Illinois General Assembly - Full Text of HB0810
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Full Text of HB0810  96th General Assembly


Sen. Pamela J. Althoff

Filed: 5/17/2009





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2     AMENDMENT NO. ______. Amend House Bill 810, AS AMENDED, by
3 replacing everything after the enacting clause with the
4 following:
5     "Section 5. The Illinois Public Aid Code is amended by
6 changing Section 5-2 as follows:
7     (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
8     Sec. 5-2. Classes of Persons Eligible. Medical assistance
9 under this Article shall be available to any of the following
10 classes of persons in respect to whom a plan for coverage has
11 been submitted to the Governor by the Illinois Department and
12 approved by him:
13         1. Recipients of basic maintenance grants under
14     Articles III and IV.
15         2. Persons otherwise eligible for basic maintenance
16     under Articles III and IV but who fail to qualify



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1     thereunder on the basis of need, and who have insufficient
2     income and resources to meet the costs of necessary medical
3     care, including but not limited to the following:
4             (a) All persons otherwise eligible for basic
5         maintenance under Article III but who fail to qualify
6         under that Article on the basis of need and who meet
7         either of the following requirements:
8                 (i) their income, as determined by the
9             Illinois Department in accordance with any federal
10             requirements, is equal to or less than 70% in
11             fiscal year 2001, equal to or less than 85% in
12             fiscal year 2002 and until a date to be determined
13             by the Department by rule, and equal to or less
14             than 100% beginning on the date determined by the
15             Department by rule, of the nonfarm income official
16             poverty line, as defined by the federal Office of
17             Management and Budget and revised annually in
18             accordance with Section 673(2) of the Omnibus
19             Budget Reconciliation Act of 1981, applicable to
20             families of the same size; or
21                 (ii) their income, after the deduction of
22             costs incurred for medical care and for other types
23             of remedial care, is equal to or less than 70% in
24             fiscal year 2001, equal to or less than 85% in
25             fiscal year 2002 and until a date to be determined
26             by the Department by rule, and equal to or less



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1             than 100% beginning on the date determined by the
2             Department by rule, of the nonfarm income official
3             poverty line, as defined in item (i) of this
4             subparagraph (a).
5             (b) All persons who would be determined eligible
6         for such basic maintenance under Article IV by
7         disregarding the maximum earned income permitted by
8         federal law.
9         3. Persons who would otherwise qualify for Aid to the
10     Medically Indigent under Article VII.
11         4. Persons not eligible under any of the preceding
12     paragraphs who fall sick, are injured, or die, not having
13     sufficient money, property or other resources to meet the
14     costs of necessary medical care or funeral and burial
15     expenses.
16         5.(a) Women during pregnancy, after the fact of
17     pregnancy has been determined by medical diagnosis, and
18     during the 60-day period beginning on the last day of the
19     pregnancy, together with their infants and children born
20     after September 30, 1983, whose income and resources are
21     insufficient to meet the costs of necessary medical care to
22     the maximum extent possible under Title XIX of the Federal
23     Social Security Act.
24         (b) The Illinois Department and the Governor shall
25     provide a plan for coverage of the persons eligible under
26     paragraph 5(a) by April 1, 1990. Such plan shall provide



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1     ambulatory prenatal care to pregnant women during a
2     presumptive eligibility period and establish an income
3     eligibility standard that is equal to 133% of the nonfarm
4     income official poverty line, as defined by the federal
5     Office of Management and Budget and revised annually in
6     accordance with Section 673(2) of the Omnibus Budget
7     Reconciliation Act of 1981, applicable to families of the
8     same size, provided that costs incurred for medical care
9     are not taken into account in determining such income
10     eligibility.
11         (c) The Illinois Department may conduct a
12     demonstration in at least one county that will provide
13     medical assistance to pregnant women, together with their
14     infants and children up to one year of age, where the
15     income eligibility standard is set up to 185% of the
16     nonfarm income official poverty line, as defined by the
17     federal Office of Management and Budget. The Illinois
18     Department shall seek and obtain necessary authorization
19     provided under federal law to implement such a
20     demonstration. Such demonstration may establish resource
21     standards that are not more restrictive than those
22     established under Article IV of this Code.
23         6. Persons under the age of 18 who fail to qualify as
24     dependent under Article IV and who have insufficient income
25     and resources to meet the costs of necessary medical care
26     to the maximum extent permitted under Title XIX of the



