TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.100 DISABLED ADULT CHILDREN
Section 118.100 Disabled
Adult Children
Individuals who meet the
following criteria are eligible, without regard to income eligibility
requirements, for medical assistance under the AABD program. The individual:
a) is 18 years of age or older;
b) received Supplemental Security Income (SSI) and/or State
Supplemental Payments (SSP) due to disability or blindness. Receipt of SSP
from another State will serve to meet this subsection;
c) became blind or disabled before he or she reached age 22; and
d) lost Supplemental Security Income and/or State Supplemental
Payments on or after July 1, 1987 as a result of entitlement to or increase in
the Title II benefits under 42 U.S.C. 402(d)(child insurance).
SUBPART B: MEDICAL PAYMENTS FOR DRUGS FOR PERSONS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) OR AIDS RELATED COMPLEXES (ARC)
 | TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.150 CONTINUATION OF HEALTH INSURANCE COVERAGE
Section 118.150 Continuation
of Health Insurance Coverage
a) The continuation of health insurance coverage program is a
pilot program to assist persons with AIDS or disability as a result of having
the human immunodeficiency virus (HIV) who are eligible for insurance coverage
under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of
1985. The program will cover a maximum of about 100 persons, subject to
available funds. Under the program, the Department will pay a maximum monthly
health insurance premium of $300 for eligible persons for individual or family
(spouse and dependent children) health insurance coverage.
b) Eligibility. Persons eligible for coverage under this program
must meet each of the following requirements:
1) Be diagnosed with AIDS or be disabled due to HIV;
2) Be a resident of Illinois;
3) Be unable to continue employment and be eligible for
continuation of insurance coverage under the provisions of COBRA;
4) Be covered by an individual or family health insurance plan
which includes coverage of prescribed drugs;
5) Have assets of not more than $10,000; and
6) Have income of not more than 200% of the federal poverty
level.
c) Application. Persons who wish to be covered shall apply to
the Illinois Department of Public Health on forms provided by that agency. The
application shall include the following information:
1) Information necessary to identify the person, the former
employer, the insurer, and the type of health insurance coverage provided;
2) Income and asset information necessary to determine the income
and asset eligibility of the person;
3) Information necessary to verify Illinois residency;
4) Verification of a diagnosis of AIDS from a licensed physician
or a determination of disability from the Social Security Administration with
verification of testing positive for HIV; and
5) Any other information which may be required to determine
eligibility or the length of coverage, such as a determination of disability
from the Social Security Administration.
d) The Department will make the insurance premium payments for
eligible individuals directly to the health insurer or former employer.
Coverage will continue for the period for which the person is eligible for
COBRA coverage, subject to available funds.
(Source: Added at 17 Ill. Reg. 19956, effective November 12, 1993)
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.200 DRUGS TO PROLONG THE LIVES OF PERSONS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) OR AIDS RELATED COMPLEXES (ARC)
Section 118.200 Drugs to
Prolong the Lives of Persons With Acquired Immunodeficiency Syndrome (AIDS) or
AIDS Related Complexes (ARC)
The Department's program for
funding of drugs to prolong the lives of persons with Acquired Immunodeficiency
Syndrome (AIDS) or AIDS Related Complexes (ARC) has been replaced by a program
operated by the Department of Public Health (see 77 Ill. Adm. Code 692).
(Source: Amended at 16 Ill. Reg. 11607, effective July 15, 1992)
SUBPART C: WIDOWS AND WIDOWERS
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.300 WIDOWS AND WIDOWERS
Section 118.300 Widows and
Widowers
Individuals who meet the
following criteria are eligible, without regard to income eligibility
requirements, for medical assistance under the Aid to the Aged, Blind or
Disabled (AABD) Program.
a) Disabled widows and widowers who:
1) were entitled to benefits under Title II of the Social
Security Act (SSA) for December 1983;
2) were entitled to and received SSA disabled widow's/widower's
benefits for January 1984;
3) are ineligible for Supplemental Security Income (SSI) and/or
State Supplemental Payment (SSP) due to the increase in widow's or widower's
benefits;
4) have been continuously entitled to widow's or widower's
benefits since the first month of the benefit increase; and
5) would be eligible for SSI and/or SSP if the amount of the
increase and any subsequent cost of living adjustments in widow's or widower's
benefits were disregarded.
b) Widows and Widowers receiving early benefits who:
1) are eligible for and receiving early widow's or widower's
benefits under Title II of the Social Security Act;
2) are not entitled to Medicare Part A (hospital insurance) as
determined by the Social Security Administration; and
3) received SSI but are now ineligible for SSI benefits or SSP
because of receipt of Title II benefits.
