98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB2019

 

Introduced , by Rep. Tom Cross

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-2  from Ch. 23, par. 5-2

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning the classes of persons eligible for Medicaid.


LRB098 07253 KTG 37315 b

 

 

A BILL FOR

 

HB2019LRB098 07253 KTG 37315 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-2 as follows:
 
6    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
7    Sec. 5-2. Classes of Persons Eligible. Medical assistance
8under this Article shall be available to any of the the
9following classes of persons in respect to whom a plan for
10coverage has been submitted to the Governor by the Illinois
11Department and approved by him:
12        1. Recipients of basic maintenance grants under
13    Articles III and IV.
14        2. Persons otherwise eligible for basic maintenance
15    under Articles III and IV, excluding any eligibility
16    requirements that are inconsistent with any federal law or
17    federal regulation, as interpreted by the U.S. Department
18    of Health and Human Services, but who fail to qualify
19    thereunder on the basis of need or who qualify but are not
20    receiving basic maintenance under Article IV, and who have
21    insufficient income and resources to meet the costs of
22    necessary medical care, including but not limited to the
23    following:

 

 

HB2019- 2 -LRB098 07253 KTG 37315 b

1            (a) All persons otherwise eligible for basic
2        maintenance under Article III but who fail to qualify
3        under that Article on the basis of need and who meet
4        either of the following requirements:
5                (i) their income, as determined by the
6            Illinois Department in accordance with any federal
7            requirements, is equal to or less than 70% in
8            fiscal year 2001, equal to or less than 85% in
9            fiscal year 2002 and until a date to be determined
10            by the Department by rule, and equal to or less
11            than 100% beginning on the date determined by the
12            Department by rule, of the nonfarm income official
13            poverty line, as defined by the federal Office of
14            Management and Budget and revised annually in
15            accordance with Section 673(2) of the Omnibus
16            Budget Reconciliation Act of 1981, applicable to
17            families of the same size; or
18                (ii) their income, after the deduction of
19            costs incurred for medical care and for other types
20            of remedial care, is equal to or less than 70% in
21            fiscal year 2001, equal to or less than 85% in
22            fiscal year 2002 and until a date to be determined
23            by the Department by rule, and equal to or less
24            than 100% beginning on the date determined by the
25            Department by rule, of the nonfarm income official
26            poverty line, as defined in item (i) of this

 

 

HB2019- 3 -LRB098 07253 KTG 37315 b

1            subparagraph (a).
2            (b) All persons who, excluding any eligibility
3        requirements that are inconsistent with any federal
4        law or federal regulation, as interpreted by the U.S.
5        Department of Health and Human Services, would be
6        determined eligible for such basic maintenance under
7        Article IV by disregarding the maximum earned income
8        permitted by federal law.
9        3. Persons who would otherwise qualify for Aid to the
10    Medically Indigent under Article VII.
11        4. Persons not eligible under any of the preceding
12    paragraphs who fall sick, are injured, or die, not having
13    sufficient money, property or other resources to meet the
14    costs of necessary medical care or funeral and burial
15    expenses.
16        5.(a) Women during pregnancy, after the fact of
17    pregnancy has been determined by medical diagnosis, and
18    during the 60-day period beginning on the last day of the
19    pregnancy, together with their infants and children born
20    after September 30, 1983, whose income and resources are
21    insufficient to meet the costs of necessary medical care to
22    the maximum extent possible under Title XIX of the Federal
23    Social Security Act.
24        (b) The Illinois Department and the Governor shall
25    provide a plan for coverage of the persons eligible under
26    paragraph 5(a) by April 1, 1990. Such plan shall provide

 

 

HB2019- 4 -LRB098 07253 KTG 37315 b

1    ambulatory prenatal care to pregnant women during a
2    presumptive eligibility period and establish an income
3    eligibility standard that is equal to 133% of the nonfarm
4    income official poverty line, as defined by the federal
5    Office of Management and Budget and revised annually in
6    accordance with Section 673(2) of the Omnibus Budget
7    Reconciliation Act of 1981, applicable to families of the
8    same size, provided that costs incurred for medical care
9    are not taken into account in determining such income
10    eligibility.
11        (c) The Illinois Department may conduct a
12    demonstration in at least one county that will provide
13    medical assistance to pregnant women, together with their
14    infants and children up to one year of age, where the
15    income eligibility standard is set up to 185% of the
16    nonfarm income official poverty line, as defined by the
17    federal Office of Management and Budget. The Illinois
18    Department shall seek and obtain necessary authorization
19    provided under federal law to implement such a
20    demonstration. Such demonstration may establish resource
21    standards that are not more restrictive than those
22    established under Article IV of this Code.
23        6. Persons under the age of 18 who fail to qualify as
24    dependent under Article IV and who have insufficient income
25    and resources to meet the costs of necessary medical care
26    to the maximum extent permitted under Title XIX of the