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1     Federal Social Security Act.
2         7. Persons who are under 21 years of age and would
3     qualify as disabled as defined under the Federal
4     Supplemental Security Income Program, provided medical
5     service for such persons would be eligible for Federal
6     Financial Participation, and provided the Illinois
7     Department determines that:
8             (a) the person requires a level of care provided by
9         a hospital, skilled nursing facility, or intermediate
10         care facility, as determined by a physician licensed to
11         practice medicine in all its branches;
12             (b) it is appropriate to provide such care outside
13         of an institution, as determined by a physician
14         licensed to practice medicine in all its branches;
15             (c) the estimated amount which would be expended
16         for care outside the institution is not greater than
17         the estimated amount which would be expended in an
18         institution.
19         8. Persons who become ineligible for basic maintenance
20     assistance under Article IV of this Code in programs
21     administered by the Illinois Department due to employment
22     earnings and persons in assistance units comprised of
23     adults and children who become ineligible for basic
24     maintenance assistance under Article VI of this Code due to
25     employment earnings. The plan for coverage for this class
26     of persons shall:



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1             (a) extend the medical assistance coverage for up
2         to 12 months following termination of basic
3         maintenance assistance; and
4             (b) offer persons who have initially received 6
5         months of the coverage provided in paragraph (a) above,
6         the option of receiving an additional 6 months of
7         coverage, subject to the following:
8                 (i) such coverage shall be pursuant to
9             provisions of the federal Social Security Act;
10                 (ii) such coverage shall include all services
11             covered while the person was eligible for basic
12             maintenance assistance;
13                 (iii) no premium shall be charged for such
14             coverage; and
15                 (iv) such coverage shall be suspended in the
16             event of a person's failure without good cause to
17             file in a timely fashion reports required for this
18             coverage under the Social Security Act and
19             coverage shall be reinstated upon the filing of
20             such reports if the person remains otherwise
21             eligible.
22         9. Persons with acquired immunodeficiency syndrome
23     (AIDS) or with AIDS-related conditions with respect to whom
24     there has been a determination that but for home or
25     community-based services such individuals would require
26     the level of care provided in an inpatient hospital,



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1     skilled nursing facility or intermediate care facility the
2     cost of which is reimbursed under this Article. Assistance
3     shall be provided to such persons to the maximum extent
4     permitted under Title XIX of the Federal Social Security
5     Act.
6         10. Participants in the long-term care insurance
7     partnership program established under the Illinois
8     Long-Term Care Partnership Program Act who meet the
9     qualifications for protection of resources described in
10     Section 15 of that Act.
11         11. Persons with disabilities who are employed and
12     eligible for Medicaid, pursuant to Section
13     1902(a)(10)(A)(ii)(xv) of the Social Security Act, as
14     provided by the Illinois Department by rule. In
15     establishing eligibility standards under this paragraph
16     11, the Department shall, subject to federal approval:
17             (a) set the income eligibility standard at not
18         lower than 350% of the federal poverty level;
19             (b) exempt retirement accounts that the person
20         cannot access without penalty before the age of 59 1/2,
21         and medical savings accounts established pursuant to
22         26 U.S.C. 220;
23             (c) allow non-exempt assets up to $25,000 as to
24         those assets accumulated during periods of eligibility
25         under this paragraph 11; and
26             (d) continue to apply subparagraphs (b) and (c) in



