Sen. J. Bradley Burzynski
Filed: 4/29/2008
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1 | AMENDMENT TO HOUSE BILL 1533
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2 | AMENDMENT NO. ______. Amend House Bill 1533, by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 5-2 as follows:
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6 | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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7 | Sec. 5-2. Classes of Persons Eligible. Medical assistance | ||||||
8 | under this
Article shall be available to any of the following | ||||||
9 | classes of persons in
respect to whom a plan for coverage has | ||||||
10 | been submitted to the Governor
by the Illinois Department and | ||||||
11 | approved by him:
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12 | 1. Recipients of basic maintenance grants under | ||||||
13 | Articles III and IV.
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14 | 2. Persons otherwise eligible for basic maintenance | ||||||
15 | under Articles
III and IV but who fail to qualify | ||||||
16 | thereunder on the basis of need, and
who have insufficient |
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1 | income and resources to meet the costs of
necessary medical | ||||||
2 | care, including but not limited to the following:
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3 | (a) All persons otherwise eligible for basic | ||||||
4 | maintenance under Article
III but who fail to qualify | ||||||
5 | under that Article on the basis of need and who
meet | ||||||
6 | either of the following requirements:
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7 | (i) their income, as determined by the | ||||||
8 | Illinois Department in
accordance with any federal | ||||||
9 | requirements, is equal to or less than 70% in
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10 | fiscal year 2001, equal to or less than 85% in | ||||||
11 | fiscal year 2002 and until
a date to be determined | ||||||
12 | by the Department by rule, and equal to or less
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13 | than 100% beginning on the date determined by the | ||||||
14 | Department by rule, of the nonfarm income official | ||||||
15 | poverty
line, as defined by the federal Office of | ||||||
16 | Management and Budget and revised
annually in | ||||||
17 | accordance with Section 673(2) of the Omnibus | ||||||
18 | Budget Reconciliation
Act of 1981, applicable to | ||||||
19 | families of the same size; or
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20 | (ii) their income, after the deduction of | ||||||
21 | costs incurred for medical
care and for other types | ||||||
22 | of remedial care, is equal to or less than 70% in
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23 | fiscal year 2001, equal to or less than 85% in | ||||||
24 | fiscal year 2002 and until
a date to be determined | ||||||
25 | by the Department by rule, and equal to or less
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26 | than 100% beginning on the date determined by the |
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1 | Department by rule, of the nonfarm income official | ||||||
2 | poverty
line, as defined in item (i) of this | ||||||
3 | subparagraph (a).
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4 | (b) All persons who would be determined eligible | ||||||
5 | for such basic
maintenance under Article IV by | ||||||
6 | disregarding the maximum earned income
permitted by | ||||||
7 | federal law.
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8 | 3. Persons who would otherwise qualify for Aid to the | ||||||
9 | Medically
Indigent under Article VII.
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10 | 4. Persons not eligible under any of the preceding | ||||||
11 | paragraphs who fall
sick, are injured, or die, not having | ||||||
12 | sufficient money, property or other
resources to meet the | ||||||
13 | costs of necessary medical care or funeral and burial
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14 | expenses.
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15 | 5.(a) Women during pregnancy, after the fact
of | ||||||
16 | pregnancy has been determined by medical diagnosis, and | ||||||
17 | during the
60-day period beginning on the last day of the | ||||||
18 | pregnancy, together with
their infants and children born | ||||||
19 | after September 30, 1983,
whose income and
resources are | ||||||
20 | insufficient to meet the costs of necessary medical care to
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21 | the maximum extent possible under Title XIX of the
Federal | ||||||
22 | Social Security Act.