 

 

HB2019- 5 -LRB098 07253 KTG 37315 b

1    Federal Social Security Act.
2        7. (Blank).
3        8. Persons who become ineligible for basic maintenance
4    assistance under Article IV of this Code in programs
5    administered by the Illinois Department due to employment
6    earnings and persons in assistance units comprised of
7    adults and children who become ineligible for basic
8    maintenance assistance under Article VI of this Code due to
9    employment earnings. The plan for coverage for this class
10    of persons shall:
11            (a) extend the medical assistance coverage for up
12        to 12 months following termination of basic
13        maintenance assistance; and
14            (b) offer persons who have initially received 6
15        months of the coverage provided in paragraph (a) above,
16        the option of receiving an additional 6 months of
17        coverage, subject to the following:
18                (i) such coverage shall be pursuant to
19            provisions of the federal Social Security Act;
20                (ii) such coverage shall include all services
21            covered while the person was eligible for basic
22            maintenance assistance;
23                (iii) no premium shall be charged for such
24            coverage; and
25                (iv) such coverage shall be suspended in the
26            event of a person's failure without good cause to

 

 

HB2019- 6 -LRB098 07253 KTG 37315 b

1            file in a timely fashion reports required for this
2            coverage under the Social Security Act and
3            coverage shall be reinstated upon the filing of
4            such reports if the person remains otherwise
5            eligible.
6        9. Persons with acquired immunodeficiency syndrome
7    (AIDS) or with AIDS-related conditions with respect to whom
8    there has been a determination that but for home or
9    community-based services such individuals would require
10    the level of care provided in an inpatient hospital,
11    skilled nursing facility or intermediate care facility the
12    cost of which is reimbursed under this Article. Assistance
13    shall be provided to such persons to the maximum extent
14    permitted under Title XIX of the Federal Social Security
15    Act.
16        10. Participants in the long-term care insurance
17    partnership program established under the Illinois
18    Long-Term Care Partnership Program Act who meet the
19    qualifications for protection of resources described in
20    Section 15 of that Act.
21        11. Persons with disabilities who are employed and
22    eligible for Medicaid, pursuant to Section
23    1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
24    subject to federal approval, persons with a medically
25    improved disability who are employed and eligible for
26    Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of

 

 

HB2019- 7 -LRB098 07253 KTG 37315 b

1    the Social Security Act, as provided by the Illinois
2    Department by rule. In establishing eligibility standards
3    under this paragraph 11, the Department shall, subject to
4    federal approval:
5            (a) set the income eligibility standard at not
6        lower than 350% of the federal poverty level;
7            (b) exempt retirement accounts that the person
8        cannot access without penalty before the age of 59 1/2,
9        and medical savings accounts established pursuant to
10        26 U.S.C. 220;
11            (c) allow non-exempt assets up to $25,000 as to
12        those assets accumulated during periods of eligibility
13        under this paragraph 11; and
14            (d) continue to apply subparagraphs (b) and (c) in
15        determining the eligibility of the person under this
16        Article even if the person loses eligibility under this
17        paragraph 11.
18        12. Subject to federal approval, persons who are
19    eligible for medical assistance coverage under applicable
20    provisions of the federal Social Security Act and the
21    federal Breast and Cervical Cancer Prevention and
22    Treatment Act of 2000. Those eligible persons are defined
23    to include, but not be limited to, the following persons:
24            (1) persons who have been screened for breast or
25        cervical cancer under the U.S. Centers for Disease
26        Control and Prevention Breast and Cervical Cancer

 

 