(Source: Amended at 19 Ill. Reg. 7959, effective June 5, 1995)
SUBPART D: MISCELLANEOUS PROGRAM
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.400 INCORPORATION BY REFERENCE
Section 118.400
Incorporation By Reference
Any rules or regulations of an
agency of the United States or of a nationally recognized organization or
association that are incorporated by reference in this Part are incorporated as
of the date specified, and do not include any later amendments or editions.
(Source: Section 118.300 renumbered to Section 118.400 at 14 Ill. Reg.
10442, effective June 20, 1990)
SUBPART E: CERTAIN NON-CITIZEN CHILDREN
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.500 MEDICAL SERVICES FOR CERTAIN NON-CITIZEN CHILDREN
Section 118.500 Medical
Services for Certain Non-Citizen Children
a) Certain non-citizen children under 19 years of age may be
eligible for certain medical services. Such non-citizen children include:
1) Children
defined at 89 Ill. Adm. Code 120.310(b) or 89 Ill. Adm. Code 125.200(e) who are
excluded from receiving medical services under Article V of the Public Aid Code
because of the application of 89 Ill. Adm. Code 120.310(b)(2) or health care
benefits or rebates under the Children's Health Insurance Program (89 Ill. Adm.
Code 125) because of the application of 89 Ill. Adm. Code 125.205(a)(4);
2) Children who are Permanently Residing in the United States Under
Color of Law (PRUCOL); and
3) Children who do not meet requirements as defined at 89 Ill.
Adm. Code 120.310(b) and 89 Ill. Adm. Code 125.200(e).
b) Such
non-citizen children who would otherwise be eligible for Medical Assistance may
receive coverage for those medical services available under Article V,
including those services under Article V administered by other agencies. All
other requirements set forth under Article V must be met.
c) Such
non-citizen children who would otherwise be eligible under 89 Ill. Adm. Code
125 may receive coverage for those medical services available under 89 Ill.
Adm. Code 125. All other requirements described at 89 Ill. Adm. Code 125 must
be met.
d) The provisions of 89 Ill. Adm. Code 125, Subpart B, including
the handling of appeals and the conduct of hearings pursuant to the provisions
of Subpart A of the Department's administrative rules at 89 Ill. Adm. Code 104,
Practice in Administrative Hearings, shall govern any appeals under this
Subpart.
e) There is no entitlement to medical services under this Subpart
E and such services are available only to the extent that payments under this
Subpart do not exceed the amounts appropriated for the purpose of this
Subpart. The Department may cease enrollment, change standards of eligibility,
or reduce services for non-citizen children if such appropriated funds are
needed to provide services to children eligible under 89 Ill. Adm. Code 125 or
if such action is deemed necessary to assure that payments do not exceed
appropriation authority.
(Source: Amended at 30 Ill.
Reg. 16966, effective October 13, 2006)
SUBPART F: FAMILYCARE ELIGIBILITY
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.600 LIMITED FAMILYCARE EXPANSION (REPEALED)
Section 118.600 Limited
FamilyCare Expansion (Repealed)
(Source:
Repealed at 37 Ill. Reg. 10201, effective June 27, 2013)
SUBPART G: HEALTH BENEFITS FOR IMMIGRANT SENIORS
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.700 GENERAL DESCRIPTION
Section 118.700 General Description
This Subpart implements Section 12-4.35(a-5) of the Code that
authorizes the Department to administer in Illinois the Health Benefits for
Immigrant Seniors Program to noncitizens 65 years of age or older who are not
eligible for medical assistance receiving federal
financial participation due to immigration status. Eligible individuals are
not eligible for medical assistance under Article V of the Public Aid Code.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.705 DEFINITIONS
Section
118.705 Definitions
For the purposes of this Subpart, the following terms have
the meanings ascribed in this Section:
"Code" means the Public
Aid Code [305 ILCS 5].
