HB4343 EngrossedLRB102 22609 KTG 31752 b

1    AN ACT concerning public aid.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.1 and by adding Sections 5-1.6, 5-13.1
6and 11-5.5 as follows:
7    (305 ILCS 5/5-1.6 new)
8    Sec. 5-1.6. Continuous eligibility; ex parte
10    (a) By July 1, 2022, the Department of Healthcare and
11Family Services shall seek a State Plan amendment or any
12federal waivers necessary to make changes to the medical
13assistance program. The Department shall apply for federal
14approval to implement 12 months of continuous eligibility for
15adults participating in the medical assistance program. The
16Department shall secure federal financial participation in
17accordance with this Section for expenditures made by the
18Department in State Fiscal Year 2023 and every State fiscal
19year thereafter.
20    (b) By July 1, 2022, the Department of Healthcare and
21Family Services shall seek a State Plan amendment or any
22federal waivers or approvals necessary to make changes to the
23medical assistance redetermination process for people without



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1any income at the time of redetermination. These changes shall
2seek to allow all people without income to be considered for ex
3parte redetermination. If there is no non-income related
4disqualifying information for medical assistance recipients
5without any income, then a person without any income shall be
6redetermined ex parte. Within 60 days after receiving federal
7approval or guidance, the Department of Healthcare and Family
8Services and the Department of Human Services shall make
9necessary technical and rule changes to implement changes to
10the redetermination process. The percentage of medical
11assistance recipients whose eligibility is renewed through the
12ex parte redetermination process shall be reported monthly by
13the Department of Healthcare and Family Services on its
14website in accordance with subsection (d) of Section 11-5.1 of
15this Code as well as shared in all Medicaid Advisory Committee
16meetings and Medicaid Advisory Committee Public Education
17Subcommittee meetings.
18    (305 ILCS 5/5-13.1 new)
19    Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers,
20and making information about waivers more accessible.
21    (a) It is the intent of the General Assembly to ease the
22burden of liens and estate recovery for correctly paid
23benefits for participants, applicants, and their families and
24heirs, and to make information about waivers more widely



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1    (b) The Department shall waive estate recovery under
2Sections 3-9 and 5-13 where recovery would not be
3cost-effective, would work an undue hardship, or for any other
4just reason, and shall make information about waivers and
5estate recovery easily accessible.
6        (1) Cost-effectiveness waiver. Subject to federal
7    approval, the Department shall waive any claim against the
8    first $25,000 of any estate to prevent substantial and
9    unreasonable hardship. The Department shall consider the
10    gross assets in the estate, including, but not limited to,
11    the net value of real estate less mortgages or liens with
12    priority over the Department's claims. The Department may
13    increase the cost-effectiveness threshold in the future.
14        (2) Undue hardship waiver. The Department may develop
15    additional hardship waiver standards in addition to those
16    already employed, including, but not limited to, waivers
17    aimed at preserving income-producing real property or a
18    modest home as defined by rule.
19        (3) Accessible information. The Department shall make
20    information about estate recovery and hardship waivers
21    easily accessible. The Department shall maintain
22    information about how to request a hardship waiver on its
23    website in English, Spanish, and the next 4 most commonly
24    used languages, including a short guide and simple form to
25    facilitate requesting hardship exemptions in each
26    language. On an annual basis, the Department shall



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1    publicly report on the number of estate recovery cases
2    that are pursued and the number of undue hardship
3    exemptions granted, including demographic data of the
4    deceased beneficiaries where available.
5    (305 ILCS 5/11-5.1)
6    Sec. 11-5.1. Eligibility verification. Notwithstanding any
7other provision of this Code, with respect to applications for
8medical assistance provided under Article V of this Code,
9eligibility shall be determined in a manner that ensures
10program integrity and complies with federal laws and
11regulations while minimizing unnecessary barriers to
12enrollment. To this end, as soon as practicable, and unless
13the Department receives written denial from the federal
14government, this Section shall be implemented:
15    (a) The Department of Healthcare and Family Services or
16its designees shall:
17        (1) By no later than July 1, 2011, require
18    verification of, at a minimum, one month's income from all
19    sources required for determining the eligibility of
20    applicants for medical assistance under this Code. Such
21    verification shall take the form of pay stubs, business or
22    income and expense records for self-employed persons,
23    letters from employers, and any other valid documentation
24    of income including data obtained electronically by the
25    Department or its designees from other sources as



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1    described in subsection (b) of this Section. A month's
2    income may be verified by a single pay stub with the
3    monthly income extrapolated from the time period covered
4    by the pay stub.
5        (2) By no later than October 1, 2011, require
6    verification of, at a minimum, one month's income from all
7    sources required for determining the continued eligibility
8    of recipients at their annual review of eligibility for
9    medical assistance under this Code. Information the
10    Department receives prior to the annual review, including
11    information available to the Department as a result of the
12    recipient's application for other non-Medicaid benefits,
13    that is sufficient to make a determination of continued
14    Medicaid eligibility may be reviewed and verified, and
15    subsequent action taken including client notification of
16    continued Medicaid eligibility. The date of client
17    notification establishes the date for subsequent annual
18    Medicaid eligibility reviews. Such verification shall take
19    the form of pay stubs, business or income and expense
20    records for self-employed persons, letters from employers,
21    and any other valid documentation of income including data
22    obtained electronically by the Department or its designees
23    from other sources as described in subsection (b) of this
24    Section. A month's income may be verified by a single pay
25    stub with the monthly income extrapolated from the time
26    period covered by the pay stub. The Department shall send