HB2019- 8 -LRB098 07253 KTG 37315 b

1        Program established under Title XV of the federal
2        Public Health Services Act in accordance with the
3        requirements of Section 1504 of that Act as
4        administered by the Illinois Department of Public
5        Health; and
6            (2) persons whose screenings under the above
7        program were funded in whole or in part by funds
8        appropriated to the Illinois Department of Public
9        Health for breast or cervical cancer screening.
10        "Medical assistance" under this paragraph 12 shall be
11    identical to the benefits provided under the State's
12    approved plan under Title XIX of the Social Security Act.
13    The Department must request federal approval of the
14    coverage under this paragraph 12 within 30 days after the
15    effective date of this amendatory Act of the 92nd General
16    Assembly.
17        In addition to the persons who are eligible for medical
18    assistance pursuant to subparagraphs (1) and (2) of this
19    paragraph 12, and to be paid from funds appropriated to the
20    Department for its medical programs, any uninsured person
21    as defined by the Department in rules residing in Illinois
22    who is younger than 65 years of age, who has been screened
23    for breast and cervical cancer in accordance with standards
24    and procedures adopted by the Department of Public Health
25    for screening, and who is referred to the Department by the
26    Department of Public Health as being in need of treatment

 

 

HB2019- 9 -LRB098 07253 KTG 37315 b

1    for breast or cervical cancer is eligible for medical
2    assistance benefits that are consistent with the benefits
3    provided to those persons described in subparagraphs (1)
4    and (2). Medical assistance coverage for the persons who
5    are eligible under the preceding sentence is not dependent
6    on federal approval, but federal moneys may be used to pay
7    for services provided under that coverage upon federal
8    approval.
9        13. Subject to appropriation and to federal approval,
10    persons living with HIV/AIDS who are not otherwise eligible
11    under this Article and who qualify for services covered
12    under Section 5-5.04 as provided by the Illinois Department
13    by rule.
14        14. Subject to the availability of funds for this
15    purpose, the Department may provide coverage under this
16    Article to persons who reside in Illinois who are not
17    eligible under any of the preceding paragraphs and who meet
18    the income guidelines of paragraph 2(a) of this Section and
19    (i) have an application for asylum pending before the
20    federal Department of Homeland Security or on appeal before
21    a court of competent jurisdiction and are represented
22    either by counsel or by an advocate accredited by the
23    federal Department of Homeland Security and employed by a
24    not-for-profit organization in regard to that application
25    or appeal, or (ii) are receiving services through a
26    federally funded torture treatment center. Medical

 

 

HB2019- 10 -LRB098 07253 KTG 37315 b

1    coverage under this paragraph 14 may be provided for up to
2    24 continuous months from the initial eligibility date so
3    long as an individual continues to satisfy the criteria of
4    this paragraph 14. If an individual has an appeal pending
5    regarding an application for asylum before the Department
6    of Homeland Security, eligibility under this paragraph 14
7    may be extended until a final decision is rendered on the
8    appeal. The Department may adopt rules governing the
9    implementation of this paragraph 14.
10        15. Family Care Eligibility.
11            (a) On and after July 1, 2012, a caretaker relative
12        who is 19 years of age or older when countable income
13        is at or below 133% of the Federal Poverty Level
14        Guidelines, as published annually in the Federal
15        Register, for the appropriate family size. A person may
16        not spend down to become eligible under this paragraph
17        15.
18            (b) Eligibility shall be reviewed annually.
19            (c) (Blank).
20            (d) (Blank).
21            (e) (Blank).
22            (f) (Blank).
23            (g) (Blank).
24            (h) (Blank).
25            (i) Following termination of an individual's
26        coverage under this paragraph 15, the individual must

 

 

HB2019- 11 -LRB098 07253 KTG 37315 b

1        be determined eligible before the person can be
2        re-enrolled.
3        16. Subject to appropriation, uninsured persons who
4    are not otherwise eligible under this Section who have been
5    certified and referred by the Department of Public Health
6    as having been screened and found to need diagnostic
7    evaluation or treatment, or both diagnostic evaluation and
8    treatment, for prostate or testicular cancer. For the
9    purposes of this paragraph 16, uninsured persons are those
10    who do not have creditable coverage, as defined under the
11    Health Insurance Portability and Accountability Act, or
12    have otherwise exhausted any insurance benefits they may
13    have had, for prostate or testicular cancer diagnostic
14    evaluation or treatment, or both diagnostic evaluation and
15    treatment. To be eligible, a person must furnish a Social
16    Security number. A person's assets are exempt from
17    consideration in determining eligibility under this
18    paragraph 16. Such persons shall be eligible for medical
19    assistance under this paragraph 16 for so long as they need
20    treatment for the cancer. A person shall be considered to
21    need treatment if, in the opinion of the person's treating
22    physician, the person requires therapy directed toward
23    cure or palliation of prostate or testicular cancer,
24    including recurrent metastatic cancer that is a known or
25    presumed complication of prostate or testicular cancer and
26    complications resulting from the treatment modalities

 

 

