HB0315sam007 95TH GENERAL ASSEMBLY

Sen. Terry Link

Filed: 4/2/2008

09500HB0315sam007 LRB095 04658 DRJ 48809 a

AMENDMENT TO HOUSE BILL 315

AMENDMENT NO. ______. Amend House Bill 315, AS AMENDED, by replacing everything after the enacting clause with the following:

"Section 5. If and only if House Bill 473 and House Bill 3860 of the 95th General Assembly become law, the Illinois Public Aid Code is amended by changing Section 5-2 as follows:

(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)

Sec. 5-2. Classes of Persons Eligible. Medical assistance under this Article shall be available to any of the following classes of persons in respect to whom a plan for coverage has been submitted to the Governor by the Illinois Department and approved by him:

1. Recipients of basic maintenance grants under Articles III and IV.

2. Persons otherwise eligible for basic maintenance under Articles III and IV but who fail to qualify thereunder on the basis of need, and who have insufficient income and resources to meet the costs of necessary medical care, including but not limited to the following:

(a) All persons otherwise eligible for basic maintenance under Article III but who fail to qualify under that Article on the basis of need and who meet either of the following requirements:

(i) their income, as determined by the Illinois Department in accordance with any federal requirements, is equal to or less than 70% in fiscal year 2001, equal to or less than 85% in fiscal year 2002 and until a date to be determined by the Department by rule, and equal to or less than 100% beginning on the date determined by the Department by rule, of the nonfarm income official poverty line, as defined by the federal Office of Management and Budget and revised annually in accordance with Section 673(2) of the Omnibus Budget Reconciliation Act of 1981, applicable to families of the same size; or

(ii) their income, after the deduction of costs incurred for medical care and for other types of remedial care, is equal to or less than 70% in fiscal year 2001, equal to or less than 85% in fiscal year 2002 and until a date to be determined by the Department by rule, and equal to or less than 100% beginning on the date determined by the Department by rule, of the nonfarm income official poverty line, as defined in item (i) of this subparagraph (a).

(b) All persons who would be determined eligible for such basic maintenance under Article IV by disregarding the maximum earned income permitted by federal law.

3. Persons who would otherwise qualify for Aid to the Medically Indigent under Article VII.

4. Persons not eligible under any of the preceding paragraphs who fall sick, are injured, or die, not having sufficient money, property or other resources to meet the costs of necessary medical care or funeral and burial expenses.

5.(a) Women during pregnancy, after the fact of pregnancy has been determined by medical diagnosis, and during the 60-day period beginning on the last day of the pregnancy, together with their infants and children born after September 30, 1983, whose income and resources are insufficient to meet the costs of necessary medical care to the maximum extent possible under Title XIX of the Federal Social Security Act.

(b) The Illinois Department and the Governor shall provide a plan for coverage of the persons eligible under paragraph 5(a) by April 1, 1990. Such plan shall provide ambulatory prenatal care to pregnant women during a presumptive eligibility period and establish an income eligibility standard that is equal to 133% of the nonfarm income official poverty line, as defined by the federal Office of Management and Budget and revised annually in accordance with Section 673(2) of the Omnibus Budget Reconciliation Act of 1981, applicable to families of the same size, provided that costs incurred for medical care are not taken into account in determining such income eligibility.

(c) The Illinois Department may conduct a demonstration in at least one county that will provide medical assistance to pregnant women, together with their infants and children up to one year of age, where the income eligibility standard is set up to 185% of the nonfarm income official poverty line, as defined by the federal Office of Management and Budget. The Illinois Department shall seek and obtain necessary authorization provided under federal law to implement such a demonstration. Such demonstration may establish resource standards that are not more restrictive than those established under Article IV of this Code.

6. Persons under the age of 18 who fail to qualify as dependent under Article IV and who have insufficient income and resources to meet the costs of necessary medical care to the maximum extent permitted under Title XIX of the Federal Social Security Act.

7. Persons who are under 21 years of age and would qualify as disabled as defined under the Federal Supplemental Security Income Program, provided medical service for such persons would be eligible for Federal Financial Participation, and provided the Illinois Department determines that:

(a) the person requires a level of care provided by a hospital, skilled nursing facility, or intermediate care facility, as determined by a physician licensed to practice medicine in all its branches;

(b) it is appropriate to provide such care outside of an institution, as determined by a physician licensed to practice medicine in all its branches;

(c) the estimated amount which would be expended for care outside the institution is not greater than the estimated amount which would be expended in an institution.

