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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. If and only if both Senate Bill 2840, AS | ||||||
5 | AMENDED, of the 97th General Assembly and Senate Bill 3397, AS | ||||||
6 | AMENDED, of
the 97th General Assembly become law, then the | ||||||
7 | Illinois Public Aid Code is amended by changing Sections 5-1.4, | ||||||
8 | 5-2, 5-2.03, 15-1, 15-2, 15-5, and 15-11 as follows: | ||||||
9 | (305 ILCS 5/5-1.4) | ||||||
10 | Sec. 5-1.4. Moratorium on eligibility expansions. | ||||||
11 | Beginning on January 25, 2011 ( the effective date of Public Act | ||||||
12 | 96-1501) this amendatory Act of the 96th General Assembly , | ||||||
13 | there shall be a 4-year 2-year moratorium on the expansion of | ||||||
14 | eligibility through increasing financial eligibility | ||||||
15 | standards, or through increasing income disregards, or through | ||||||
16 | the creation of new programs which would add new categories of | ||||||
17 | eligible individuals under the medical assistance program in | ||||||
18 | addition to those categories covered on January 1, 2011 or | ||||||
19 | above the level of any subsequent reduction in eligibility . | ||||||
20 | This moratorium shall not apply to expansions required as a | ||||||
21 | federal condition of State participation in the medical | ||||||
22 | assistance program or to expansions approved by the federal | ||||||
23 | government that are financed entirely by units of local |
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1 | government and federal matching funds. If the State of Illinois | ||||||
2 | finds that the State has borne a cost related to such an | ||||||
3 | expansion, the unit of local government shall reimburse the | ||||||
4 | State. All federal funds associated with an expansion funded by | ||||||
5 | a unit of local government shall be returned to the local | ||||||
6 | government entity funding the expansion, pursuant to an | ||||||
7 | intergovernmental agreement between the Department of | ||||||
8 | Healthcare and Family Services and the local government entity. | ||||||
9 | Within 10 calendar days of the effective date of this | ||||||
10 | amendatory Act of the 97th General Assembly, the Department of | ||||||
11 | Healthcare and Family Services shall formally advise the | ||||||
12 | Centers for Medicare and Medicaid Services of the passage of | ||||||
13 | this amendatory Act of the 97th General Assembly. The State is | ||||||
14 | prohibited from submitting additional waiver requests that | ||||||
15 | expand or allow for an increase in the classes of persons | ||||||
16 | eligible for medical assistance under this Article to the | ||||||
17 | federal government for its consideration beginning on the 20th | ||||||
18 | calendar day following the effective date of this amendatory | ||||||
19 | Act of the 97th General Assembly until January 25, 2015 .
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20 | (Source: P.A. 96-1501, eff. 1-25-11.)
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21 | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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22 | Sec. 5-2. Classes of Persons Eligible. Medical assistance | ||||||
23 | under this
Article shall be available to any of the following | ||||||
24 | classes of persons in
respect to whom a plan for coverage has | ||||||
25 | been submitted to the Governor
by the Illinois Department and |
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1 | approved by him:
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2 | 1. Recipients of basic maintenance grants under | ||||||
3 | Articles III and IV.
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4 | 2. Persons otherwise eligible for basic maintenance | ||||||
5 | under Articles
III and IV, excluding any eligibility | ||||||
6 | requirements that are inconsistent with any federal law or | ||||||
7 | federal regulation, as interpreted by the U.S. Department | ||||||
8 | of Health and Human Services, but who fail to qualify | ||||||
9 | thereunder on the basis of need or who qualify but are not | ||||||
10 | receiving basic maintenance under Article IV, and
who have | ||||||
11 | insufficient income and resources to meet the costs of
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12 | necessary medical care, including but not limited to the | ||||||
13 | following:
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14 | (a) All persons otherwise eligible for basic | ||||||
15 | maintenance under Article
III but who fail to qualify | ||||||
16 | under that Article on the basis of need and who
meet | ||||||
17 | either of the following requirements:
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18 | (i) their income, as determined by the | ||||||
19 | Illinois Department in
accordance with any federal | ||||||
20 | requirements, is equal to or less than 70% in
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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
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24 | than 100% beginning on the date determined by the | ||||||
25 | Department by rule, of the nonfarm income official | ||||||
26 | poverty
line, as defined by the federal Office of |
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1 | Management and Budget and revised
annually in | ||||||
2 | accordance with Section 673(2) of the Omnibus | ||||||
3 | Budget Reconciliation
Act of 1981, applicable to | ||||||
4 | families of the same size; or
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5 | (ii) their income, after the deduction of | ||||||
6 | costs incurred for medical
care and for other types | ||||||
7 | of remedial care, is equal to or less than 70% in
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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 in item (i) of this | ||||||
14 | subparagraph (a).
