. 20.  Eligibility.
 9        (a)  To  be eligible for this Program, a person must be a
10    person who has a child eligible under this  Act  and  who  is
11    eligible  under  a waiver of federal requirements pursuant to
12    an application made pursuant to subdivision (a)(1) of Section
13    40 of this Act or who is a child who:
14             (1)  is a child who  is  not  eligible  for  medical
15        assistance;
16             (2)  is  a  child  whose annual household income, as
17        determined by  the  Department,  is  above  133%  of  the
18        federal poverty level and at or below 185% of the federal
19        poverty level;
20             (3)  is a  resident of the State of Illinois; and
21             (4)  is  a  child  who  is  either  a  United States
22        citizen or included in one of the following categories of
23        non-citizens:
24                  (A)  unmarried dependent children of  either  a
25             United  States  Veteran  honorably  discharged  or a
26             person on active military duty;
27                  (B)  refugees  under   Section   207   of   the
28             Immigration and Nationality Act;
29                  (C)  asylees   under   Section   208   of   the
30             Immigration and Nationality Act;
31                  (D)  persons  for  whom  deportation  has  been
                            -2-                LRB9214781LBpr
 1             withheld  under  Section  243(h)  of the Immigration
 2             and Nationality Act;
 3                  (E)  persons granted  conditional  entry  under
 4             Section 203(a)(7) of the Immigration and Nationality
 5             Act as in effect prior to April 1, 1980;
 6                  (F)  persons  lawfully  admitted  for permanent
 7             residence under the Immigration and Nationality Act;
 8             and
 9                  (G)  parolees, for at  least  one  year,  under
10             Section 212(d)(5) of the Immigration and Nationality
11             Act.
12        Those  children  who  are  in the categories set forth in
13    subdivisions (4)(F) and (4)(G) of this subsection, who  enter
14    the  United  States on or after August 22, 1996, shall not be
15    eligible for 5 years beginning on the date the child  entered
16    the United States.
17        (b)  A  child  who  is  determined  to  be  eligible  for
18    assistance  shall remain eligible for 12 months, provided the
19    child maintains his or her residence in the  State,  has  not
20    yet attained 19 years of age, and is not excluded pursuant to
21    subsection  (c).   Eligibility  shall be re-determined by the
22    Department at least annually.
23        (c)  A child shall not be  eligible  for  coverage  under
24    this Program if:
25             (1)  the  premium required pursuant to Section 30 of
26        this Act has not been paid.  If the required premiums are
27        not paid the liability of the Program shall be limited to
28        benefits incurred under the Program for the  time  period
29        for  which  premiums  had  been  paid.   If  the required
30        monthly  premium  is  not  paid,  the  child   shall   be
31        ineligible  for  re-enrollment  for a minimum period of 3
32        months.  Re-enrollment shall be completed  prior  to  the
33        next covered medical visit and the first month's required
34        premium  shall  be  paid  in  advance of the next covered
                            -3-                LRB9214781LBpr
 1        medical visit.  The  Department  shall  promulgate  rules
 2        regarding grace periods, notice requirements, and hearing
 3        procedures pursuant to this subsection;
 4             (2)  the  child is an inmate of a public institution
 5        or a patient in an institution for mental diseases; or
 6             (3)  the child is a  member  of  a  family  that  is
 7        eligible  for  health benefits covered under the State of
 8        Illinois health benefits plan on the basis of a  member's
 9        employment with a public agency.
10        (d)  A  child  may  be  determined  to  be  eligible  for
11    coverage  under  this  Program  if the child's family medical
12    expenses, as  itemized  on  Schedule  A,  Form  1040  of  the
13    Department  of  the  Treasury  Internal  Revenue  Service tax
14    returns of  the  previous  year,  allow  the  child's  annual
15    household   income  to  fall  within  the  range  defined  in
16    subsection (a) of  this  Section.   The  deduction  shall  be
17    locked-in  until  the  child attains 19 years of age.  Income
18    eligibility shall be redetermined according to subsection (b)
19    of this Section.
20    (Source: P.A. 90-736, eff. 8-12-98.)