8. Persons who become ineligible for basic maintenance assistance under Article IV of this Code in programs administered by the Illinois Department due to employment earnings and persons in assistance units comprised of adults and children who become ineligible for basic maintenance assistance under Article VI of this Code due to employment earnings. The plan for coverage for this class of persons shall:

(a) extend the medical assistance coverage for up to 12 months following termination of basic maintenance assistance; and

(b) offer persons who have initially received 6 months of the coverage provided in paragraph (a) above, the option of receiving an additional 6 months of coverage, subject to the following:

(i) such coverage shall be pursuant to provisions of the federal Social Security Act;

(ii) such coverage shall include all services covered while the person was eligible for basic maintenance assistance;

(iii) no premium shall be charged for such coverage; and

(iv) such coverage shall be suspended in the event of a person's failure without good cause to file in a timely fashion reports required for this coverage under the Social Security Act and coverage shall be reinstated upon the filing of such reports if the person remains otherwise eligible.

9. Persons with acquired immunodeficiency syndrome (AIDS) or with AIDS-related conditions with respect to whom there has been a determination that but for home or community-based services such individuals would require the level of care provided in an inpatient hospital, skilled nursing facility or intermediate care facility the cost of which is reimbursed under this Article. Assistance shall be provided to such persons to the maximum extent permitted under Title XIX of the Federal Social Security Act.

10. Participants in the long-term care insurance partnership program established under the Illinois Long-Term Care Partnership Program Act Partnership for Long-Term Care Act who meet the qualifications for protection of resources described in Section 15 25 of that Act.

11. Persons with disabilities who are employed and eligible for Medicaid, pursuant to Section 1902(a)(10)(A)(ii)(xv) of the Social Security Act, as provided by the Illinois Department by rule. In establishing eligibility standards under this paragraph 11, the Department shall, subject to federal approval:

(a) set the income eligibility standard at not lower than 350% of the federal poverty level;

(b) exempt retirement accounts that the person cannot access without penalty before the age of 59 1/2, and medical savings accounts established pursuant to 26 U.S.C. 220;

(c) allow non-exempt assets up to $25,000 as to those assets accumulated during periods of eligibility under this paragraph 11; and

(d) continue to apply subparagraphs (b) and (c) in determining the eligibility of the person under this Article even if the person loses eligibility under this paragraph 11.

12. Subject to federal approval, persons who are eligible for medical assistance coverage under applicable provisions of the federal Social Security Act and the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000. Those eligible persons are defined to include, but not be limited to, the following persons:

(1) persons who have been screened for breast or cervical cancer under the U.S. Centers for Disease Control and Prevention Breast and Cervical Cancer Program established under Title XV of the federal Public Health Services Act in accordance with the requirements of Section 1504 of that Act as administered by the Illinois Department of Public Health; and

(2) persons whose screenings under the above program were funded in whole or in part by funds available appropriated to the Illinois Department of Public Health for breast or cervical cancer screening.

Additionally, uninsured persons for whom one or more screening or diagnostic services for breast or cervical cancer have been paid in whole or in part by public funds if, during the course of those screening or diagnostic services, cancer was detected. Such persons shall be eligible for medical assistance under this provision for so long as they need treatment for the cancer.

"Medical assistance" under this paragraph 12 shall be identical to the benefits provided under the State's approved plan under Title XIX of the Social Security Act. The Department must request federal approval of the coverage under this paragraph 12 within 30 days after the effective date of this amendatory Act of the 92nd General Assembly.

13. Subject to appropriation and to federal approval, persons living with HIV/AIDS who are not otherwise eligible under this Article and who qualify for services covered under Section 5-5.04 as provided by the Illinois Department by rule.

14. Subject to the availability of funds for this purpose, the Department may provide coverage under this Article to persons who reside in Illinois who are not eligible under any of the preceding paragraphs and who meet the income guidelines of paragraph 2(a) of this Section and (i) have an application for asylum pending before the federal Department of Homeland Security or on appeal before a court of competent jurisdiction and are represented either by counsel or by an advocate accredited by the federal Department of Homeland Security and employed by a not-for-profit organization in regard to that application or appeal, or (ii) are receiving services through a federally funded torture treatment center. Medical coverage under this paragraph 14 may be provided for up to 24 continuous months from the initial eligibility date so long as an individual continues to satisfy the criteria of this paragraph 14. If an individual has an appeal pending regarding an application for asylum before the Department of Homeland Security, eligibility under this paragraph 14 may be extended until a final decision is rendered on the appeal. The Department may adopt rules governing the implementation of this paragraph 14.