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15 | (b) All persons who, excluding any eligibility | ||||||
16 | requirements that are inconsistent with any federal | ||||||
17 | law or federal regulation, as interpreted by the U.S. | ||||||
18 | Department of Health and Human Services, would be | ||||||
19 | determined eligible for such basic
maintenance under | ||||||
20 | Article IV by disregarding the maximum earned income
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21 | permitted by federal law.
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22 | 3. Persons who would otherwise qualify for Aid to the | ||||||
23 | Medically
Indigent under Article VII.
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24 | 4. Persons not eligible under any of the preceding | ||||||
25 | paragraphs who fall
sick, are injured, or die, not having | ||||||
26 | sufficient money, property or other
resources to meet the |
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1 | costs of necessary medical care or funeral and burial
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2 | expenses.
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3 | 5.(a) Women during pregnancy, after the fact
of | ||||||
4 | pregnancy has been determined by medical diagnosis, and | ||||||
5 | during the
60-day period beginning on the last day of the | ||||||
6 | pregnancy, together with
their infants and children born | ||||||
7 | after September 30, 1983,
whose income and
resources are | ||||||
8 | insufficient to meet the costs of necessary medical care to
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9 | the maximum extent possible under Title XIX of the
Federal | ||||||
10 | Social Security Act.
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11 | (b) The Illinois Department and the Governor shall | ||||||
12 | provide a plan for
coverage of the persons eligible under | ||||||
13 | paragraph 5(a) by April 1, 1990. Such
plan shall provide | ||||||
14 | ambulatory prenatal care to pregnant women during a
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15 | presumptive eligibility period and establish an income | ||||||
16 | eligibility standard
that is equal to 133%
of the nonfarm | ||||||
17 | income official poverty line, as defined by
the federal | ||||||
18 | Office of Management and Budget and revised annually in
| ||||||
19 | accordance with Section 673(2) of the Omnibus Budget | ||||||
20 | Reconciliation Act of
1981, applicable to families of the | ||||||
21 | same size, provided that costs incurred
for medical care | ||||||
22 | are not taken into account in determining such income
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23 | eligibility.
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24 | (c) The Illinois Department may conduct a | ||||||
25 | demonstration in at least one
county that will provide | ||||||
26 | medical assistance to pregnant women, together
with their |
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1 | infants and children up to one year of age,
where the | ||||||
2 | income
eligibility standard is set up to 185% of the | ||||||
3 | nonfarm income official
poverty line, as defined by the | ||||||
4 | federal Office of Management and Budget.
The Illinois | ||||||
5 | Department shall seek and obtain necessary authorization
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6 | provided under federal law to implement such a | ||||||
7 | demonstration. Such
demonstration may establish resource | ||||||
8 | standards that are not more
restrictive than those | ||||||
9 | established under Article IV of this Code.
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10 | 6. Persons under the age of 18 who fail to qualify as | ||||||
11 | dependent under
Article IV and who have insufficient income | ||||||
12 | and resources to meet the costs
of necessary medical care | ||||||
13 | to the maximum extent permitted under Title XIX
of the | ||||||
14 | Federal Social Security Act.
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15 | 7. Persons who are under 21 years of age and would
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16 | qualify as
disabled as defined under the Federal | ||||||
17 | Supplemental Security Income Program,
provided medical | ||||||
18 | service for such persons would be eligible for Federal
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19 | Financial Participation, and provided the Illinois | ||||||
20 | Department determines that:
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21 | (a) the person requires a level of care provided by | ||||||
22 | a hospital, skilled
nursing facility, or intermediate | ||||||
23 | care facility, as determined by a physician
licensed to | ||||||
24 | practice medicine in all its branches;
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25 | (b) it is appropriate to provide such care outside | ||||||
26 | of an institution, as
determined by a physician |
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1 | licensed to practice medicine in all its branches;
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2 | (c) the estimated amount which would be expended | ||||||
3 | for care outside the
institution is not greater than | ||||||
4 | the estimated amount which would be
expended in an | ||||||
5 | institution.
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6 | 8. Persons who become ineligible for basic maintenance | ||||||
7 | assistance
under Article IV of this Code in programs | ||||||
8 | administered by the Illinois
Department due to employment | ||||||
9 | earnings and persons in
assistance units comprised of | ||||||
10 | adults and children who become ineligible for
basic | ||||||
11 | maintenance assistance under Article VI of this Code due to
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12 | employment earnings. The plan for coverage for this class | ||||||
13 | of persons shall:
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14 | (a) extend the medical assistance coverage for up | ||||||
15 | to 12 months following
termination of basic | ||||||
16 | maintenance assistance; and
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17 | (b) offer persons who have initially received 6 | ||||||
18 | months of the
coverage provided in paragraph (a) above, | ||||||
19 | the option of receiving an
additional 6 months of | ||||||
20 | coverage, subject to the following:
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21 | (i) such coverage shall be pursuant to | ||||||
22 | provisions of the federal
Social Security Act;
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23 | (ii) such coverage shall include all services | ||||||
24 | covered while the person
was eligible for basic | ||||||
25 | maintenance assistance;
| ||||||
26 | (iii) no premium shall be charged for such |
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1 | coverage; and
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2 | (iv) such coverage shall be suspended in the | ||||||
3 | event of a person's
failure without good cause to | ||||||
4 | file in a timely fashion reports required for
this | ||||||
5 | coverage under the Social Security Act and | ||||||
6 | coverage shall be reinstated
upon the filing of | ||||||
7 | such reports if the person remains otherwise | ||||||
8 | eligible.