21        (215 ILCS 106/25)
22        (Section scheduled to be repealed on July 1, 2002)
23        Sec. 25.  Health benefits for children.
24        (a)  The  Department  shall,  subject  to  appropriation,
25    provide health benefits coverage to eligible children by:
26             (1)  Subsidizing the cost of privately  or  publicly
27        sponsored  health  insurance,  including  employer  based
28        health insurance, to assist families to take advantage of
29        available  privately sponsored health insurance for their
30        eligible children; and
31             (2)  Purchasing or providing  health  care  benefits
32        for  eligible  children.   The  health  benefits provided
33        under  this  subdivision   (a)(2)   shall,   subject   to
                            -4-                LRB9214781LBpr
 1        appropriation  and  without regard to any applicable cost
 2        sharing under Section 30, be identical  to  the  benefits
 3        provided  for  children  under  the State's approved plan
 4        under Title XIX of the Social  Security  Act.   Providers
 5        under   this  subdivision  (a)(2)  shall  be  subject  to
 6        approval by the Department to provide health  care  under
 7        the  Illinois  Public Aid Code and shall be reimbursed at
 8        the same rate as providers  under  the  State's  approved
 9        plan  under  Title  XIX  of  the  Social Security Act. In
10        addition,   providers   may   retain   co-payments   when
11        determined appropriate by the Department.
12        (b)  The subsidization provided pursuant  to  subdivision
13    (a)(1) shall be credited to the family of the eligible child.
14        (c)  The  Department  is prohibited from denying coverage
15    to a child who is enrolled in a  privately  sponsored  health
16    insurance  plan  pursuant  to  subdivision (a)(1) because the
17    plan does not meet federal  benchmarking  standards  or  cost
18    sharing  and  contribution  requirements.  To be eligible for
19    inclusion  in   the   Program,   the   plan   shall   contain
20    comprehensive  major  medical coverage which shall consist of
21    physician and hospital inpatient services. The Department  is
22    prohibited  from  denying coverage to a child who is enrolled
23    in a privately sponsored health insurance  plan  pursuant  to
24    subdivision  (a)(1)  because  the  plan  offers  benefits  in
25    addition to physician and hospital inpatient services.
26        (d)  The  total dollar amount of subsidizing coverage per
27    child per month pursuant to subdivision (a)(1) shall be equal
28    to the average dollar payments, less premiums  incurred,  per
29    child   per  month  pursuant  to  subdivision  (a)(2).    The
30    Department shall set this amount prospectively based upon the
31    prior fiscal year's experience adjusted for incurred but  not
32    reported  claims  and estimated increases or decreases in the
33    cost of medical care.   Payments  obligated  before  July  1,
34    1999,  will be computed using State Fiscal Year 1996 payments
                            -5-                LRB9214781LBpr
 1    for children  eligible  for  Medical  Assistance  and  income
 2    assistance  under the Aid to Families with Dependent Children
 3    Program,  with   appropriate   adjustments   for   cost   and
 4    utilization  changes through January 1, 1999.  The Department
 5    is  prohibited  from  providing   a   subsidy   pursuant   to
 6    subdivision (a)(1) that is more than the individual's monthly
 7    portion of the premium.
 8        (e)  An  eligible  child  may  obtain  immediate coverage
 9    under this Program only once  during  a  medical  visit.   If
10    coverage  lapses, re-enrollment shall be completed in advance
11    of the next covered  medical  visit  and  the  first  month's
12    required  premium  shall  be  paid  in advance of any covered
13    medical visit.
14        (f)  In  order   to   accelerate   and   facilitate   the
15    development  of  networks  to deliver services to children in
16    areas  outside  counties  with  populations  in   excess   of
17    3,000,000,  in  the  event  less  than  25%  of  the eligible
18    children in a county or contiguous counties has enrolled with
19    a Health Maintenance Organization pursuant to Section 5-11 of
20    the Illinois Public Aid Code, the Department may develop  and
21    implement   demonstration   projects  to  create  alternative
22    networks designed to enhance enrollment and participation  in
23    the  program.   The  Department  shall  prescribe by rule the
24    criteria,   standards,   and   procedures    for    effecting
25    demonstration projects under this Section.
26    (Source: P.A. 90-736, eff. 8-12-98.)

27        (215 ILCS 106/97)
28        (Section scheduled to be repealed on July 1, 2002)
29        Sec. 97.  Repealer.  This Act is repealed on July 1, 2003
30    2002.
31    (Source: P.A. 90-736, eff. 8-12-98; 91-712, eff. 7-1-00.)

32        Section  99.  Effective date.  This Act takes effect upon
                            -6-                LRB9214781LBpr
 1    becoming law.

[ Top ]