HB6297 95TH GENERAL ASSEMBLY

LRB095 20194 DRJ 47112 b

95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
HB6297

Introduced , by Rep. David E. Miller - John A. Fritchey - Lou Lang

SYNOPSIS AS INTRODUCED:

215 ILCS 106/41 new

Amends the Children's Health Insurance Program Act. Provides that for purposes of the "FamilyCare" program under the Act, a caretaker relative, including a pregnant woman or her spouse if living together, who is 19 years of age or older qualifies for medical assistance if certain conditions are met, including conditions relating to (i) disenrollment for Medicaid or benefits under the Children's health Insurance Program Act or the Covering ALL KIDS Health Insurance Act or (ii) the availability of affordable health insurance to the individual. Provides that for the purpose of determining eligibility under these provisions, the Department of Healthcare and Family Services shall disregard income in an amount equal to the difference between 133% and 400% of the Federal Poverty Level Guidelines for the appropriate family size. States provisions concerning the commencement of eligibility. Requires that eligibility be reviewed annually. Provides for monthly premiums to be paid by caretaker relatives, based on family income. Provides for re-enrollment following termination of an individual's coverage under the program. Provides that the provisions of the amendatory Act are subject to appropriation. Provides that neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any rulemaking authority under the amendatory Act, but that the Governor may suggest rules by filing them with the General Assembly and requesting that the General Assembly authorize such rulemaking by law, enact the suggested rules into law, or take other appropriate action in the General Assembly's discretion.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Children's Health Insurance Program Act is amended by adding Section 41 as follows:

(215 ILCS 106/41 new)

Sec. 41. FamilyCare eligibility.

(a) A caretaker relative who is 19 years of age or older qualifies for medical assistance under Article V of the Illinois Public Aid Code when countable income is at or below the appropriate income standard and all MANG(C) eligibility requirements in 89 Ill. Adm. Code Part 120, with the exception of Sections 120.320 through 120.323, are met. The appropriate income standard is 133% of the Federal Poverty Level Guidelines, as published annually in the Federal Register, for the appropriate family size. If income is greater than this amount, it shall be compared to the MANG(C) Income Standard in 89 Ill. Adm. Code 120.30 to determine the spenddown amount.

(b) A caretaker relative, including a pregnant woman or her spouse if living together, who is 19 years of age or older qualifies for medical assistance under subsection (a) if all of the following are met:

(1) The individual is not otherwise eligible under 89 Ill. Adm. Code Part 120 or 89 Ill. Adm. Code Part 123 or Section 125.200.

(2) All MANG(C) eligibility requirements in 89 Ill. Adm. Code Part 120, with the exception of Sections 120.320 through 120.323, are met.

(3) The individual meets the requirements set forth in either subparagraph (A) or subparagraph (B):

(A) Upon initial determination of eligibility:

(i) the individual has been without health insurance for at least 12 months prior to the date of application unless the individual is a pregnant woman, in which case the individual was without health insurance when her pregnancy was medically confirmed;

(ii) the individual lost employer-sponsored health insurance when his or her job or his or her spouse's job ended;

(iii) the individual has exhausted the lifetime benefit limit of his or her health insurance;

(iv) the individual's health insurance is purchased under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA);

(v) the individual was disenrolled for medical assistance under the Illinois Public Aid Code or benefits, including rebates, under the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act within one year prior to applying under this Section, unless the individual has State-sponsored health insurance;

(vi) the individual aged out of coverage under a parent's health insurance; or

(vii) the individual's income, as determined for establishing the appropriate premium payment under subsection (h) of this Section, is at or below 200% of the Federal Poverty Level Guidelines.