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1    a notice to recipients at least 60 days prior to the end of
2    their period of eligibility that informs them of the
3    requirements for continued eligibility. If a recipient
4    does not fulfill the requirements for continued
5    eligibility by the deadline established in the notice a
6    notice of cancellation shall be issued to the recipient
7    and coverage shall end no later than the last day of the
8    month following the last day of the eligibility period. A
9    recipient's eligibility may be reinstated without
10    requiring a new application if the recipient fulfills the
11    requirements for continued eligibility prior to the end of
12    the third month following the last date of coverage (or
13    longer period if required by federal regulations). Nothing
14    in this Section shall prevent an individual whose coverage
15    has been cancelled from reapplying for health benefits at
16    any time.
17        (3) By no later than July 1, 2011, require
18    verification of Illinois residency.
19    The Department, with federal approval, may choose to adopt
20continuous financial eligibility for a full 12 months for
21adults on Medicaid.
22    (b) The Department shall establish or continue cooperative
23arrangements with the Social Security Administration, the
24Illinois Secretary of State, the Department of Human Services,
25the Department of Revenue, the Department of Employment
26Security, and any other appropriate entity to gain electronic



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1access, to the extent allowed by law, to information available
2to those entities that may be appropriate for electronically
3verifying any factor of eligibility for benefits under the
4Program. Data relevant to eligibility shall be provided for no
5other purpose than to verify the eligibility of new applicants
6or current recipients of health benefits under the Program.
7Data shall be requested or provided for any new applicant or
8current recipient only insofar as that individual's
9circumstances are relevant to that individual's or another
10individual's eligibility.
11    (c) Within 90 days of the effective date of this
12amendatory Act of the 96th General Assembly, the Department of
13Healthcare and Family Services shall send notice to current
14recipients informing them of the changes regarding their
15eligibility verification.
16    (d) As soon as practical if the data is reasonably
17available, but no later than January 1, 2017, the Department
18shall compile on a monthly basis data on eligibility
19redeterminations of beneficiaries of medical assistance
20provided under Article V of this Code. In addition to the other
21data required under this subsection, the Department shall
22compile on a monthly basis data on the percentage of
23beneficiaries whose eligibility is renewed through ex parte
24redeterminations as described in subsection (b) of Section
255-1.6 of this Code, subject to federal approval of the changes
26made in subsection (b) of Section 5-1.6 by this amendatory Act



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1of the 102nd General Assembly. This data shall be posted on the
2Department's website, and data from prior months shall be
3retained and available on the Department's website. The data
4compiled and reported shall include the following:
5        (1) The total number of redetermination decisions made
6    in a month and, of that total number, the number of
7    decisions to continue or change benefits and the number of
8    decisions to cancel benefits.
9        (2) A breakdown of enrollee language preference for
10    the total number of redetermination decisions made in a
11    month and, of that total number, a breakdown of enrollee
12    language preference for the number of decisions to
13    continue or change benefits, and a breakdown of enrollee
14    language preference for the number of decisions to cancel
15    benefits. The language breakdown shall include, at a
16    minimum, English, Spanish, and the next 4 most commonly
17    used languages.
18        (3) The percentage of cancellation decisions made in a
19    month due to each of the following:
20            (A) The beneficiary's ineligibility due to excess
21        income.
22            (B) The beneficiary's ineligibility due to not
23        being an Illinois resident.
24            (C) The beneficiary's ineligibility due to being
25        deceased.
26            (D) The beneficiary's request to cancel benefits.



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1            (E) The beneficiary's lack of response after
2        notices mailed to the beneficiary are returned to the
3        Department as undeliverable by the United States
4        Postal Service.
5            (F) The beneficiary's lack of response to a
6        request for additional information when reliable
7        information in the beneficiary's account, or other
8        more current information, is unavailable to the
9        Department to make a decision on whether to continue
10        benefits.
11            (G) Other reasons tracked by the Department for
12        the purpose of ensuring program integrity.
13        (4) If a vendor is utilized to provide services in
14    support of the Department's redetermination decision
15    process, the total number of redetermination decisions
16    made in a month and, of that total number, the number of
17    decisions to continue or change benefits, and the number
18    of decisions to cancel benefits (i) with the involvement
19    of the vendor and (ii) without the involvement of the
20    vendor.
21        (5) Of the total number of benefit cancellations in a
22    month, the number of beneficiaries who return from
23    cancellation within one month, the number of beneficiaries
24    who return from cancellation within 2 months, and the
25    number of beneficiaries who return from cancellation
26    within 3 months. Of the number of beneficiaries who return