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9 | 9. Persons with acquired immunodeficiency syndrome | ||||||
10 | (AIDS) or with
AIDS-related conditions with respect to whom | ||||||
11 | there has been a determination
that but for home or | ||||||
12 | community-based services such individuals would
require | ||||||
13 | the level of care provided in an inpatient hospital, | ||||||
14 | skilled
nursing facility or intermediate care facility the | ||||||
15 | cost of which is
reimbursed under this Article. Assistance | ||||||
16 | shall be provided to such
persons to the maximum extent | ||||||
17 | permitted under Title
XIX of the Federal Social Security | ||||||
18 | Act.
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19 | 10. Participants in the long-term care insurance | ||||||
20 | partnership program
established under the Illinois | ||||||
21 | Long-Term Care Partnership Program Act who meet the
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22 | qualifications for protection of resources described in | ||||||
23 | Section 15 of that
Act.
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24 | 11. Persons with disabilities who are employed and | ||||||
25 | eligible for Medicaid,
pursuant to Section | ||||||
26 | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, |
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1 | subject to federal approval, persons with a medically | ||||||
2 | improved disability who are employed and eligible for | ||||||
3 | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | ||||||
4 | the Social Security Act, as
provided by the Illinois | ||||||
5 | Department by rule. In establishing eligibility standards | ||||||
6 | under this paragraph 11, the Department shall, subject to | ||||||
7 | federal approval: | ||||||
8 | (a) set the income eligibility standard at not | ||||||
9 | lower than 350% of the federal poverty level; | ||||||
10 | (b) exempt retirement accounts that the person | ||||||
11 | cannot access without penalty before the age
of 59 1/2, | ||||||
12 | and medical savings accounts established pursuant to | ||||||
13 | 26 U.S.C. 220; | ||||||
14 | (c) allow non-exempt assets up to $25,000 as to | ||||||
15 | those assets accumulated during periods of eligibility | ||||||
16 | under this paragraph 11; and
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17 | (d) continue to apply subparagraphs (b) and (c) in | ||||||
18 | determining the eligibility of the person under this | ||||||
19 | Article even if the person loses eligibility under this | ||||||
20 | paragraph 11.
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21 | 12. Subject to federal approval, persons who are | ||||||
22 | eligible for medical
assistance coverage under applicable | ||||||
23 | provisions of the federal Social Security
Act and the | ||||||
24 | federal Breast and Cervical Cancer Prevention and | ||||||
25 | Treatment Act of
2000. Those eligible persons are defined | ||||||
26 | to include, but not be limited to,
the following persons:
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1 | (1) persons who have been screened for breast or | ||||||
2 | cervical cancer under
the U.S. Centers for Disease | ||||||
3 | Control and Prevention Breast and Cervical Cancer
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4 | Program established under Title XV of the federal | ||||||
5 | Public Health Services Act in
accordance with the | ||||||
6 | requirements of Section 1504 of that Act as | ||||||
7 | administered by
the Illinois Department of Public | ||||||
8 | Health; and
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9 | (2) persons whose screenings under the above | ||||||
10 | program were funded in whole
or in part by funds | ||||||
11 | appropriated to the Illinois Department of Public | ||||||
12 | Health
for breast or cervical cancer screening.
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13 | "Medical assistance" under this paragraph 12 shall be | ||||||
14 | identical to the benefits
provided under the State's | ||||||
15 | approved plan under Title XIX of the Social Security
Act. | ||||||
16 | The Department must request federal approval of the | ||||||
17 | coverage under this
paragraph 12 within 30 days after the | ||||||
18 | effective date of this amendatory Act of
the 92nd General | ||||||
19 | Assembly.
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20 | In addition to the persons who are eligible for medical | ||||||
21 | assistance pursuant to subparagraphs (1) and (2) of this | ||||||
22 | paragraph 12, and to be paid from funds appropriated to the | ||||||
23 | Department for its medical programs, any uninsured person | ||||||
24 | as defined by the Department in rules residing in Illinois | ||||||
25 | who is younger than 65 years of age, who has been screened | ||||||
26 | for breast and cervical cancer in accordance with standards |
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1 | and procedures adopted by the Department of Public Health | ||||||
2 | for screening, and who is referred to the Department by the | ||||||
3 | Department of Public Health as being in need of treatment | ||||||
4 | for breast or cervical cancer is eligible for medical | ||||||
5 | assistance benefits that are consistent with the benefits | ||||||
6 | provided to those persons described in subparagraphs (1) | ||||||
7 | and (2). Medical assistance coverage for the persons who | ||||||
8 | are eligible under the preceding sentence is not dependent | ||||||
9 | on federal approval, but federal moneys may be used to pay | ||||||
10 | for services provided under that coverage upon federal | ||||||
11 | approval. | ||||||
12 | 13. Subject to appropriation and to federal approval, | ||||||
13 | persons living with HIV/AIDS who are not otherwise eligible | ||||||
14 | under this Article and who qualify for services covered | ||||||
15 | under Section 5-5.04 as provided by the Illinois Department | ||||||
16 | by rule.