"Department" means the
Department of Healthcare and Family Services and any successor agencies.
"FPL" means the federal
poverty income guidelines established by the federal Department of Health and
Human Services and published in the Federal Register.
"Health Benefits for
Immigrant Seniors" or "Program" means the Program authorized by
Section 12-4.35(a-5) of the Code and created by this Subpart.
"Resident" means an
individual who has an Illinois residence, as established in Section 5-3 of the
Code.
"Medical assistance receiving
federal financial participation" does not include emergency medical for
certain non-citizens.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.710 ELIGIBILITY
Section 118.710 Eligibility
An individual may be eligible for Health Benefits for
Immigrant Seniors provided that all of the following eligibility criteria are
met:
a) The
individual is not eligible for medical assistance receiving
federal financial participation other than emergency medical for certain
non-citizens;
b) The
individual is not:
1) A
U.S. citizen; or
2) A
person lawfully admitted for permanent residence under
the Immigration and Nationality Act (INA), regardless of length of
residency.
c) The
individual is a resident of the State of Illinois;
d) The
individual is 65 years of age or over;
e) The
individual's income is at or below 100% FPL without, or after deducting, the
costs of medical or remedial care as determined in accordance with 89 Ill. Adm.
Code 120.60(c);
f) The
individual has nonexempt resources at or below the AABD MANG resource disregard
level (see 89 Ill. Adm. Code 120.382). Certain resources shall be exempt from
consideration in determining eligibility (see 89 Ill. Adm. Code 120.381). The
resource test established in this Section will not apply any time the AABD MANG
resource test is suspended;
g) The
individual's resources are at or below the appropriate limit for their
household size, without, or after deducting, the costs of medical or remedial
care as determined in accordance with 89 Ill. Adm. Code 120.60(c);
h) The
individual cooperates in establishing eligibility (see 89 Ill. Adm. Code
120.308); and
i) The
individual assigns rights to medical support and collection of payment (see 89
Ill. Adm. Code 120.319).
(Source: Amended at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.715 ELIGIBILITY EXCLUSIONS AND TERMINATIONS
Section 118.715 Eligibility Exclusions and Terminations
a) An
individual shall not be determined eligible for Health Benefits for Immigrant
Seniors if the individual is an inmate of a public institution.
b) An
individual's coverage under the Program shall be terminated if the individual:
1) No
longer qualifies as an Illinois resident;
2) Becomes
eligible for medical assistance under the Public Aid Code that receives federal
financial participation;
3) Fails
to report to the Department changes that affect eligibility for the Program;
4) Asks
the Department to terminate the coverage;
5) Is no
longer eligible based on any other applicable State or federal law or
regulation;
6) Failed
to provide eligibility information that was truthful and accurate to the best
of the individual's knowledge and belief and that affected the individual's
eligibility;
7) Was
incorrectly determined eligible;
8) Fails
to complete the redetermination of eligibility within the required timeframes
or provide proof of on-going eligibility; or
9) Becomes
an inmate of a public institution.
c) Following
termination of an individual's coverage under the Program, the following action
is required before the individual can be re-enrolled:
1) A new
application is completed and submitted, or an existing application or case is reopened,
and the individual is determined otherwise eligible; and
2) The
individual cooperates with the Department to meet the prescribed timeframes regarding
a determination of eligibility found in 305 ILCS 5/11-5.1(a)(2) and 89 Ill.