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23 | (b) The Illinois Department and the Governor shall | ||||||
24 | provide a plan for
coverage of the persons eligible under | ||||||
25 | paragraph 5(a) by April 1, 1990. Such
plan shall provide | ||||||
26 | ambulatory prenatal care to pregnant women during a
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1 | presumptive eligibility period and establish an income | ||||||
2 | eligibility standard
that is equal to 133%
of the nonfarm | ||||||
3 | income official poverty line, as defined by
the federal | ||||||
4 | Office of Management and Budget and revised annually in
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5 | accordance with Section 673(2) of the Omnibus Budget | ||||||
6 | Reconciliation Act of
1981, applicable to families of the | ||||||
7 | same size, provided that costs incurred
for medical care | ||||||
8 | are not taken into account in determining such income
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9 | eligibility.
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10 | (c) The Illinois Department may conduct a | ||||||
11 | demonstration in at least one
county that will provide | ||||||
12 | medical assistance to pregnant women, together
with their | ||||||
13 | infants and children up to one year of age,
where the | ||||||
14 | income
eligibility standard is set up to 185% of the | ||||||
15 | nonfarm income official
poverty line, as defined by the | ||||||
16 | federal Office of Management and Budget.
The Illinois | ||||||
17 | Department shall seek and obtain necessary authorization
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18 | provided under federal law to implement such a | ||||||
19 | demonstration. Such
demonstration may establish resource | ||||||
20 | standards that are not more
restrictive than those | ||||||
21 | established under Article IV of this Code.
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22 | 6. Persons under the age of 18 who fail to qualify as | ||||||
23 | dependent under
Article IV and who have insufficient income | ||||||
24 | and resources to meet the costs
of necessary medical care | ||||||
25 | to the maximum extent permitted under Title XIX
of the | ||||||
26 | Federal Social Security Act.
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1 | 7. Persons who are under 21 years of age and would
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2 | qualify as
disabled as defined under the Federal | ||||||
3 | Supplemental Security Income Program,
provided medical | ||||||
4 | service for such persons would be eligible for Federal
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5 | Financial Participation, and provided the Illinois | ||||||
6 | Department determines that:
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7 | (a) the person requires a level of care provided by | ||||||
8 | a hospital, skilled
nursing facility, or intermediate | ||||||
9 | care facility, as determined by a physician
licensed to | ||||||
10 | practice medicine in all its branches;
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11 | (b) it is appropriate to provide such care outside | ||||||
12 | of an institution, as
determined by a physician | ||||||
13 | licensed to practice medicine in all its branches;
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14 | (c) the estimated amount which would be expended | ||||||
15 | for care outside the
institution is not greater than | ||||||
16 | the estimated amount which would be
expended in an | ||||||
17 | institution.
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18 | 8. Persons who become ineligible for basic maintenance | ||||||
19 | assistance
under Article IV of this Code in programs | ||||||
20 | administered by the Illinois
Department due to employment | ||||||
21 | earnings and persons in
assistance units comprised of | ||||||
22 | adults and children who become ineligible for
basic | ||||||
23 | maintenance assistance under Article VI of this Code due to
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24 | employment earnings. The plan for coverage for this class | ||||||
25 | of persons shall:
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26 | (a) extend the medical assistance coverage for up |
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1 | to 12 months following
termination of basic | ||||||
2 | maintenance assistance; and
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3 | (b) offer persons who have initially received 6 | ||||||
4 | months of the
coverage provided in paragraph (a) above, | ||||||
5 | the option of receiving an
additional 6 months of | ||||||
6 | coverage, subject to the following:
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7 | (i) such coverage shall be pursuant to | ||||||
8 | provisions of the federal
Social Security Act;
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9 | (ii) such coverage shall include all services | ||||||
10 | covered while the person
was eligible for basic | ||||||
11 | maintenance assistance;
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12 | (iii) no premium shall be charged for such | ||||||
13 | coverage; and
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14 | (iv) such coverage shall be suspended in the | ||||||
15 | event of a person's
failure without good cause to | ||||||
16 | file in a timely fashion reports required for
this | ||||||
17 | coverage under the Social Security Act and | ||||||
18 | coverage shall be reinstated
upon the filing of | ||||||
19 | such reports if the person remains otherwise | ||||||
20 | eligible.