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17 | 14. Subject to the availability of funds for this | ||||||
18 | purpose, the Department may provide coverage under this | ||||||
19 | Article to persons who reside in Illinois who are not | ||||||
20 | eligible under any of the preceding paragraphs and who meet | ||||||
21 | the income guidelines of paragraph 2(a) of this Section and | ||||||
22 | (i) have an application for asylum pending before the | ||||||
23 | federal Department of Homeland Security or on appeal before | ||||||
24 | a court of competent jurisdiction and are represented | ||||||
25 | either by counsel or by an advocate accredited by the | ||||||
26 | federal Department of Homeland Security and employed by a |
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1 | not-for-profit organization in regard to that application | ||||||
2 | or appeal, or (ii) are receiving services through a | ||||||
3 | federally funded torture treatment center. Medical | ||||||
4 | coverage under this paragraph 14 may be provided for up to | ||||||
5 | 24 continuous months from the initial eligibility date so | ||||||
6 | long as an individual continues to satisfy the criteria of | ||||||
7 | this paragraph 14. If an individual has an appeal pending | ||||||
8 | regarding an application for asylum before the Department | ||||||
9 | of Homeland Security, eligibility under this paragraph 14 | ||||||
10 | may be extended until a final decision is rendered on the | ||||||
11 | appeal. The Department may adopt rules governing the | ||||||
12 | implementation of this paragraph 14.
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13 | 15. Family Care Eligibility. | ||||||
14 | (a) Through December 31, 2013, a caretaker | ||||||
15 | relative who is 19 years of age or older when countable | ||||||
16 | income is at or below 185% of the Federal Poverty Level | ||||||
17 | Guidelines, as published annually in the Federal | ||||||
18 | Register, for the appropriate family size. Beginning | ||||||
19 | January 1, 2014, a caretaker relative who is 19 years | ||||||
20 | of age or older when countable income is at or below | ||||||
21 | 133% of the Federal Poverty Level Guidelines, as | ||||||
22 | published annually in the Federal Register, for the | ||||||
23 | appropriate family size. A person may not spend down to | ||||||
24 | become eligible under this paragraph 15. | ||||||
25 | (b) Eligibility shall be reviewed annually. | ||||||
26 | (c) Caretaker relatives enrolled under this |
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1 | paragraph 15 in families with countable income above | ||||||
2 | 150% and at or below 185% of the Federal Poverty Level | ||||||
3 | Guidelines shall be counted as family members and pay | ||||||
4 | premiums as established under the Children's Health | ||||||
5 | Insurance Program Act. | ||||||
6 | (d) Premiums shall be billed by and payable to the | ||||||
7 | Department or its authorized agent, on a monthly basis. | ||||||
8 | (e) The premium due date is the last day of the | ||||||
9 | month preceding the month of coverage. | ||||||
10 | (f) Individuals shall have a grace period through | ||||||
11 | 60 days of coverage to pay the premium. | ||||||
12 | (g) Failure to pay the full monthly premium by the | ||||||
13 | last day of the grace period shall result in | ||||||
14 | termination of coverage. | ||||||
15 | (h) Partial premium payments shall not be | ||||||
16 | refunded. | ||||||
17 | (i) 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) The first month's premium must be paid if | ||||||
4 | there was an unpaid premium on the date the | ||||||
5 | individual's previous coverage was canceled. | ||||||
6 | The Department is authorized to implement the | ||||||
7 | provisions of this amendatory Act of the 95th General | ||||||
8 | Assembly by adopting the medical assistance rules in effect | ||||||
9 | as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | ||||||
10 | 89 Ill. Admin. Code 120.32 along with only those changes | ||||||
11 | necessary to conform to federal Medicaid requirements, | ||||||
12 | federal laws, and federal regulations, including but not | ||||||
13 | limited to Section 1931 of the Social Security Act (42 | ||||||
14 | U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | ||||||
15 | of Health and Human Services, and the countable income | ||||||
16 | eligibility standard authorized by this paragraph 15. The | ||||||
17 | Department may not otherwise adopt any rule to implement | ||||||
18 | this increase except as authorized by law, to meet the | ||||||
19 | eligibility standards authorized by the federal government | ||||||
20 | in the Medicaid State Plan or the Title XXI Plan, or to | ||||||
21 | meet an order from the federal government or any court. | ||||||
22 | 16. Subject to appropriation, uninsured persons who | ||||||
23 | are not otherwise eligible under this Section who have been | ||||||
24 | certified and referred by the Department of Public Health | ||||||
25 | as having been screened and found to need diagnostic | ||||||
26 | evaluation or treatment, or both diagnostic evaluation and |
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1 | treatment, for prostate or testicular cancer. For the | ||||||
2 | purposes of this paragraph 16, uninsured persons are those | ||||||
3 | who do not have creditable coverage, as defined under the | ||||||
4 | Health Insurance Portability and Accountability Act, or | ||||||
5 | have otherwise exhausted any insurance benefits they may | ||||||
6 | have had, for prostate or testicular cancer diagnostic | ||||||
7 | evaluation or treatment, or both diagnostic evaluation and | ||||||
8 | treatment.