Adm. Code 120.308(h).
d) If the
Department determines the individual's exclusion or termination was in error,
the individual can be re-enrolled.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.720 APPLICATION PROCESS
Section 118.720 Application Process
a) Individuals
apply for the Program by submitting an application through any available method
(see 89 Ill. Adm. Code 110.5), including on-line at ABE.illinois.gov (Illinois
Application for Benefits Eligibility), by mail, in person, by phone, or another
method. The Department may designate entities that may assist individuals to
submit applications.
b) The
application shall meet all requirements of 89 Ill. Adm. Code 110.10
(Application for Medical Assistance), including provisions regarding who may
apply on behalf of the individual.
c) Applicants
are obligated to provide truthful and accurate information for determining
eligibility and to promptly report any change in information provided on the
application.
d) The
Department may cease enrollment and deny applications that meet the eligibility
requirements of this Subpart if the Department determines this action is
necessary to maintain the cost of the Program within the available funding.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.725 DETERMINATION OF MONTHLY COUNTABLE INCOME
Section 118.725 Determination of Monthly Countable
Income
a) The
earned and unearned income of the following persons, when included in the
applicable standard under 89 Ill. Adm. Code 120.10, shall be counted when
determining eligibility under Section 118.710, except as specified in
subsections (b) and (c):
1) Income
of the individual;
2) Income
of the individual's spouse; and
3) Unearned
income of a dependent child under the age of 18 years who is included in the
income standard as set forth at 89 Ill. Adm. Code 120.20 because it is to the
advantage of the individual.
b) Monthly
unearned income shall be counted as described at 89 Ill. Adm. Code 120.330
through 120.347, 120.350, 120.355, 120.371 and 120.376.
c) Monthly
earned income shall be considered as described at 89 Ill. Adm. Code 120.360,
120.361 and 120.371 through 120.375.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.730 ELIGIBILITY DETERMINATION AND ENROLLMENT PROCESS
Section 118.730 Eligibility Determination and Enrollment
Process
a) The
applicant's eligibility for medical assistance receiving federal financial
participation will be considered as a part of the eligibility determination
process for this Program.
b) If
the monthly countable income is at or below 100% FPL without, or after
deducting, the costs of medical or remedial care as determined in accordance
with 89 Ill. Adm. Code 120.60(c), the application will be approved if all other
factors of eligibility under Section 118.710, including resource limits, are
met. The Health Benefits for Immigrant Seniors Program income standard is 100%
FPL.
c) Applicants
will be notified, in writing, regarding the outcome of their eligibility
determination.
d) Eligibility
will be redetermined at least annually.
e) Individuals
may obtain backdated medical coverage for up to three months prior to the month
of application, unless:
1) the
individual does not meet all eligibility requirements for one or more backdated
months; or
2) the Department determines that it is necessary to limit or
eliminate the backdated medical coverage in order to assure payments for this
Program do not exceed available annual funding. The Department shall
publish notice of such a determination via the Department's website at https://hfs.illinois.gov/info/legal/publicnotices.html.
(Source: Amended at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.735 APPEALS
Section 118.735 Appeals
a) Any
person who applies for or receives benefits under the Program shall have the
right to appeal any of the following actions:
1) Refusal
to accept, or failure to act on, an application or reapplication;
2) Denial
of an application or cancellation at the redetermination of eligibility,
including denial based on failure to meet one or more of the eligibility
requirements specified in this Subpart.
A) No
eligibility exists during the appeal process.
B) If the
appeal is upheld, the individual will have the opportunity to receive coverage
back to the original application date, including possible backdated months or
the cancellation month;
3) Termination
of coverage based on failure to continue to meet one or more of the eligibility
requirements specified in this Subpart.
A) If the
termination is not upheld on appeal, coverage under the Program shall be
reinstated retroactive to the termination date.
B) The
individual may choose coverage for all or some of the months during the appeal
process as long as the retroactive months are consecutive to the new initial
month of regular eligibility; and
4) Individuals
or their representatives do not have the right to appeal Department decisions
necessary to keep the cost of the Program within the annual appropriations,
such as a Department decision to:
A) Deny
an application due to closing of enrollment for the Program;
B) Make a
change to the Program pursuant to Section 118.760; and
C) Require
more frequent redeterminations of eligibility.
b) In
addition to the actions that are appealable under subsection (a), individuals
shall have the right to appeal any of the following actions:
1) Denial
of payment for a medical service or item that requires prior approval; or
2) Decision
granting prior approval for a lesser or different medical service or item than
was originally requested.
c) Individuals
may initiate the appeal process by submitting a request for appeal to the
Department's Bureau of Administrative Hearings.