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21 | 9. Persons with acquired immunodeficiency syndrome | ||||||
22 | (AIDS) or with
AIDS-related conditions with respect to whom | ||||||
23 | there has been a determination
that but for home or | ||||||
24 | community-based services such individuals would
require | ||||||
25 | the level of care provided in an inpatient hospital, | ||||||
26 | skilled
nursing facility or intermediate care facility the |
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1 | cost of which is
reimbursed under this Article. Assistance | ||||||
2 | shall be provided to such
persons to the maximum extent | ||||||
3 | permitted under Title
XIX of the Federal Social Security | ||||||
4 | Act.
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5 | 10. Participants in the long-term care insurance | ||||||
6 | partnership program
established under the Illinois | ||||||
7 | Long-Term Care Partnership Program Act Partnership for | ||||||
8 | Long-Term Care Act who meet the
qualifications for | ||||||
9 | protection of resources described in Section 15 25 of that
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10 | Act.
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11 | 11. Persons with disabilities who are employed and | ||||||
12 | eligible for Medicaid,
pursuant to Section | ||||||
13 | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, as
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14 | provided by the Illinois Department by rule. In | ||||||
15 | establishing eligibility standards under this paragraph | ||||||
16 | 11, the Department shall, subject to federal approval: | ||||||
17 | (a) set the income eligibility standard at not | ||||||
18 | lower than 350% of the federal poverty level; | ||||||
19 | (b) exempt retirement accounts that the person | ||||||
20 | cannot access without penalty before the age
of 59 1/2, | ||||||
21 | and medical savings accounts established pursuant to | ||||||
22 | 26 U.S.C. 220; | ||||||
23 | (c) allow non-exempt assets up to $25,000 as to | ||||||
24 | those assets accumulated during periods of eligibility | ||||||
25 | under this paragraph 11; and
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26 | (d) continue to apply subparagraphs (b) and (c) in |
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1 | determining the eligibility of the person under this | ||||||
2 | Article even if the person loses eligibility under this | ||||||
3 | paragraph 11.
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4 | 12. Subject to federal approval, persons who are | ||||||
5 | eligible for medical
assistance coverage under applicable | ||||||
6 | provisions of the federal Social Security
Act and the | ||||||
7 | federal Breast and Cervical Cancer Prevention and | ||||||
8 | Treatment Act of
2000. Those eligible persons are defined | ||||||
9 | to include, but not be limited to,
the following persons:
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10 | (1) persons who have been screened for breast or | ||||||
11 | cervical cancer under
the U.S. Centers for Disease | ||||||
12 | Control and Prevention Breast and Cervical Cancer
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13 | Program established under Title XV of the federal | ||||||
14 | Public Health Services Act in
accordance with the | ||||||
15 | requirements of Section 1504 of that Act as | ||||||
16 | administered by
the Illinois Department of Public | ||||||
17 | Health; and
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18 | (2) persons whose screenings under the above | ||||||
19 | program were funded in whole
or in part by funds | ||||||
20 | appropriated to the Illinois Department of Public | ||||||
21 | Health
for breast or cervical cancer screening.
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22 | "Medical assistance" under this paragraph 12 shall be | ||||||
23 | identical to the benefits
provided under the State's | ||||||
24 | approved plan under Title XIX of the Social Security
Act. | ||||||
25 | The Department must request federal approval of the | ||||||
26 | coverage under this
paragraph 12 within 30 days after the |
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1 | effective date of this amendatory Act of
the 92nd General | ||||||
2 | Assembly.
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3 | 13. Subject to appropriation and to federal approval, | ||||||
4 | persons living with HIV/AIDS who are not otherwise eligible | ||||||
5 | under this Article and who qualify for services covered | ||||||
6 | under Section 5-5.04 as provided by the Illinois Department | ||||||
7 | by rule.