To be eligible, a person must furnish a Social | ||||||
9 | Security number.
A person's assets are exempt from | ||||||
10 | consideration in determining eligibility under this | ||||||
11 | paragraph 16.
Such persons shall be eligible for medical | ||||||
12 | assistance under this paragraph 16 for so long as they need | ||||||
13 | treatment for the cancer. A person shall be considered to | ||||||
14 | need treatment if, in the opinion of the person's treating | ||||||
15 | physician, the person requires therapy directed toward | ||||||
16 | cure or palliation of prostate or testicular cancer, | ||||||
17 | including recurrent metastatic cancer that is a known or | ||||||
18 | presumed complication of prostate or testicular cancer and | ||||||
19 | complications resulting from the treatment modalities | ||||||
20 | themselves. Persons who require only routine monitoring | ||||||
21 | services are not considered to need treatment.
"Medical | ||||||
22 | assistance" under this paragraph 16 shall be identical to | ||||||
23 | the benefits provided under the State's approved plan under | ||||||
24 | Title XIX of the Social Security Act.
Notwithstanding any | ||||||
25 | other provision of law, the Department (i) does not have a | ||||||
26 | claim against the estate of a deceased recipient of |
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| |||||||
1 | services under this paragraph 16 and (ii) does not have a | ||||||
2 | lien against any homestead property or other legal or | ||||||
3 | equitable real property interest owned by a recipient of | ||||||
4 | services under this paragraph 16. | ||||||
5 | 17. Persons who, pursuant to a waiver approved by the | ||||||
6 | Secretary of the U.S. Department of Health and Human | ||||||
7 | Services, are eligible for medical assistance under Title | ||||||
8 | XIX or XXI of the federal Social Security Act. | ||||||
9 | Notwithstanding any other provision of this Code and | ||||||
10 | consistent with the terms of the approved waiver, the | ||||||
11 | Illinois Department, may by rule: | ||||||
12 | (a) Limit the geographic areas in which the waiver | ||||||
13 | program operates. | ||||||
14 | (b) Determine the scope, quantity, duration, and | ||||||
15 | quality, and the rate and method of reimbursement, of | ||||||
16 | the medical services to be provided, which may differ | ||||||
17 | from those for other classes of persons eligible for | ||||||
18 | assistance under this Article. | ||||||
19 | (c) Restrict the persons' freedom in choice of | ||||||
20 | providers. | ||||||
21 | In implementing the provisions of Public Act 96-20, the | ||||||
22 | Department is authorized to adopt only those rules necessary, | ||||||
23 | including emergency rules. Nothing in Public Act 96-20 permits | ||||||
24 | the Department to adopt rules or issue a decision that expands | ||||||
25 | eligibility for the FamilyCare Program to a person whose income | ||||||
26 | exceeds 185% of the Federal Poverty Level as determined from |
| |||||||
| |||||||
1 | time to time by the U.S. Department of Health and Human | ||||||
2 | Services, unless the Department is provided with express | ||||||
3 | statutory authority. | ||||||
4 | The Illinois Department and the Governor shall provide a | ||||||
5 | plan for
coverage of the persons eligible under paragraph 7 as | ||||||
6 | soon as possible after
July 1, 1984.
| ||||||
7 | The eligibility of any such person for medical assistance | ||||||
8 | under this
Article is not affected by the payment of any grant | ||||||
9 | under the Senior
Citizens and Disabled Persons Property Tax | ||||||
10 | Relief and Pharmaceutical
Assistance Act or any distributions | ||||||
11 | or items of income described under
subparagraph (X) of
| ||||||
12 | paragraph (2) of subsection (a) of Section 203 of the Illinois | ||||||
13 | Income Tax
Act. The Department shall by rule establish the | ||||||
14 | amounts of
assets to be disregarded in determining eligibility | ||||||
15 | for medical assistance,
which shall at a minimum equal the | ||||||
16 | amounts to be disregarded under the
Federal Supplemental | ||||||
17 | Security Income Program. The amount of assets of a
single | ||||||
18 | person to be disregarded
shall not be less than $2,000, and the | ||||||
19 | amount of assets of a married couple
to be disregarded shall | ||||||
20 | not be less than $3,000.