d) The
request for a hearing may be filed by the individual affected by the action or
by the individual's authorized representative.
e) For
purposes of initiating the appeal process, a copy of a written, signed request
for a hearing is considered the same as the original written, signed request.
f) The
request for a hearing must be filed no later than 60 days after notice of the
appealable action has been given.
g) The
provisions of 89 Ill. Adm. Code 104.Subpart A (Practice in Administrative
Hearings) shall govern the handling of appeals and the conduct of hearings
under the Program.
h) An
individual can, prior to a decision being rendered on the appeal, reapply for
the Program.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.740 RENEWALS OF ELIGIBILITY
Section 118.740 Renewals of Eligibility
a) Prior
to the eligibility period ending, and in sufficient time for the individual to
respond to the Department's request for information, the Department or its
designee will send an annual renewal notice to the individual. Failure to
respond to the renewal notice when required may result in termination.
b) Renewals
shall be subject to all eligibility requirements and exclusions set forth in
this Subpart, including Sections 118.710, 118.715, 118.725 and 118.730.
c) The
Department may require renewal of eligibility more frequently than annually if
necessary to keep spending within available funding.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.745 COVERED SERVICES
Section 118.745 Covered Services
Covered health care services shall be the same as covered
services for adults described in Article V of the Code, including kidney
transplants, except as provided in Section 118.750. The Department may also
cover certain services, including, but not limited to, select Department of
Human Services Home Services Program (HSP) services and select Department on
Aging Community Care Program (CCP) services, to the extent the individual is
otherwise determined eligible for those services.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.750 SERVICE EXCLUSIONS
Section 118.750 Service Exclusions
The following health care services shall not be covered
under this Subpart:
a) Nursing
facility services;
b) Intermediate
Care Facility for Persons with Developmental Disabilities (ICF/DD) services;
c) Specialized
Mental Health Rehabilitation facility (SMHRF) services;
d) Medically
Complex for the Developmentally Disabled facility (MC/DD) services; and
e) Funeral
and burial expenses.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.755 PROVIDER REIMBURSEMENT
Section 118.755 Provider Reimbursement
a) Provider
participation under this Subpart shall be subject to enrollment with, and
approval by, the Department.
b) Providers
shall be reimbursed in accordance with the established rates of the Department
or other appropriate State agency.
c) Providers
under this Subpart shall be prohibited from billing individuals covered under
this Program for any difference between the charge amount and the amount paid
by the Department.
(Source: Added at 44 Ill. Reg. 19684,
effective December 11, 2020)
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.760 PROGRAM LIMITATIONS
Section 118.760 Program Limitations
There is no entitlement to medical services under this
Subpart and those services are available only to the extent that payments made
for individuals eligible under this Subpart do not exceed the funding available
for this Program. The Department may take any action it deems necessary to
assure payments for this Program do not exceed available funding, including but
not limited to: ceasing or limiting enrollment, changing standards of
eligibility that are not statutorily required, changing enrollment practices,
changing eligibility time periods, and reducing available medical services.
a) The Department shall publish notice of the
opening or closing of enrollment via the Department's website at https://hfs.illinois.gov/info/legal/publicnotices.html
no later than fourteen (14) calendar days prior to the action.
b) Co-payments
or cost sharing may be charged for services provided to the population by a
health care provider as described below, except for practitioner visits
scheduled for family planning services.
1) Co-payment and cost sharing requirements are as
follows, unless the services meet the requirement under 89 Ill. Adm. Code
120.310(b)(4) as an emergency medical condition or are otherwise covered under
Department rule without a co-pay:
A) Inpatient
hospitalizations, $250 per hospital stay; and
B) Hospital
or Ambulatory Surgical Treatment Center outpatient services set forth at 89
Ill. Adm. Code 148.140(b), 10 percent of the Department rate as set forth in 89
Ill. Adm. Code 128.350(c).
2) Providers
are responsible for collecting co-payments.