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8 | 14. Subject to the availability of funds for this | ||||||
9 | purpose, the Department may provide coverage under this | ||||||
10 | Article to persons who reside in Illinois who are not | ||||||
11 | eligible under any of the preceding paragraphs and who meet | ||||||
12 | the income guidelines of paragraph 2(a) of this Section and | ||||||
13 | (i) have an application for asylum pending before the | ||||||
14 | federal Department of Homeland Security or on appeal before | ||||||
15 | a court of competent jurisdiction and are represented | ||||||
16 | either by counsel or by an advocate accredited by the | ||||||
17 | federal Department of Homeland Security and employed by a | ||||||
18 | not-for-profit organization in regard to that application | ||||||
19 | or appeal, or (ii) are receiving services through a | ||||||
20 | federally funded torture treatment center. Medical | ||||||
21 | coverage under this paragraph 14 may be provided for up to | ||||||
22 | 24 continuous months from the initial eligibility date so | ||||||
23 | long as an individual continues to satisfy the criteria of | ||||||
24 | this paragraph 14. If an individual has an appeal pending | ||||||
25 | regarding an application for asylum before the Department | ||||||
26 | of Homeland Security, eligibility under this paragraph 14 |
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1 | may be extended until a final decision is rendered on the | ||||||
2 | appeal. The Department may adopt rules governing the | ||||||
3 | implementation of this paragraph 14.
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4 | 15. FamilyCare eligibility. | ||||||
5 | (a) A caretaker relative who is 19 years of age or | ||||||
6 | older when countable income is at or below 185% of the | ||||||
7 | Federal Poverty Level Guidelines, as published | ||||||
8 | annually in the Federal Register, for the appropriate | ||||||
9 | family size. A person may not spend down to become | ||||||
10 | eligible under this paragraph 15. | ||||||
11 | (b) A caretaker relative, including a pregnant | ||||||
12 | woman or her spouse if living together, who is 19 years | ||||||
13 | of age or older qualifies for medical assistance if the | ||||||
14 | individual is not otherwise eligible for medical | ||||||
15 | assistance or healthcare benefits under the Children's | ||||||
16 | Health Insurance Program Act or the Covering ALL KIDS | ||||||
17 | Health Insurance Act. | ||||||
18 | (c) A caretaker relative may not spend down to | ||||||
19 | become eligible under this paragraph 15. | ||||||
20 | (d) Eligibility shall commence as follows: | ||||||
21 | (1) Eligibility determinations for the program | ||||||
22 | made by the 15th day of the month shall be | ||||||
23 | effective the first day of the following month. | ||||||
24 | Eligibility determinations for the program made | ||||||
25 | after the 15th day of the month shall be effective | ||||||
26 | no later than the first day of the second month |
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1 | following that determination. | ||||||
2 | (2) Individuals found eligible under this | ||||||
3 | paragraph 15 may obtain coverage for a period prior | ||||||
4 | to the date of application for the program subject | ||||||
5 | to the following: | ||||||
6 | (A) The individual must request prior | ||||||
7 | coverage within 6 months following the initial | ||||||
8 | date of coverage. | ||||||
9 | (B) The prior coverage shall be individual | ||||||
10 | specific and shall only be available the first | ||||||
11 | time the individual is enrolled under this | ||||||
12 | paragraph 15. | ||||||
13 | (C) The prior coverage shall begin with | ||||||
14 | services rendered during the 2 weeks prior to | ||||||
15 | the date the individual's application was | ||||||
16 | filed and shall continue until the | ||||||
17 | individual's coverage under subdivision (e)(1) | ||||||
18 | of this paragraph 15 is effective. | ||||||
19 | (e) Eligibility shall be reviewed annually. | ||||||
20 | (f) Caretaker relatives enrolled under this | ||||||
21 | paragraph 15 in families with countable income above | ||||||
22 | 150% and at or below 185% of the Federal Poverty Level | ||||||
23 | Guidelines shall be counted as family members and pay | ||||||
24 | premiums as established under the Children's Health | ||||||
25 | Insurance Program Act. | ||||||
26 | (g) Premiums shall be billed by and payable to the |