HB2019- 12 -LRB098 07253 KTG 37315 b

1    themselves. Persons who require only routine monitoring
2    services are not considered to need treatment. "Medical
3    assistance" under this paragraph 16 shall be identical to
4    the benefits provided under the State's approved plan under
5    Title XIX of the Social Security Act. Notwithstanding any
6    other provision of law, the Department (i) does not have a
7    claim against the estate of a deceased recipient of
8    services under this paragraph 16 and (ii) does not have a
9    lien against any homestead property or other legal or
10    equitable real property interest owned by a recipient of
11    services under this paragraph 16.
12        17. Persons who, pursuant to a waiver approved by the
13    Secretary of the U.S. Department of Health and Human
14    Services, are eligible for medical assistance under Title
15    XIX or XXI of the federal Social Security Act.
16    Notwithstanding any other provision of this Code and
17    consistent with the terms of the approved waiver, the
18    Illinois Department, may by rule:
19            (a) Limit the geographic areas in which the waiver
20        program operates.
21            (b) Determine the scope, quantity, duration, and
22        quality, and the rate and method of reimbursement, of
23        the medical services to be provided, which may differ
24        from those for other classes of persons eligible for
25        assistance under this Article.
26            (c) Restrict the persons' freedom in choice of

 

 

HB2019- 13 -LRB098 07253 KTG 37315 b

1        providers.
2    In implementing the provisions of Public Act 96-20, the
3Department is authorized to adopt only those rules necessary,
4including emergency rules. Nothing in Public Act 96-20 permits
5the Department to adopt rules or issue a decision that expands
6eligibility for the FamilyCare Program to a person whose income
7exceeds 185% of the Federal Poverty Level as determined from
8time to time by the U.S. Department of Health and Human
9Services, unless the Department is provided with express
10statutory authority.
11    The Illinois Department and the Governor shall provide a
12plan for coverage of the persons eligible under paragraph 7 as
13soon as possible after July 1, 1984.
14    The eligibility of any such person for medical assistance
15under this Article is not affected by the payment of any grant
16under the Senior Citizens and Disabled Persons Property Tax
17Relief Act or any distributions or items of income described
18under subparagraph (X) of paragraph (2) of subsection (a) of
19Section 203 of the Illinois Income Tax Act. The Department
20shall by rule establish the amounts of assets to be disregarded
21in determining eligibility for medical assistance, which shall
22at a minimum equal the amounts to be disregarded under the
23Federal Supplemental Security Income Program. The amount of
24assets of a single person to be disregarded shall not be less
25than $2,000, and the amount of assets of a married couple to be
26disregarded shall not be less than $3,000.

 

 

HB2019- 14 -LRB098 07253 KTG 37315 b

1    To the extent permitted under federal law, any person found
2guilty of a second violation of Article VIIIA shall be
3ineligible for medical assistance under this Article, as
4provided in Section 8A-8.
5    The eligibility of any person for medical assistance under
6this Article shall not be affected by the receipt by the person
7of donations or benefits from fundraisers held for the person
8in cases of serious illness, as long as neither the person nor
9members of the person's family have actual control over the
10donations or benefits or the disbursement of the donations or
11benefits.
12    Notwithstanding any other provision of this Code, if the
13United States Supreme Court holds Title II, Subtitle A, Section
142001(a) of Public Law 111-148 to be unconstitutional, or if a
15holding of Public Law 111-148 makes Medicaid eligibility
16allowed under Section 2001(a) inoperable, the State or a unit
17of local government shall be prohibited from enrolling
18individuals in the Medical Assistance Program as the result of
19federal approval of a State Medicaid waiver on or after the
20effective date of this amendatory Act of the 97th General
21Assembly, and any individuals enrolled in the Medical
22Assistance Program pursuant to eligibility permitted as a
23result of such a State Medicaid waiver shall become immediately
24ineligible.
25    Notwithstanding any other provision of this Code, if an Act
26of Congress that becomes a Public Law eliminates Section

 

 

HB2019- 15 -LRB098 07253 KTG 37315 b

12001(a) of Public Law 111-148, the State or a unit of local
2government shall be prohibited from enrolling individuals in
3the Medical Assistance Program as the result of federal
4approval of a State Medicaid waiver on or after the effective
5date of this amendatory Act of the 97th General Assembly, and
6any individuals enrolled in the Medical Assistance Program
7pursuant to eligibility permitted as a result of such a State
8Medicaid waiver shall become immediately ineligible.
9(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;
1096-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
117-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
12eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
1397-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff.
147-13-12; revised 7-23-12.)