3) Providers
may elect not to charge co-payments. If co-payments are charged, the co-payment
may not exceed the amounts established in this Section.
c) Any large public hospitals, as defined in Section
148.25(a), having received payments in excess of the rates paid to non-large
public hospitals, as authorized under 89 Ill. Adm. Code 148.160 and 148.170, shall
be required to reimburse the State for any excess payment in a method and
amount as determined by the Department.
(Source: Amended at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
SUBPART H: KIDNEY TRANSPLANTATION AND RELATED SERVICES FOR NONCITIZENS
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.780 KIDNEY TRANSPLANTATION FOR NONCITIZENS WITH END-STAGE RENAL DISEASE
Section 118.780 Kidney Transplantation for Noncitizens
with End-Stage Renal Disease
Pursuant to Public Act 98-0651, which amended Section 5-5 of
the Public Aid Code, effective for dates of outpatient services and inpatient
discharges on and after October 1, 2014, notwithstanding Section 1-11 of the
Code and any citizenship or immigration requirements under Title 89, any
noncitizen is eligible for kidney transplantation when each of the following
criteria are met:
a) The noncitizen:
1) has end-stage renal
disease;
2) is
enrolled with the Department with coverage limited to renal dialysis services;
3) is
not eligible for comprehensive medical benefits under any government funded or
private insurance plan;
4) otherwise
meets the income, asset, and categorical requirements of the medical assistance
program; and
5) meets
the residency requirements of Section 5-3 of the Code.
b) Providers,
including transplant centers, providing kidney transplantation services under
this Subpart shall be pre-certified by the Department and meet all provider
requirements consistent with 89 Ill. Adm. Code 148.82. Only providers,
including transplant centers, enrolled in the medical assistance program, and
located in the State of Illinois and St. Louis, MO shall be allowed to perform
the kidney transplantation and conduct the medically necessary care identified
in subsection (c).
c) The
kidney transplantation procedure shall be medically necessary, and providers
shall be prior approved and certified by the Department to perform kidney
transplantation and services under this section. Only medically necessary
services associated with kidney transplantation shall be covered, including but
not limited to donor and recipient transplant surgeries (including facility,
surgical, and anesthesia services), recommended, to the extent covered under
the medical assistance program, pre-op evaluation and screening, assessment for
evaluation of recipient's ability to comply with medical and follow-up
instructions, acquisition and harvesting of kidney to be transplanted,
hospitalization, medical follow-up and testing, rehabilitative and home nursing
services, pharmacy costs, including anti-rejection and anti-infective
medicines, and incidental costs for care of complications in the peri-operative
period.
d) Requests
for repeat kidney transplantation shall be considered in exceptional
circumstances and shall require prior approval by the Department.
e) Transplantation
of organs other than kidneys shall not be a covered service under this Subpart.
f) Clinical trials shall
not be a covered service under this Subpart.
g) Experimental procedures
shall not be a covered service under this Subpart.
h) Reports,
including patient's progress, kidney function tests, complications, if any, and
a list of current medications shall be submitted to the Department from the
transplant center and transplant surgeon at three months after surgery and at
the anniversary date of transplantation annually for five years.
i) Payment
for services rendered under this Subpart shall be at a single bundled rate,
which shall be payment in full for all medically necessary services associated
with the transplantation under this Subpart, with the exception of
immunosuppressant drugs. The bundled rate shall have two components. First, the
inpatient stay during which the transplant takes place will be priced using the
Department's hospital rate methodology (see 89 Ill. Adm. Code 149.100) and,
second, the Department will add $15,000 to this price to cover all ancillary
services covered in subsection (c) except drugs covered through pharmacy as
appropriate and related to the transplant. These two components will comprise
the single bundled rate for transplant for the first year (12 months) from the
date of kidney transplant.
j) Drugs
paid for under this Subpart shall be subject to all the Department's
pharmaceutical protocols and procedures, including but not limited to placement
on the prior approval list, preferred drug list, genetic drug preference, and
utilization controls, except:
1) drugs may not be
shipped to any address outside the State of Illinois; and
2) immunosuppressant
drugs shall be paid for at the Department's prevailing rates under 89 Ill. Adm.
Code 140 to a pharmacy provider approved specifically for this program.
Immunosuppressant drugs paid for under this Subpart shall be covered by the
Department if medically necessary and as long as the noncitizen remains
eligible under this Subpart.
