Illinois General Assembly - Full Text of HB4634
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Full Text of HB4634  95th General Assembly

HB4634eng 95TH GENERAL ASSEMBLY



 


 
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1     AN ACT concerning State government.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Illinois Public Aid Code is amended by
5 changing Section 5-2 as follows:
 
6     (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
7     Sec. 5-2. Classes of Persons Eligible. Medical assistance
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:
12         1. Recipients of basic maintenance grants under
13     Articles III and IV.
14         2. Persons otherwise eligible for basic maintenance
15     under Articles III and IV but who fail to qualify
16     thereunder on the basis of need, and who have insufficient
17     income and resources to meet the costs of necessary medical
18     care, including but not limited to the following:
19             (a) All persons otherwise eligible for basic
20         maintenance under Article III but who fail to qualify
21         under that Article on the basis of need and who meet
22         either of the following requirements:
23                 (i) their income, as determined by the

 

 

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

 

 

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1         3. Persons who would otherwise qualify for Aid to the
2     Medically Indigent under Article VII.
3         4. Persons not eligible under any of the preceding
4     paragraphs who fall sick, are injured, or die, not having
5     sufficient money, property or other resources to meet the
6     costs of necessary medical care or funeral and burial
7     expenses.
8         5.(a) Women during pregnancy, after the fact of
9     pregnancy has been determined by medical diagnosis, and
10     during the 60-day period beginning on the last day of the
11     pregnancy, together with their infants and children born
12     after September 30, 1983, whose income and resources are
13     insufficient to meet the costs of necessary medical care to
14     the maximum extent possible under Title XIX of the Federal
15     Social Security Act.
16         (b) The Illinois Department and the Governor shall
17     provide a plan for coverage of the persons eligible under
18     paragraph 5(a) by April 1, 1990. Such plan shall provide
19     ambulatory prenatal care to pregnant women during a
20     presumptive eligibility period and establish an income
21     eligibility standard that is equal to 133% of the nonfarm
22     income official poverty line, as defined by the federal
23     Office of Management and Budget and revised annually in
24     accordance with Section 673(2) of the Omnibus Budget
25     Reconciliation Act of 1981, applicable to families of the
26     same size, provided that costs incurred for medical care

 

 

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1     are not taken into account in determining such income
2     eligibility.
3         (c) The Illinois Department may conduct a
4     demonstration in at least one county that will provide
5     medical assistance to pregnant women, together with their
6     infants and children up to one year of age, where the
7     income eligibility standard is set up to 185% of the
8     nonfarm income official poverty line, as defined by the
9     federal Office of Management and Budget. The Illinois
10     Department shall seek and obtain necessary authorization
11     provided under federal law to implement such a
12     demonstration. Such demonstration may establish resource
13     standards that are not more restrictive than those
14     established under Article IV of this Code.
15         6. Persons under the age of 18 who fail to qualify as
16     dependent under Article IV and who have insufficient income
17     and resources to meet the costs of necessary medical care
18     to the maximum extent permitted under Title XIX of the
19     Federal Social Security Act.
20         7. Persons who are under 21 years of age and would
21     qualify as disabled as defined under the Federal
22     Supplemental Security Income Program, provided medical
23     service for such persons would be eligible for Federal
24     Financial Participation, and provided the Illinois
25     Department determines that:
26             (a) the person requires a level of care provided by

 

 

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1         a hospital, skilled nursing facility, or intermediate
2         care facility, as determined by a physician licensed to
3         practice medicine in all its branches;
4             (b) it is appropriate to provide such care outside
5         of an institution, as determined by a physician
6         licensed to practice medicine in all its branches;
7             (c) the estimated amount which would be expended
8         for care outside the institution is not greater than
9         the estimated amount which would be expended in an
10         institution.
11         8. Persons who become ineligible for basic maintenance
12     assistance under Article IV of this Code in programs
13     administered by the Illinois Department due to employment
14     earnings and persons in assistance units comprised of
15     adults and children who become ineligible for basic
16     maintenance assistance under Article VI of this Code due to
17     employment earnings. The plan for coverage for this class
18     of persons shall:
19             (a) extend the medical assistance coverage for up
20         to 12 months following termination of basic
21         maintenance assistance; and
22             (b) offer persons who have initially received 6
23         months of the coverage provided in paragraph (a) above,
24         the option of receiving an additional 6 months of
25         coverage, subject to the following:
26                 (i) such coverage shall be pursuant to

 

 

