Illinois General Assembly - Full Text of HB4343
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Full Text of HB4343  102nd General Assembly




State of Illinois
2021 and 2022


Introduced 1/5/2022, by Rep. Greg Harris


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    Amends the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to waive estate recovery under specified provisions of the Code where recovery would not be cost-effective, would work an undue hardship, or for any other just reason. Provides that when an estate is not valued at a minimum of $25,000, it is not cost-effective to pursue recovery. Requires the Department to pursue a State Plan amendment to establish a cost-effectiveness threshold of $25,000. Sets forth the circumstances under which an estate may apply for an undue hardship waiver. Requires the Department to make information about estate recovery and hardship waivers easily accessible. Requires the Department to maintain on its website information on how to request a hardship waiver in English, Spanish, and the next 4 most commonly used languages. In a provision concerning eligibility verification for medical assistance, requires the Department to include seniors and persons with disabilities in ex parte renewals. Requires the Department to use its asset verification system, accept the data provided about an individual's assets, and automatically renew the individual's coverage for medical assistance. Requires the Department to pursue a State Plan amendment, if required, by July 1, 2022 to implement ex parte renewals. In order to achieve efficiencies in the Medicare Savings Program's enrollment process, requires the Department to investigate how to align the eligibility criteria under the Medicare Savings Program with the criteria used by the Medicare Part D Low-Income Subsidy (LIS) program. Requires the Department to issue a report, by July 1, 2022, with its recommendations on alignment and outreach. Provides that by October 31, 2022, the Department shall change the Medicare Savings Program's eligibility criteria to facilitate the use of LIS leads data to automate or streamline enrollment into Medicare Savings Program benefits. Repeals several provisions concerning the State's authority to place a lien on a recipient's real property interests in order to recover payments made by the State on the recipient's behalf under the Aid to the Aged, Blind or Disabled program or the Medical Assistance program. Effective immediately.

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HB4343LRB102 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 5-13.1 and
611-5.5 as follows:
7    (305 ILCS 5/5-13.1 new)
8    Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers,
9and making information about waivers more accessible.
10    (a) It is the intent of the General Assembly to ease the
11burden of liens and estate recovery for correctly paid
12benefits for participants, applicants, and their families and
13heirs, and to make information about waivers more widely
15    (b) The Department shall waive estate recovery under
16Sections 3-9 and 5-13 where recovery would not be
17cost-effective, would work an undue hardship, or for any other
18just reason, and shall make information about waivers and
19estate recovery easily accessible.
20        (1) Cost-effectiveness waiver. The Department shall
21    waive recovery in cases in which it is not cost-effective
22    for the Department to recover from an estate. The estate
23    does not need to assert undue hardship. When the estate is



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1    not valued at a minimum cost-effectiveness threshold of
2    $25,000, it is not cost-effective to pursue recovery. When
3    this cost-effectiveness threshold is not met, the
4    Department shall not file a claim or otherwise pursue
5    recovery. In determining whether an estate meets this
6    cost-effectiveness threshold, the Department shall
7    consider the gross assets in the estate, including, but
8    not limited to, the net value of real estate less
9    mortgages or liens with priority over the Department's
10    claims. The Department shall pursue a State Plan amendment
11    to establish this cost-effectiveness threshold of $25,000,
12    and may increase the cost-effectiveness threshold in the
13    future.
14        (2) Undue hardship waiver. The estate may apply for a
15    waiver of estate recovery due to undue hardship. The
16    Department shall find that an undue hardship exists when:
17    (i) the estate subject to recovery is an income-producing
18    asset of survivors, such as a family farm, day care,
19    barbershop, or other family business; (ii) the estate
20    subject to recovery is a homestead of modest value defined
21    as roughly half the average home value in the county;
22    (iii) pursuing recovery would cause an heir or beneficiary
23    of the estate to become or remain eligible for a public
24    benefit program, such as the Supplemental Security Income
25    program, the Temporary Assistance for Needy Families
26    Program, or the Supplemental Nutrition Assistance Program;



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1    or (iv) any other circumstance justifies such waiver,
2    including, but not limited to, harms posed to any
3    remaining heirs or beneficiaries. The Department shall
4    develop additional hardship waiver standards in addition
5    to those set forth in this paragraph, including waivers to
6    ensure that the Department does not force the sale of a
7    home but instead works to find solutions that allow family
8    members to remain in a home.
9        (3) Accessible information. The Department shall make
10    information about estate recovery and hardship waivers
11    easily accessible. The Department shall maintain
12    information about how to request a hardship waiver on its
13    website in English, Spanish, and the next 4 most commonly
14    used languages, including a short guide and simple form to
15    facilitate requesting hardship exemptions in each
16    language. The Department shall publicly report on the
17    Department's estate recovery and waiver activities on its
18    website.
19    (305 ILCS 5/11-5.1)
20    Sec. 11-5.1. Eligibility verification. Notwithstanding any
21other provision of this Code, with respect to applications for
22medical assistance provided under Article V of this Code,
23eligibility shall be determined in a manner that ensures
24program integrity and complies with federal laws and
25regulations while minimizing unnecessary barriers to