(Source: Added at 46 Ill. Reg. 14541,
effective August 8, 2022)
| TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118
SPECIAL ELIGIBILITY GROUPS
SECTION 118.790 POST KIDNEY TRANSPLANTATION SERVICES FOR NONCITIZENS
Section
118.790 Post Kidney Transplantation Services for Noncitizens
Pursuant
to Public Act 102-0043, which amended Section 5/12-4.35 of the Public Aid Code,
any noncitizen is eligible for post-transplant drugs and related services after
12 months from the date of kidney transplant, when each of the following
criteria are met:
a) The noncitizen:
1) provides
proof that they received a kidney transplant, at least 12 months prior, at a
certified transplant center in Illinois, and now require medically necessary
post-transplant drugs and related services. Acceptable proof shall include
medical records and operative report confirming the date of and location where
the transplant occurred;
2) is not
eligible for comprehensive medical benefits under any government funded or
private insurance plan;
3) otherwise
meets the income, asset, and categorical requirements of the medical assistance
program; and,
4) meets
the residency requirements of Section 5-3 of the Code.
b) Requests
for post kidney transplant services for noncitizens shall be reviewed for
eligibility and prior authorized by the Department for medical necessity
initially and annually thereafter.
c) Covered
benefits shall include, to the extent covered under the medical assistance program,
immunosuppressant drugs; other drugs as necessary for treatment of condition(s)
resulting from a kidney transplant, or those pre-existing condition(s) which
necessitated a kidney transplant; an annual evaluation by patient’s primary
care physician, a nephrologist, and a transplant surgeon in Illinois; and a
standard battery of diagnostic tests for post-transplant patients, including
blood tests, urine tests, kidney ultrasound, and kidney biopsy.
d) Providers
may request exceptions for additional medically necessary post kidney
transplant related services, which will be reviewed by the Department on a
case-by-case basis.
e) As in
case of other partial benefits programs for special populations covered by the
Department, the programs of Kidney Transplantation for Noncitizens with
End-Stage Renal Disease, and Post Kidney Transplantation Services for
Noncitizens will be managed directly by the Department.
(Source: Added at 46 Ill. Reg. 14541,
effective August 8, 2022)
SUBPART I: HEALTH BENEFITS FOR IMMIGRANT ADULTS
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.800 GENERAL DESCRIPTION
Section 118.800 General Description
Effective July 1, 2025, this program is no longer operative.
(Source: Amended at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.805 DEFINITIONS (REPEALED)
Section 118.805
Definitions (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960, effective July
1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.810 ELIGIBILITY (REPEALED)
Section 118.810 Eligibility
(Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.815 ELIGIBILITY EXCLUSIONS AND TERMINATIONS (REPEALED)
Section 118.815 Eligibility Exclusions and Terminations (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.820 APPLICATION PROCESS (REPEALED)
Section 118.820 Application Process (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.825 DETERMINATION OF MONTHLY COUNTABLE INCOME (REPEALED)
Section 118.825 Determination of Monthly Countable
Income (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.830 ELIGIBILITY DETERMINATION AND ENROLLMENT PROCESS (REPEALED)
Section 118.830 Eligibility Determination and Enrollment
Process (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.835 APPEALS (REPEALED)
Section 118.835 Appeals
(Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.840 RENEWALS OF ELIGIBILITY (REPEALED)
Section 118.840 Renewals of Eligibility (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.845 COVERED SERVICES (REPEALED)
Section 118.845 Covered Services (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.850 SERVICE EXCLUSIONS (REPEALED)
Section 118.850 Service Exclusions (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.855 PROVIDER REIMBURSEMENT (REPEALED)
Section 118.855 Provider Reimbursement (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
ADMINISTRATIVE CODE TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER b: ASSISTANCE PROGRAMS
PART 118 SPECIAL ELIGIBILITY GROUPS
SECTION 118.860 PROGRAM LIMITATIONS (REPEALED)
Section 118.860 Program Limitations (Repealed)
(Source: Repealed at 49 Ill. Reg. 8960,
effective July 1, 2025)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