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1             provisions of the federal Social Security Act;
2                 (ii) such coverage shall include all services
3             covered while the person was eligible for basic
4             maintenance assistance;
5                 (iii) no premium shall be charged for such
6             coverage; and
7                 (iv) such coverage shall be suspended in the
8             event of a person's failure without good cause to
9             file in a timely fashion reports required for this
10             coverage under the Social Security Act and
11             coverage shall be reinstated upon the filing of
12             such reports if the person remains otherwise
13             eligible.
14         9. Persons with acquired immunodeficiency syndrome
15     (AIDS) or with AIDS-related conditions with respect to whom
16     there has been a determination that but for home or
17     community-based services such individuals would require
18     the level of care provided in an inpatient hospital,
19     skilled nursing facility or intermediate care facility the
20     cost of which is reimbursed under this Article. Assistance
21     shall be provided to such persons to the maximum extent
22     permitted under Title XIX of the Federal Social Security
23     Act.
24         10. Participants in the long-term care insurance
25     partnership program established under the Illinois
26     Long-Term Care Partnership Program Act Partnership for

 

 

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1     Long-Term Care Act who meet the qualifications for
2     protection of resources described in Section 15 25 of that
3     Act.
4         11. Persons with disabilities who are employed and
5     eligible for Medicaid, pursuant to Section
6     1902(a)(10)(A)(ii)(xv) of the Social Security Act, as
7     provided by the Illinois Department by rule. In
8     establishing eligibility standards under this paragraph
9     11, the Department shall, subject to federal approval:
10             (a) set the income eligibility standard at not
11         lower than 350% of the federal poverty level;
12             (b) exempt retirement accounts that the person
13         cannot access without penalty before the age of 59 1/2,
14         and medical savings accounts established pursuant to
15         26 U.S.C. 220;
16             (c) allow non-exempt assets up to $25,000 as to
17         those assets accumulated during periods of eligibility
18         under this paragraph 11; and
19             (d) continue to apply subparagraphs (b) and (c) in
20         determining the eligibility of the person under this
21         Article even if the person loses eligibility under this
22         paragraph 11.
23         12. Subject to federal approval, persons who are
24     eligible for medical assistance coverage under applicable
25     provisions of the federal Social Security Act and the
26     federal Breast and Cervical Cancer Prevention and

 

 

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1     Treatment Act of 2000. Those eligible persons are defined
2     to include, but not be limited to, the following persons:
3             (1) persons who have been screened for breast or
4         cervical cancer under the U.S. Centers for Disease
5         Control and Prevention Breast and Cervical Cancer
6         Program established under Title XV of the federal
7         Public Health Services Act in accordance with the
8         requirements of Section 1504 of that Act as
9         administered by the Illinois Department of Public
10         Health; and
11             (2) persons whose screenings under the above
12         program were funded in whole or in part by funds
13         appropriated to the Illinois Department of Public
14         Health for breast or cervical cancer screening.
15         "Medical assistance" under this paragraph 12 shall be
16     identical to the benefits provided under the State's
17     approved plan under Title XIX of the Social Security Act.
18     The Department must request federal approval of the
19     coverage under this paragraph 12 within 30 days after the
20     effective date of this amendatory Act of the 92nd General
21     Assembly.
22         13. Subject to appropriation and to federal approval,
23     persons living with HIV/AIDS who are not otherwise eligible
24     under this Article and who qualify for services covered
25     under Section 5-5.04 as provided by the Illinois Department
26     by rule.

 

 

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1         14. Subject to the availability of funds for this
2     purpose, the Department may provide coverage under this
3     Article to persons who reside in Illinois who are not
4     eligible under any of the preceding paragraphs and who meet
5     the income guidelines of paragraph 2(a) of this Section and
6     (i) have an application for asylum pending before the
7     federal Department of Homeland Security or on appeal before
8     a court of competent jurisdiction and are represented
9     either by counsel or by an advocate accredited by the
10     federal Department of Homeland Security and employed by a
11     not-for-profit organization in regard to that application
12     or appeal, or (ii) are receiving services through a
13     federally funded torture treatment center. Medical
14     coverage under this paragraph 14 may be provided for up to
15     24 continuous months from the initial eligibility date so
16     long as an individual continues to satisfy the criteria of
17     this paragraph 14. If an individual has an appeal pending
18     regarding an application for asylum before the Department
19     of Homeland Security, eligibility under this paragraph 14
20     may be extended until a final decision is rendered on the
21     appeal. The Department may adopt rules governing the
22     implementation of this paragraph 14.
23         15. Subject to appropriation, uninsured persons who
24     are not otherwise eligible under this Section who have been
25     certified and referred by the Department of Public Health
26     as having been screened and found to need diagnostic