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1enrollment. To this end, as soon as practicable, and unless
2the Department receives written denial from the federal
3government, this Section shall be implemented:
4    (a) The Department of Healthcare and Family Services or
5its designees shall:
6        (1) By no later than July 1, 2011, require
7    verification of, at a minimum, one month's income from all
8    sources required for determining the eligibility of
9    applicants for medical assistance under this Code. Such
10    verification shall take the form of pay stubs, business or
11    income and expense records for self-employed persons,
12    letters from employers, and any other valid documentation
13    of income including data obtained electronically by the
14    Department or its designees from other sources as
15    described in subsection (b) of this Section. A month's
16    income may be verified by a single pay stub with the
17    monthly income extrapolated from the time period covered
18    by the pay stub.
19        (2) By no later than October 1, 2011, require
20    verification of, at a minimum, one month's income from all
21    sources required for determining the continued eligibility
22    of recipients at their annual review of eligibility for
23    medical assistance under this Code. Information the
24    Department receives prior to the annual review, including
25    information available to the Department as a result of the
26    recipient's application for other non-Medicaid benefits,



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1    that is sufficient to make a determination of continued
2    Medicaid eligibility may be reviewed and verified, and
3    subsequent action taken including client notification of
4    continued Medicaid eligibility. The date of client
5    notification establishes the date for subsequent annual
6    Medicaid eligibility reviews. Such verification shall take
7    the form of pay stubs, business or income and expense
8    records for self-employed persons, letters from employers,
9    and any other valid documentation of income including data
10    obtained electronically by the Department or its designees
11    from other sources as described in subsection (b) of this
12    Section. A month's income may be verified by a single pay
13    stub with the monthly income extrapolated from the time
14    period covered by the pay stub. The Department shall send
15    a notice to recipients at least 60 days prior to the end of
16    their period of eligibility that informs them of the
17    requirements for continued eligibility. If a recipient
18    does not fulfill the requirements for continued
19    eligibility by the deadline established in the notice a
20    notice of cancellation shall be issued to the recipient
21    and coverage shall end no later than the last day of the
22    month following the last day of the eligibility period. A
23    recipient's eligibility may be reinstated without
24    requiring a new application if the recipient fulfills the
25    requirements for continued eligibility prior to the end of
26    the third month following the last date of coverage (or



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1    longer period if required by federal regulations). Nothing
2    in this Section shall prevent an individual whose coverage
3    has been cancelled from reapplying for health benefits at
4    any time.
5        (3) By no later than July 1, 2011, require
6    verification of Illinois residency.
7    The Department, with federal approval, may choose to adopt
8continuous financial eligibility for a full 12 months for
9adults on Medicaid.
10    (b) The Department shall establish or continue cooperative
11arrangements with the Social Security Administration, the
12Illinois Secretary of State, the Department of Human Services,
13the Department of Revenue, the Department of Employment
14Security, and any other appropriate entity to gain electronic
15access, to the extent allowed by law, to information available
16to those entities that may be appropriate for electronically
17verifying any factor of eligibility for benefits under the
18Program. Data relevant to eligibility shall be provided for no
19other purpose than to verify the eligibility of new applicants
20or current recipients of health benefits under the Program.
21Data shall be requested or provided for any new applicant or
22current recipient only insofar as that individual's
23circumstances are relevant to that individual's or another
24individual's eligibility.
25    (c) Within 90 days of the effective date of this
26amendatory Act of the 96th General Assembly, the Department of



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1Healthcare and Family Services shall send notice to current
2recipients informing them of the changes regarding their
3eligibility verification.
4    (d) As soon as practical if the data is reasonably
5available, but no later than January 1, 2017, the Department
6shall compile on a monthly basis data on eligibility
7redeterminations of beneficiaries of medical assistance
8provided under Article V of this Code. This data shall be
9posted on the Department's website, and data from prior months
10shall be retained and available on the Department's website.
11The data compiled and reported shall include the following:
12        (1) The total number of redetermination decisions made
13    in a month and, of that total number, the number of
14    decisions to continue or change benefits and the number of
15    decisions to cancel benefits.
16        (2) A breakdown of enrollee language preference for
17    the total number of redetermination decisions made in a
18    month and, of that total number, a breakdown of enrollee
19    language preference for the number of decisions to
20    continue or change benefits, and a breakdown of enrollee
21    language preference for the number of decisions to cancel
22    benefits. The language breakdown shall include, at a
23    minimum, English, Spanish, and the next 4 most commonly
24    used languages.
25        (3) The percentage of cancellation decisions made in a
26    month due to each of the following:



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1            (A) The beneficiary's ineligibility due to excess
2        income.
3            (B) The beneficiary's ineligibility due to not
4        being an Illinois resident.
5            (C) The beneficiary's ineligibility due to being
6        deceased.
7            (D) The beneficiary's request to cancel benefits.
8            (E) The beneficiary's lack of response after
9        notices mailed to the beneficiary are returned to the
10        Department as undeliverable by the United States
11        Postal Service.
12            (F) The beneficiary's lack of response to a
13        request for additional information when reliable
14        information in the beneficiary's account, or other
15        more current information, is unavailable to the
16        Department to make a decision on whether to continue
17        benefits.
18            (G) Other reasons tracked by the Department for
19        the purpose of ensuring program integrity.
20        (4) If a vendor is utilized to provide services in
21    support of the Department's redetermination decision
22    process, the total number of redetermination decisions
23    made in a month and, of that total number, the number of
24    decisions to continue or change benefits, and the number
25    of decisions to cancel benefits (i) with the involvement
26    of the vendor and (ii) without the involvement of the



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1    vendor.
2        (5) Of the total number of benefit cancellations in a
3    month, the number of beneficiaries who return from
4    cancellation within one month, the number of beneficiaries
5    who return from cancellation within 2 months, and the
6    number of beneficiaries who return from cancellation
7    within 3 months. Of the number of beneficiaries who return
8    from cancellation within 3 months, the percentage of those
9    cancellations due to each of the reasons listed under
10    paragraph (3) of this subsection.
11    (e) The Department shall conduct a complete review of the
12Medicaid redetermination process in order to identify changes
13that can increase the use of ex parte redetermination
14processing. This review shall be completed within 90 days
15after the effective date of this amendatory Act of the 101st
16General Assembly. Within 90 days of completion of the review,
17the Department shall seek written federal approval of policy
18changes the review recommended and implement once approved.
19The review shall specifically include, but not be limited to,
20use of ex parte redeterminations of the following populations:
21        (1) Recipients of developmental disabilities services.
22        (2) Recipients of benefits under the State's Aid to
23    the Aged, Blind, or Disabled program.
24        (3) Recipients of Medicaid long-term care services and
25    supports, including waiver services.
26        (4) All Modified Adjusted Gross Income (MAGI)



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1    populations.
2        (5) Populations with no verifiable income.
3        (6) Self-employed people.
4    The report shall also outline populations and
5circumstances in which an ex parte redetermination is not a
6recommended option.
7    (f) The Department shall explore and implement, as
8practical and technologically possible, roles that
9stakeholders outside State agencies can play to assist in
10expediting eligibility determinations and redeterminations
11within 24 months after the effective date of this amendatory
12Act of the 101st General Assembly. Such practical roles to be
13explored to expedite the eligibility determination processes
14shall include the implementation of hospital presumptive
15eligibility, as authorized by the Patient Protection and
16Affordable Care Act.
17    (g) The Department or its designee shall seek federal
18approval to enhance the reasonable compatibility standard from
195% to 10%.
20    (h) Reporting. The Department of Healthcare and Family
21Services and the Department of Human Services shall publish
22quarterly reports on their progress in implementing policies
23and practices pursuant to this Section as modified by this
24amendatory Act of the 101st General Assembly.
25        (1) The reports shall include, but not be limited to,
26    the following:



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1            (A) Medical application processing, including a
2        breakdown of the number of MAGI, non-MAGI, long-term
3        care, and other medical cases pending for various
4        incremental time frames between 0 to 181 or more days.
5            (B) Medical redeterminations completed, including:
6        (i) a breakdown of the number of households that were
7        redetermined ex parte and those that were not; (ii)
8        the reasons households were not redetermined ex parte;
9        and (iii) the relative percentages of these reasons.
10            (C) A narrative discussion on issues identified in
11        the functioning of the State's Integrated Eligibility
12        System and progress on addressing those issues, as
13        well as progress on implementing strategies to address
14        eligibility backlogs, including expanding ex parte
15        determinations to ensure timely eligibility
16        determinations and renewals.
17        (2) Initial reports shall be issued within 90 days
18    after the effective date of this amendatory Act of the
19    101st General Assembly.
20        (3) All reports shall be published on the Department's
21    website.
22    (i) It is the determination of the General Assembly that
23the Department must include seniors and persons with
24disabilities in ex parte renewals. Federal regulations require
25ex parte renewals for recipients of benefits under the State's
26Aid to the Aged, Blind or Disabled (AABD) program, but the