15. FamilyCare eligibility.

(a) A caretaker relative who is 19 years of age or older when countable income is at or below 133% of the Federal Poverty Level Guidelines, as published annually in the Federal Register, for the appropriate family size. A person may not spend down to become eligible under this paragraph 15.

(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 subparagraph (a) of this paragraph 15 if all of the following are met:

(1) The individual is not otherwise eligible for medical assistance or healthcare benefits under the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act.

(2) The individual meets the requirements set forth in the following subdivision (b)(2)(A) or (b)(2)(B) as appropriate:

(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 paragraph 15, 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 subparagraph (g) of this paragraph 15, is at or below 200% of the Federal Poverty Level Guidelines.

(B) Upon annual redetermination of eligibility:

(i) the individual's income, as determined for establishing the appropriate premium payment under subparagraph (g) of this paragraph 15, is at or below 200% of the Federal Poverty Level Guidelines;

(ii) the individual was initially enrolled under subdivision (b)(2)(A)(i), (b)(2)(A)(v), or (b)(2)(A)(vi) of this paragraph 15; or

(iii) affordable health insurance is not available to the individual. For the purposes of this paragraph 15, health insurance for an individual is affordable if the monthly cost to the policyholder of the premium for the insurance does not exceed 3% of the family's monthly countable income. The amount of income disregarded under subparagraph (c) of this paragraph 15 shall not be disregarded when making this determination.

For the purposes of this subdivision (b)(2)(B), health insurance shall be considered unavailable to the individual if subdivision (b)(2)(A)(iii) or (b)(2)(A)(iv) of this paragraph 15 applies or if the individual has been enrolled under this paragraph 15 longer than 12 months.

(c) For the purpose of determining eligibility under this paragraph 15, 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) A caretaker relative may not spend down to become eligible under this paragraph 15.

(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 as determined for establishing the appropriate premium payment under subparagraph (g) of this paragraph 15 that is at or below 200% of the Federal Poverty Level Guidelines found eligible under this paragraph 15 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 paragraph 15.

(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 paragraph 15 is effective.

(f) Eligibility shall be reviewed annually.

(g) Caretaker relatives enrolled under this paragraph 15 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 be counted as family members and pay premiums as established under the Children's Health Insurance Program Act.

(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 subparagraph (c) of this paragraph 15 shall not be disregarded in determining premium levels or in determining 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 paragraph 15, 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 this Code, the Children's Health Insurance Program Act, the Covering ALL KIDS Health Insurance Act, or any other healthcare program administered by the Department 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 paragraph 15, "health insurance" means any health insurance coverage as defined in Section 2 of the Comprehensive Health Insurance Plan Act.

The Illinois Department and the Governor shall provide a plan for coverage of the persons eligible under paragraph 7 as soon as possible after July 1, 1984.

The eligibility of any such person for medical assistance under this Article is not affected by the payment of any grant under the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act or any distributions or items of income described under subparagraph (X) of paragraph (2) of subsection (a) of Section 203 of the Illinois Income Tax Act. The Department shall by rule establish the amounts of assets to be disregarded in determining eligibility for medical assistance, which shall at a minimum equal the amounts to be disregarded under the Federal Supplemental Security Income Program. The amount of assets of a single person to be disregarded shall not be less than $2,000, and the amount of assets of a married couple to be disregarded shall not be less than $3,000.

To the extent permitted under federal law, any person found guilty of a second violation of Article VIIIA shall be ineligible for medical assistance under this Article, as provided in Section 8A-8.

The eligibility of any person for medical assistance under this Article shall not be affected by the receipt by the person of donations or benefits from fundraisers held for the person in cases of serious illness, as long as neither the person nor members of the person's family have actual control over the donations or benefits or the disbursement of the donations or benefits.

(Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06; 95-546, eff. 8-29-07; revised 1-22-08.)

Section 99. Effective date. This Act takes effect upon becoming law.".