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



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1     effective date of this amendatory Act of the 92nd General
2     Assembly.
3         In addition to the persons who are eligible for medical
4     assistance pursuant to subparagraphs (1) and (2) of this
5     paragraph 12, any uninsured person who does not have
6     credible coverage, as defined under the Health Insurance
7     Portability and Accountability Act, for breast or cervical
8     cancer treatment residing in Illinois who is younger than
9     65 years of age, who has been screened for breast and
10     cervical cancer in accordance with standards and
11     procedures adopted by the Department of Public Health for
12     screening, and who is referred to the Department by the
13     Department of Public Health as being in need of treatment
14     for breast or cervical cancer is eligible for medical
15     assistance benefits that are consistent with the benefits
16     provided to those persons described in subparagraphs (1)
17     and (2). Medical assistance coverage for the persons who
18     are eligible under the preceding sentence is not dependent
19     on federal approval, but federal moneys may be used to pay
20     for services provided under that coverage upon federal
21     approval.
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. Family Care Eligibility.
24             (a) A caretaker relative who is 19 years of age or
25         older when countable income is at or below 185% of the
26         Federal Poverty Level Guidelines, as published



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1         annually in the Federal Register, for the appropriate
2         family size. A person may not spend down to become
3         eligible under this paragraph 15.
4             (b) Eligibility shall be reviewed annually.
5             (c) Caretaker relatives enrolled under this
6         paragraph 15 in families with countable income above
7         150% and at or below 185% of the Federal Poverty Level
8         Guidelines shall be counted as family members and pay
9         premiums as established under the Children's Health
10         Insurance Program Act.
11             (d) Premiums shall be billed by and payable to the
12         Department or its authorized agent, on a monthly basis.
13             (e) The premium due date is the last day of the
14         month preceding the month of coverage.
15             (f) Individuals shall have a grace period through
16         the month of coverage to pay the premium.
17             (g) Failure to pay the full monthly premium by the
18         last day of the grace period shall result in
19         termination of coverage.
20             (h) Partial premium payments shall not be
21         refunded.
22             (i) Following termination of an individual's
23         coverage under this paragraph 15, the following action
24         is required before the individual can be re-enrolled:
25                 (1) A new application must be completed and the
26             individual must be determined otherwise eligible.



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1                 (2) There must be full payment of premiums due
2             under this Code, the Children's Health Insurance
3             Program Act, the Covering ALL KIDS Health
4             Insurance Act, or any other healthcare program
5             administered by the Department for periods in
6             which a premium was owed and not paid for the
7             individual.
8                 (3) The first month's premium must be paid if
9             there was an unpaid premium on the date the
10             individual's previous coverage was canceled.
11         The Department is authorized to implement the
12     provisions of this amendatory Act of the 95th General
13     Assembly by adopting the medical assistance rules in effect
14     as of October 1, 2007, at 89 Ill. Admin. Code 125, along
15     with only those changes necessary to conform to federal
16     Medicaid requirements. The Department may not otherwise
17     adopt any rule to implement this increase except as
18     authorized by law, to meet the eligibility standards
19     authorized by the federal government in the Medicaid State
20     Plan or the Title XXI Plan, or to meet an order from the
21     federal government or any court.
22     The Illinois Department and the Governor shall provide a
23 plan for coverage of the persons eligible under paragraph 7 as
24 soon as possible after July 1, 1984.
25     The eligibility of any such person for medical assistance
26 under this Article is not affected by the payment of any grant



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1 under the Senior Citizens and Disabled Persons Property Tax
2 Relief and Pharmaceutical Assistance Act or any distributions
3 or items of income described under subparagraph (X) of
4 paragraph (2) of subsection (a) of Section 203 of the Illinois
5 Income Tax Act. The Department shall by rule establish the
6 amounts of assets to be disregarded in determining eligibility
7 for medical assistance, which shall at a minimum equal the
8 amounts to be disregarded under the Federal Supplemental
9 Security Income Program. The amount of assets of a single
10 person to be disregarded shall not be less than $2,000, and the
11 amount of assets of a married couple to be disregarded shall
12 not be less than $3,000.
13     To the extent permitted under federal law, any person found
14 guilty of a second violation of Article VIIIA shall be
15 ineligible for medical assistance under this Article, as
16 provided in Section 8A-8.
17     The eligibility of any person for medical assistance under
18 this Article shall not be affected by the receipt by the person
19 of donations or benefits from fundraisers held for the person
20 in cases of serious illness, as long as neither the person nor
21 members of the person's family have actual control over the
22 donations or benefits or the disbursement of the donations or
23 benefits.
24 (Source: P.A. 94-629, eff. 1-1-06; 94-1043, eff. 7-24-06;
25 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09.)



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