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1Department conducts few, if any, AABD ex parte renewals. This
2leaves individuals in the AABD population subject to loss of
3coverage and gaps in care, although the income in an AABD
4household is often stable and can be electronically verified.
5It is the determination of the General Assembly that the
6Department must use its asset verification system, accept the
7data provided about an individual's assets, and automatically
8renew the individual's coverage. If a State Plan amendment is
9required, the Department shall pursue such State Plan
10amendment by July 1, 2022. Within 60 days of receiving federal
11approval or guidance, the Department of Healthcare and Family
12Services and the Department of Human Services shall make
13necessary technical and rule changes to implement these
14changes to the redetermination process.
15(Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20.)
16    (305 ILCS 5/11-5.5 new)
17    Sec. 11-5.5. Streamlining enrollment into the Medicare
18Savings Program.
19    (a) It is the determination of the General Assembly that
20Medicare Savings Programs (MSPs) are under enrolled in the
21State due to beneficiaries' lack of awareness of the programs
22and MSPs' cumbersome eligibility determination and enrollment
23processes. To achieve efficiencies in the enrollment process
24and to simplify outreach to potential beneficiaries, the
25Department shall investigate how to align the Medicare Part D



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1Low-Income Subsidy (LIS) and Medicare Savings Program
2eligibility criteria. It is the intent of the General Assembly
3that under-enrollment be reduced while the Department
4maintains current rules that are more generous than the
5federal standard, and use the LIS leads data that it receives
6from the Social Security Administration to automate or
7streamline enrollment into MSP benefits.
8    (b) The Department shall issue a report making
9recommendations on alignment and outreach by July 1, 2022. The
10report shall address the following, at a minimum:
11        (1) the eligibility criteria and definitions that the
12    Department proposes to change to make full use of LIS
13    leads data, including, but not limited to, eligibility
14    criteria governing family size, income and asset
15    disregards, treatment of in-kind support, accepting the
16    burial set aside without documentation, consideration of
17    the value of a second vehicle, disregarding the cash value
18    of a life insurance policy, and any other differences
19    between the processes used to determine what is counted as
20    income or assets between MSP and LIS;
21        (2) any other eligibility changes or program
22    improvements the Department will adopt, including, but not
23    limited to, removing the asset test for MSPs or
24    implementing improvements to make better use of the LIS
25    leads data transmitted to the Department, and
26        (3) the Department's plan for targeted outreach to



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1    increase MSP enrollment.
2    (c) Within 60 days of issuing its report, the Department
3shall seek public feedback on those recommendations and plans.
4    (d) By October 31, 2022, in response to the report and
5public feedback, the Department shall change the MSP
6eligibility criteria to facilitate the use of LIS leads data
7to automate or streamline enrollment into MSP benefits. The
8Department may adopt any rules necessary to implement the
9provisions of this paragraph.
10    (305 ILCS 5/3-10 rep.)
11    (305 ILCS 5/3-10.1 rep.)
12    (305 ILCS 5/3-10.2 rep.)
13    (305 ILCS 5/3-10.3 rep.)
14    (305 ILCS 5/3-10.4 rep.)
15    (305 ILCS 5/3-10.5 rep.)
16    (305 ILCS 5/3-10.6 rep.)
17    (305 ILCS 5/3-10.7 rep.)
18    (305 ILCS 5/3-10.8 rep.)
19    (305 ILCS 5/3-10.9 rep.)
20    (305 ILCS 5/3-10.10 rep.)
21    (305 ILCS 5/5-13.5 rep.)
22    Section 10. The Illinois Public Aid Code is amended by
23repealing Sections 3-10, 3-10.1, 3-10.2, 3-10.3, 3-10.4,
243-10.5, 3-10.6, 3-10.7, 3-10.8, 3-10.9, and 3-10.10, and



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



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2 Statutes amended in order of appearance
3    305 ILCS 5/5-13.1 new
4    305 ILCS 5/11-5.1
5    305 ILCS 5/11-5.5 new
6    305 ILCS 5/3-10 rep.
7    305 ILCS 5/3-10.1 rep.
8    305 ILCS 5/3-10.2 rep.
9    305 ILCS 5/3-10.3 rep.
10    305 ILCS 5/3-10.4 rep.
11    305 ILCS 5/3-10.5 rep.
12    305 ILCS 5/3-10.6 rep.
13    305 ILCS 5/3-10.7 rep.
14    305 ILCS 5/3-10.8 rep.
15    305 ILCS 5/3-10.9 rep.
16    305 ILCS 5/3-10.10 rep.
17    305 ILCS 5/5-13.5 rep.