| ||||||
21 | To the extent permitted under federal law, any person found | ||||||
22 | guilty of a
second violation of Article VIIIA
shall be | ||||||
23 | ineligible for medical assistance under this Article, as | ||||||
24 | provided
in Section 8A-8.
| ||||||
25 | The eligibility of any person for medical assistance under | ||||||
26 | this Article
shall not be affected by the receipt by the person |
| |||||||
| |||||||
1 | of donations or benefits
from fundraisers held for the person | ||||||
2 | in cases of serious illness,
as long as neither the person nor | ||||||
3 | members of the person's family
have actual control over the | ||||||
4 | donations or benefits or the disbursement
of the donations or | ||||||
5 | benefits.
| ||||||
6 | Notwithstanding any other provision of this Code, if the | ||||||
7 | United States Supreme Court holds Title II, Subtitle A, Section | ||||||
8 | 2001(a) of Public Law 111-148 to be unconstitutional, or if a | ||||||
9 | holding of Public Law 111-148 makes Medicaid eligibility | ||||||
10 | allowed under Section 2001(a) inoperable, the State or a unit | ||||||
11 | of local government shall be prohibited from enrolling | ||||||
12 | individuals in the Medical Assistance Program as the result of | ||||||
13 | federal approval of a State Medicaid waiver on or after the | ||||||
14 | effective date of this amendatory Act of the 97th General | ||||||
15 | Assembly, and any individuals enrolled in the Medical | ||||||
16 | Assistance Program pursuant to eligibility permitted as a | ||||||
17 | result of such a State Medicaid waiver shall become immediately | ||||||
18 | ineligible. | ||||||
19 | Notwithstanding any other provision of this Code, if an Act | ||||||
20 | of Congress that becomes a Public Law eliminates Section | ||||||
21 | 2001(a) of Public Law 111-148, the State or a unit of local | ||||||
22 | government shall be prohibited from enrolling individuals in | ||||||
23 | the Medical Assistance Program as the result of federal | ||||||
24 | approval of a State Medicaid waiver on or after the effective | ||||||
25 | date of this amendatory Act of the 97th General Assembly, and | ||||||
26 | any individuals enrolled in the Medical Assistance Program |
| |||||||
| |||||||
1 | pursuant to eligibility permitted as a result of such a State | ||||||
2 | Medicaid waiver shall become immediately ineligible. | ||||||
3 | (Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; | ||||||
4 | 96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. | ||||||
5 | 7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, | ||||||
6 | eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; | ||||||
7 | revised 10-4-11.)
| ||||||
8 | (305 ILCS 5/5-2.03) | ||||||
9 | Sec. 5-2.03. Presumptive eligibility. Beginning on the | ||||||
10 | effective date of this amendatory Act of the 96th General | ||||||
11 | Assembly and except where federal law requires presumptive | ||||||
12 | eligibility, no adult may be presumed eligible for medical | ||||||
13 | assistance under this Code and the Department may not cover any | ||||||
14 | service rendered to an adult unless the adult has completed an | ||||||
15 | application for benefits, all required verifications have been | ||||||
16 | received, and the Department or its designee has found the | ||||||
17 | adult eligible for the date on which that service was provided. | ||||||
18 | Nothing in this Section shall apply to pregnant women or to | ||||||
19 | persons enrolled under the medical assistance program due to | ||||||
20 | expansions approved by the federal government that are financed | ||||||
21 | entirely by units of local government and federal matching | ||||||
22 | funds .
| ||||||
23 | (Source: P.A. 96-1501, eff. 1-25-11.)
| ||||||
24 | (305 ILCS 5/15-1) (from Ch. 23, par. 15-1)
|
| |||||||
| |||||||
1 | Sec. 15-1. Definitions. As used in this Article, unless the | ||||||
2 | context
requires otherwise:
| ||||||
3 | (a) (Blank). "Base amount" means $108,800,000 multiplied | ||||||
4 | by a
fraction, the numerator of which is the number of days | ||||||
5 | represented by the
payments in question and the denominator of | ||||||
6 | which is 365.
| ||||||
7 | (a-5) "County provider" means a health care provider that | ||||||
8 | is, or is
operated by, a county with a population greater than | ||||||
9 | 3,000,000.
| ||||||
10 | (b) "Fund" means the County Provider Trust Fund.
| ||||||
11 | (c) "Hospital" or "County hospital" means a hospital, as | ||||||
12 | defined in Section
14-1 of this Code, which is a county | ||||||
13 | hospital located in a county of over
3,000,000 population.
| ||||||
14 | (Source: P.A. 87-13; 88-85; 88-554, eff. 7-26-94.)
| ||||||
15 | (305 ILCS 5/15-2) (from Ch. 23, par. 15-2)
| ||||||
16 | Sec. 15-2. County Provider Trust Fund.
| ||||||
17 | (a) There is created in the State Treasury the County | ||||||
18 | Provider
Trust Fund. Interest earned by the Fund shall be | ||||||
19 | credited to the Fund.