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1    from cancellation within 3 months, the percentage of those
2    cancellations due to each of the reasons listed under
3    paragraph (3) of this subsection.
4    (e) The Department shall conduct a complete review of the
5Medicaid redetermination process in order to identify changes
6that can increase the use of ex parte redetermination
7processing. This review shall be completed within 90 days
8after the effective date of this amendatory Act of the 101st
9General Assembly. Within 90 days of completion of the review,
10the Department shall seek written federal approval of policy
11changes the review recommended and implement once approved.
12The review shall specifically include, but not be limited to,
13use of ex parte redeterminations of the following populations:
14        (1) Recipients of developmental disabilities services.
15        (2) Recipients of benefits under the State's Aid to
16    the Aged, Blind, or Disabled program.
17        (3) Recipients of Medicaid long-term care services and
18    supports, including waiver services.
19        (4) All Modified Adjusted Gross Income (MAGI)
20    populations.
21        (5) Populations with no verifiable income.
22        (6) Self-employed people.
23    The report shall also outline populations and
24circumstances in which an ex parte redetermination is not a
25recommended option.
26    (f) The Department shall explore and implement, as



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1practical and technologically possible, roles that
2stakeholders outside State agencies can play to assist in
3expediting eligibility determinations and redeterminations
4within 24 months after the effective date of this amendatory
5Act of the 101st General Assembly. Such practical roles to be
6explored to expedite the eligibility determination processes
7shall include the implementation of hospital presumptive
8eligibility, as authorized by the Patient Protection and
9Affordable Care Act.
10    (g) The Department or its designee shall seek federal
11approval to enhance the reasonable compatibility standard from
125% to 10%.
13    (h) Reporting. The Department of Healthcare and Family
14Services and the Department of Human Services shall publish
15quarterly reports on their progress in implementing policies
16and practices pursuant to this Section as modified by this
17amendatory Act of the 101st General Assembly.
18        (1) The reports shall include, but not be limited to,
19    the following:
20            (A) Medical application processing, including a
21        breakdown of the number of MAGI, non-MAGI, long-term
22        care, and other medical cases pending for various
23        incremental time frames between 0 to 181 or more days.
24            (B) Medical redeterminations completed, including:
25        (i) a breakdown of the number of households that were
26        redetermined ex parte and those that were not; (ii)



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1        the reasons households were not redetermined ex parte;
2        and (iii) the relative percentages of these reasons.
3            (C) A narrative discussion on issues identified in
4        the functioning of the State's Integrated Eligibility
5        System and progress on addressing those issues, as
6        well as progress on implementing strategies to address
7        eligibility backlogs, including expanding ex parte
8        determinations to ensure timely eligibility
9        determinations and renewals.
10        (2) Initial reports shall be issued within 90 days
11    after the effective date of this amendatory Act of the
12    101st General Assembly.
13        (3) All reports shall be published on the Department's
14    website.
15    (i) It is the determination of the General Assembly that
16the Department must include seniors and persons with
17disabilities in ex parte renewals. It is the determination of
18the General Assembly that the Department must use its asset
19verification system to assist in the determination of whether
20an individual's coverage can be renewed using the ex parte
21process. If a State Plan amendment is required, the Department
22shall pursue such State Plan amendment by July 1, 2022. Within
2360 days after receiving federal approval or guidance, the
24Department of Healthcare and Family Services and the
25Department of Human Services shall make necessary technical
26and rule changes to implement these changes to the



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1redetermination process.
2(Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20.)
3    (305 ILCS 5/11-5.5 new)
4    Sec. 11-5.5. Streamlining enrollment into the Medicare
5Savings Program.
6    (a) The Department shall investigate how to align the
7Medicare Part D Low-Income Subsidy and Medicare Savings
8Program eligibility criteria.
9    (b) The Department shall issue a report making
10recommendations on how to streamline enrollment into Medicare
11Savings Program benefits by July 1, 2022.
12    (c) Within 90 days after issuing its report, the
13Department shall seek public feedback on those recommendations
14and plans.
15    (d) By July 1, 2023, the Department shall implement the
16necessary changes to streamline enrollment into the Medicare
17Savings Program. The Department may adopt any rules necessary
18to implement the provisions of this paragraph.
19    (305 ILCS 5/3-10 rep.)
20    (305 ILCS 5/3-10.1 rep.)
21    (305 ILCS 5/3-10.2 rep.)
22    (305 ILCS 5/3-10.3 rep.)
23    (305 ILCS 5/3-10.4 rep.)
24    (305 ILCS 5/3-10.5 rep.)



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1    (305 ILCS 5/3-10.6 rep.)
2    (305 ILCS 5/3-10.7 rep.)
3    (305 ILCS 5/3-10.8 rep.)
4    (305 ILCS 5/3-10.9 rep.)
5    (305 ILCS 5/3-10.10 rep.)
6    (305 ILCS 5/5-13.5 rep.)
7    Section 10. The Illinois Public Aid Code is amended by
8repealing Sections 3-10, 3-10.1, 3-10.2, 3-10.3, 3-10.4,
93-10.5, 3-10.6, 3-10.7, 3-10.8, 3-10.9, and 3-10.10, and
11    Section 99. Effective date. This Act takes effect upon
12becoming law.