 

 

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1     evaluation or treatment, or both diagnostic evaluation and
2     treatment, for prostate or testicular cancer. For the
3     purposes of this paragraph 15, uninsured persons are those
4     who do not have creditable coverage, as defined under the
5     Health Insurance Portability and Accountability Act, or
6     have otherwise exhausted any insurance benefits they may
7     have had, for prostate or testicular cancer diagnostic
8     evaluation or treatment, or both diagnostic evaluation and
9     treatment. To be eligible, a person must furnish a Social
10     Security number. A person's assets are exempt from
11     consideration in determining eligibility under this
12     paragraph 15. Such persons shall be eligible for medical
13     assistance under this paragraph 15 for so long as they need
14     treatment for the cancer. A person shall be considered to
15     need treatment if, in the opinion of the person's treating
16     physician, the person requires therapy directed toward
17     cure or palliation of prostate or testicular cancer,
18     including recurrent metastatic cancer that is a known or
19     presumed complication of prostate or testicular cancer and
20     complications resulting from the treatment modalities
21     themselves. Persons who require only routine monitoring
22     services are not considered to need treatment. "Medical
23     assistance" under this paragraph 15 shall be identical to
24     the benefits provided under the State's approved plan under
25     Title XIX of the Social Security Act. Notwithstanding any
26     other provision of law, the Department (i) does not have a

 

 

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1     claim against the estate of a deceased recipient of
2     services under this paragraph 15 and (ii) does not have a
3     lien against any homestead property or other legal or
4     equitable real property interest owned by a recipient of
5     services under this paragraph 15.
6     The Illinois Department and the Governor shall provide a
7 plan for coverage of the persons eligible under paragraph 7 as
8 soon as possible after July 1, 1984.
9     The eligibility of any such person for medical assistance
10 under this Article is not affected by the payment of any grant
11 under the Senior Citizens and Disabled Persons Property Tax
12 Relief and Pharmaceutical Assistance Act or any distributions
13 or items of income described under subparagraph (X) of
14 paragraph (2) of subsection (a) of Section 203 of the Illinois
15 Income Tax Act. The Department shall by rule establish the
16 amounts of assets to be disregarded in determining eligibility
17 for medical assistance, which shall at a minimum equal the
18 amounts to be disregarded under the Federal Supplemental
19 Security Income Program. The amount of assets of a single
20 person to be disregarded shall not be less than $2,000, and the
21 amount of assets of a married couple to be disregarded shall
22 not be less than $3,000.
23     To the extent permitted under federal law, any person found
24 guilty of a second violation of Article VIIIA shall be
25 ineligible for medical assistance under this Article, as
26 provided in Section 8A-8.

 

 

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1     The eligibility of any person for medical assistance under
2 this Article shall not be affected by the receipt by the person
3 of donations or benefits from fundraisers held for the person
4 in cases of serious illness, as long as neither the person nor
5 members of the person's family have actual control over the
6 donations or benefits or the disbursement of the donations or
7 benefits.
8     Notwithstanding any other rulemaking authority that may
9 exist, neither the Governor nor any agency or agency head under
10 the jurisdiction of the Governor has any authority to make or
11 promulgate rules to implement or enforce the provisions of this
12 amendatory Act of the 95th General Assembly. If, however, the
13 Governor believes that rules are necessary to implement or
14 enforce the provisions of this amendatory Act of the 95th
15 General Assembly, the Governor may suggest rules to the General
16 Assembly by filing them with the Clerk of the House and
17 Secretary of the Senate and by requesting that the General
18 Assembly authorize such rulemaking by law, enact those
19 suggested rules into law, or take any other appropriate action
20 in the General Assembly's discretion. Nothing contained in this
21 amendatory Act of the 95th General Assembly shall be
22 interpreted to grant rulemaking authority under any other
23 Illinois statute where such authority is not otherwise
24 explicitly given. For the purposes of this amendatory Act of
25 the 95th General Assembly, "rules" is given the meaning
26 contained in Section 1-70 of the Illinois Administrative

 

 

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1 Procedure Act, and "agency" and "agency head" are given the
2 meanings contained in Sections 1-20 and 1-25 of the Illinois
3 Administrative Procedure Act to the extent that such
4 definitions apply to agencies or agency heads under the
5 jurisdiction of the Governor.
6 (Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06;
7 95-546, eff. 8-29-07; revised 1-22-08.)