The Fund shall not be used to replace any | ||||||
20 | funds appropriated to the
Medicaid program by the General | ||||||
21 | Assembly.
| ||||||
22 | (b) The Fund is created solely for the purposes of | ||||||
23 | receiving, investing,
and distributing monies in accordance | ||||||
24 | with this Article XV. The Fund shall
consist of:
| ||||||
25 | (1) All monies collected or received by the Illinois |
| |||||||
| |||||||
1 | Department under
Section 15-3 of this Code;
| ||||||
2 | (2) All federal financial participation monies | ||||||
3 | received by the Illinois
Department pursuant to Title XIX | ||||||
4 | of the Social Security Act, 42 U.S.C.
1396b, attributable | ||||||
5 | to eligible expenditures made by the Illinois Department
| ||||||
6 | pursuant to Section 15-5 of this Code;
| ||||||
7 | (3) All federal moneys received by the
Illinois | ||||||
8 | Department pursuant to Title XXI of the Social Security Act
| ||||||
9 | attributable to eligible expenditures made by the Illinois | ||||||
10 | Department
pursuant to Section 15-5 of this Code; and
| ||||||
11 | (4) All other monies received by the Fund from any | ||||||
12 | source, including
interest thereon.
| ||||||
13 | (c) Disbursements from the Fund shall be by warrants drawn | ||||||
14 | by the State
Comptroller upon receipt of vouchers duly executed | ||||||
15 | and certified by the
Illinois Department and shall be made | ||||||
16 | only:
| ||||||
17 | (1) For hospital inpatient care, hospital outpatient | ||||||
18 | care, care
provided by other outpatient facilities | ||||||
19 | operated by a county, and
disproportionate share hospital | ||||||
20 | adjustment payments made under Title XIX of the Social
| ||||||
21 | Security Act and Article V of this Code as required by | ||||||
22 | Section 15-5 of this
Code;
| ||||||
23 | (1.5) For services provided or purchased by county | ||||||
24 | providers pursuant to Section
5-11 of this Code;
| ||||||
25 | (2) For the reimbursement of administrative expenses | ||||||
26 | incurred by county
providers on behalf of the Illinois |
| |||||||
| |||||||
1 | Department as permitted by Section 15-4 of
this Code;
| ||||||
2 | (3) For the reimbursement of monies received by the | ||||||
3 | Fund through
error or mistake;
| ||||||
4 | (4) For the payment of administrative expenses | ||||||
5 | necessarily incurred by the
Illinois Department or its | ||||||
6 | agent in performing the activities required by this
Article | ||||||
7 | XV;
| ||||||
8 | (5) For the payment of any amounts that are | ||||||
9 | reimbursable to the federal
government, attributable | ||||||
10 | solely to the Fund, and required to be paid by State
| ||||||
11 | warrant; and
| ||||||
12 | (6) For hospital inpatient care, hospital outpatient | ||||||
13 | care, care provided
by other outpatient facilities | ||||||
14 | operated by a county, and disproportionate
share hospital | ||||||
15 | adjustment payments made under Title XXI of the Social | ||||||
16 | Security Act,
pursuant to Section 15-5 of this Code ; and .
| ||||||
17 | (7) For medical care and related services provided | ||||||
18 | pursuant to a contract with a county. | ||||||
19 | (Source: P.A. 95-859, eff. 8-19-08.)
| ||||||
20 | (305 ILCS 5/15-5) (from Ch. 23, par. 15-5)
| ||||||
21 | Sec. 15-5. Disbursements from the Fund.
| ||||||
22 | (a) The monies in the Fund shall be disbursed only as | ||||||
23 | provided in
Section 15-2 of this Code and as follows:
| ||||||
24 | (1) To the extent that such costs are reimbursable | ||||||
25 | under federal law, to pay the county hospitals' inpatient |
| |||||||
| |||||||
1 | reimbursement rates based on
actual costs incurred, | ||||||
2 | trended forward annually by an inflation index.
| ||||||
3 | (2) To the extent that such costs are reimbursable | ||||||
4 | under federal law, to pay county hospitals and county | ||||||
5 | operated outpatient
facilities for outpatient services | ||||||
6 | based on a federally approved
methodology to cover the | ||||||
7 | maximum allowable costs.
| ||||||
8 | (3) To pay the county hospitals disproportionate share | ||||||
9 | hospital adjustment payments as may be specified in the | ||||||
10 | Illinois Title XIX State plan.
| ||||||
11 | (3.5) To pay county providers for services provided or | ||||||
12 | purchased pursuant to Section
5-11 of this Code.
| ||||||
13 | (4) To reimburse the county providers for expenses
| ||||||
14 | contractually
assumed pursuant to Section 15-4 of this | ||||||
15 | Code.