(B) Upon determination of eligibility:

(i) the individual's income, as determined for establishing the appropriate premium payment under subsection (h) of this Section, is at or below 200% of the Federal Poverty Level Guidelines;

(ii) the individual was initially enrolled under subdivision (b)(3)(A)(i), (b)(3)(A)(v), or (b)(3)(A)(vi) of this Section; or

(iii) affordable health insurance is not available to the individual. For the purposes of this Section, "affordable health insurance" for an individual does not exceed 4% of the family's monthly countable income. The amount of income disregarded under subsection (c) of this Section shall not be disregarded when making this determination. For the purposes of this subdivision (b)(3)(B), health insurance shall be considered unavailable to the individual if subdivision (b)(3)(A)(iii) or (b)(3)(A)(iv) applies.

(c) For the purpose of determining eligibility under this Section, the Department shall disregard income in an amount equal to the difference between 133% and 400% of the Federal Poverty Level Guidelines for the appropriate family size.

(d) If, after the application of subsection (c) of this Section, the caretaker relative is not eligible, total countable income shall be compared to the MANG(C) Income Standard in 89 Ill. Adm. Code 120.30 to determine the spenddown amount.

(e) Eligibility shall commence as follows:

(1) Eligibility determinations for the program made by the 15th day of the month shall be effective the first day of the following month. Eligibility determinations for the program made after the 15th day of the month shall be effective no later than the first day of the second month following that determination.

(2) Individuals with income at or below 200% of the Federal Poverty Level Guidelines found eligible under this Section may obtain coverage for a period prior to the date of application for the program subject to the following:

(A) The individual must request prior coverage within 6 months following the initial date of coverage.

(B) The prior coverage shall be individual specific and shall only be available the first time the individual is enrolled under this Section.

(C) The prior coverage shall begin with services rendered during the 2 weeks prior to the date the individual's application was filed and shall continue until the individual's coverage under subdivision (e)(1) of this Section is effective.

(f) Eligibility shall be reviewed annually.

(g) Caretaker relatives enrolled under this Section must pay monthly premiums as follows:

(1) Individuals who are not American Indians or Alaska Natives in families with countable income above 150% and at or below 200% of the Federal Poverty Level Guidelines shall pay premiums as set forth in 89 Ill. Adm. Code 125.320(b).

(2) Individuals in families with countable income above 200% but at or below 300% of the Federal Poverty Level Guidelines shall pay premiums of $80 per person per month.

(3) Individuals in families with countable income above 300% but at or below 400% of the Federal Poverty Level Guidelines shall pay premiums of $140 per person per month.

(h) Individuals who are American Indians or Alaska Natives shall have no co-payments if their family income is at or below 200% of the Federal Poverty Level Guidelines.

(i) The amount of income disregarded under subsection (c) of this Section shall not be disregarded in determining premium levels, or co-payments or eligibility for prior coverage or rebates.

(j) Premiums shall be billed by and payable to the Department or its authorized agent, on a monthly basis.

(k) The premium due date is the last day of the month preceding the month of coverage.

(l) Individuals shall have a grace period through the month of coverage to pay the premium.

(m) Failure to pay the full monthly premium by the last day of the grace period shall result in termination of coverage.

(n) Partial premium payments shall not be refunded.

(o) When termination of coverage is recorded by the 15th day of the month, it shall be effective the first day of the following month. When termination of coverage is recorded after the 15th day of the month, it shall be effective no later than the first day of the second month following that determination.

(p) Following termination of an individual's coverage under this Section, the following action is required before the individual can be re-enrolled:

(1) A new application must be completed and the individual must be determined otherwise eligible.

(2) There must be full payment of premiums due under 89 Ill. Adm. Code Part 120 or 89 Ill. Adm. Code Part 123 or Part 125, for periods in which a premium was owed and not paid for the individual.

(3) If the termination was the result of non-payment of premiums, the individual must be out of the program for 3 months before re-enrollment.

(4) The first month's premium must be paid if there was an unpaid premium on the date the individual's previous coverage was canceled.

(q) For the purposes of this Section, "health insurance" means any health insurance coverage as defined in Section 2 of the Comprehensive Health Insurance Plan Act.

(r) The provisions of this amendatory Act of the 95th General Assembly are subject to appropriation.

(s) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly. If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly's discretion. Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given. For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.