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1 | Department or its authorized agent, on a monthly basis. | ||||||
2 | (h) The premium due date is the last day of the | ||||||
3 | month preceding the month of coverage. | ||||||
4 | (i) Individuals shall have a grace period through | ||||||
5 | the month of coverage to pay the premium. | ||||||
6 | (j) Failure to pay the full monthly premium by the | ||||||
7 | last day of the grace period shall result in | ||||||
8 | termination of coverage. | ||||||
9 | (k) Partial premium payments shall not be | ||||||
10 | refunded. | ||||||
11 | (l) When termination of coverage is recorded by the | ||||||
12 | 15th day of the month, it shall be effective the first | ||||||
13 | day of the following month. When termination of | ||||||
14 | coverage is recorded after the 15th day of the month, | ||||||
15 | it shall be effective no later than the first day of | ||||||
16 | the second month following that determination. | ||||||
17 | (m) Following termination of an individual's | ||||||
18 | coverage under this paragraph 15, the following action | ||||||
19 | is required before the individual can be re-enrolled: | ||||||
20 | (1) A new application must be completed and the | ||||||
21 | individual must be determined otherwise eligible. | ||||||
22 | (2) There must be full payment of premiums due | ||||||
23 | under this Code, the Children's Health Insurance | ||||||
24 | Program Act, the Covering ALL KIDS Health | ||||||
25 | Insurance Act, or any other healthcare program | ||||||
26 | administered by the Department for periods in |
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1 | which a premium was owed and not paid for the | ||||||
2 | individual. | ||||||
3 | (3) If the termination was the result of | ||||||
4 | non-payment of premiums, the individual must be | ||||||
5 | out of the program for 3 months before | ||||||
6 | re-enrollment. | ||||||
7 | (4) The first month's premium must be paid if | ||||||
8 | there was an unpaid premium on the date the | ||||||
9 | individual's previous coverage was canceled. | ||||||
10 | The Illinois Department and the Governor shall provide a | ||||||
11 | plan for
coverage of the persons eligible under paragraph 7 as | ||||||
12 | soon as possible after
July 1, 1984.
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13 | The eligibility of any such person for medical assistance | ||||||
14 | under this
Article is not affected by the payment of any grant | ||||||
15 | under the Senior
Citizens and Disabled Persons Property Tax | ||||||
16 | Relief and Pharmaceutical
Assistance Act or any distributions | ||||||
17 | or items of income described under
subparagraph (X) of
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18 | paragraph (2) of subsection (a) of Section 203 of the Illinois | ||||||
19 | Income Tax
Act. The Department shall by rule establish the | ||||||
20 | amounts of
assets to be disregarded in determining eligibility | ||||||
21 | for medical assistance,
which shall at a minimum equal the | ||||||
22 | amounts to be disregarded under the
Federal Supplemental | ||||||
23 | Security Income Program. The amount of assets of a
single | ||||||
24 | person to be disregarded
shall not be less than $2,000, and the | ||||||
25 | amount of assets of a married couple
to be disregarded shall | ||||||
26 | not be less than $3,000.
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1 | To the extent permitted under federal law, any person found | ||||||
2 | guilty of a
second violation of Article VIIIA
shall be | ||||||
3 | ineligible for medical assistance under this Article, as | ||||||
4 | provided
in Section 8A-8.
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5 | The eligibility of any person for medical assistance under | ||||||
6 | this Article
shall not be affected by the receipt by the person | ||||||
7 | of donations or benefits
from fundraisers held for the person | ||||||
8 | in cases of serious illness,
as long as neither the person nor | ||||||
9 | members of the person's family
have actual control over the | ||||||
10 | donations or benefits or the disbursement
of the donations or | ||||||
11 | benefits.
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12 | (Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06; | ||||||
13 | 95-546, eff. 8-29-07; revised 1-22-08.)
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14 | Section 99. Effective date. This Act takes effect upon | ||||||
15 | becoming law.".
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