| ||||||
16 | (5) To pay the Illinois Department its necessary | ||||||
17 | administrative
expenses relative to the Fund and other | ||||||
18 | amounts agreed to, if any, by the
county providers in the | ||||||
19 | agreement provided for in subsection
(c).
| ||||||
20 | (6) To pay the county providers any other amount due | ||||||
21 | according to a federally approved State plan, including
but | ||||||
22 | not limited to payments made under the provisions of | ||||||
23 | Section
701(d)(3)(B) of the federal Medicare, Medicaid, | ||||||
24 | and SCHIP Benefits Improvement
and Protection Act of
2000. | ||||||
25 | Intergovernmental transfers supporting payments under this | ||||||
26 | paragraph
(6) shall not be subject to the
computation |
| |||||||
| |||||||
1 | described in subsection (a) of Section 15-3 of this Code, | ||||||
2 | but
shall be computed as the difference between
the total | ||||||
3 | of such payments made by the Illinois Department to county
| ||||||
4 | providers less any amount of federal
financial | ||||||
5 | participation due the Illinois Department under Titles XIX | ||||||
6 | and XXI
of the Social Security Act as a
result of such | ||||||
7 | payments to county providers.
| ||||||
8 | (b) The Illinois Department shall promptly seek all | ||||||
9 | appropriate
amendments to the Illinois Title XIX State Plan to | ||||||
10 | maximize reimbursement, including disproportionate share | ||||||
11 | hospital adjustment payments, to the county providers.
| ||||||
12 | (c) (Blank).
| ||||||
13 | (d) The payments provided for herein are intended to cover | ||||||
14 | services
rendered on and after July 1, 1991, and any agreement | ||||||
15 | executed between a
qualifying county and the Illinois | ||||||
16 | Department pursuant to this Section may
relate back to that | ||||||
17 | date, provided the Illinois Department obtains federal
| ||||||
18 | approval. Any changes in payment rates resulting from the | ||||||
19 | provisions of
Article 3 of this amendatory Act of 1992 are | ||||||
20 | intended to apply to services
rendered on or after October 1, | ||||||
21 | 1992, and any agreement executed between a
qualifying county | ||||||
22 | and the Illinois Department pursuant to this Section may
be | ||||||
23 | effective as of that date.
| ||||||
24 | (e) If one or more hospitals file suit in any court | ||||||
25 | challenging any part
of this Article XV, payments to hospitals | ||||||
26 | from the Fund under this Article
XV shall be made only to the |
| |||||||
| |||||||
1 | extent that sufficient monies are available in
the Fund and | ||||||
2 | only to the extent that any monies in the Fund are not
| ||||||
3 | prohibited from disbursement and may be disbursed under any | ||||||
4 | order of the court.
| ||||||
5 | (f) All payments under this Section are contingent upon | ||||||
6 | federal
approval of changes to the Title XIX State plan, if | ||||||
7 | that approval is required.
| ||||||
8 | (Source: P.A. 95-859, eff. 8-19-08.)
| ||||||
9 | (305 ILCS 5/15-11) | ||||||
10 | Sec. 15-11. Uses of State funds. | ||||||
11 | (a) At any point, if State revenues referenced in | ||||||
12 | subsection (b) or (c) of Section 15-10 or additional State | ||||||
13 | grants are disbursed to the Cook County Health and Hospitals | ||||||
14 | System, all funds may be used only for the following: | ||||||
15 | (1) medical services provided at hospitals or clinics | ||||||
16 | owned and operated by the Cook County Health and Hospitals | ||||||
17 | System Bureau of Health Services ; or | ||||||
18 | (2) information technology to enhance billing | ||||||
19 | capabilities for medical claiming and reimbursement ; or . | ||||||
20 | (3) services purchased by county providers pursuant to | ||||||
21 | Section 5-11 of this Code. | ||||||
22 | (b) State funds may not be used for the following: | ||||||
23 | (1) non-clinical services, except services that may be | ||||||
24 | required by accreditation bodies or State or federal | ||||||
25 | regulatory or licensing authorities; |
| |||||||
| |||||||
1 | (2) non-clinical support staff, except as pursuant to | ||||||
2 | paragraph (1) of this subsection; or | ||||||
3 | (3) capital improvements, other than investments in | ||||||
4 | medical technology, except for capital improvements that | ||||||
5 | may be required by accreditation bodies or State or federal | ||||||
6 | regulatory or licensing authorities.
| ||||||
7 | (Source: P.A. 95-859, eff. 8-19-08.)
| ||||||
8 | Section 99. Effective date. This Act takes effect upon | ||||||
9 | becoming law; however, no part of this Act takes effect until | ||||||
10 | both Senate Bill 2840, AS AMENDED, of the 97th
General Assembly | ||||||
11 | and Senate Bill 3397, AS AMENDED, of the 97th
General Assembly | ||||||
12 | have become law.
|