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


Rep. Greg Harris

Filed: 2/10/2022





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2    AMENDMENT NO. ______. Amend House Bill 4343 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 11-5.1 and by adding Sections 5-1.6, 5-13.1
6and 11-5.5 as follows:
7    (305 ILCS 5/5-1.6 new)
8    Sec. 5-1.6. Continuous eligibility; ex parte
10    (a) By July 1, 2022, the Department of Healthcare and
11Family Services shall seek a State Plan amendment or any
12federal waivers necessary to make changes to the medical
13assistance program. The Department shall apply for federal
14approval to implement 12 months of continuous eligibility for
15adults participating in the medical assistance program. The
16Department shall secure federal financial participation in



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1accordance with this Section for expenditures made by the
2Department in State Fiscal Year 2023 and every State fiscal
3year thereafter.
4    (b) By July 1, 2022, the Department of Healthcare and
5Family Services shall seek a State Plan amendment or any
6federal waivers or approvals necessary to make changes to the
7medical assistance redetermination process for people
8experiencing homelessness and for people without any income at
9the time of application or redetermination. These changes
10shall seek to move all people experiencing homelessness and
11people without income into an automated redetermination
12process, commonly referred to as ex parte redetermination.
13Within 60 days of receiving federal approval or guidance, the
14Department of Healthcare and Family Services and the
15Department of Human Services shall make necessary technical
16and rule changes to implement changes to the redetermination
17process. Upon the receipt of federal approval or guidance, the
18Department of Healthcare and Family Services and the
19Department of Human Services shall produce internal guidance
20to all agency staff to inform them of these changes. The
21percentage of medical assistance recipients whose eligibility
22is renewed through the ex parte redetermination process shall
23be reported monthly by the Department of Healthcare and Family
24Services on its website in accordance with subsection (d) of
25Section 11-5.1 of this Code as well as shared in all Medicaid
26Advisory Committee meetings and Medicaid Advisory Committee



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1Public Education Subcommittee meetings.
2    (305 ILCS 5/5-13.1 new)
3    Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers,
4and making information about waivers more accessible.
5    (a) It is the intent of the General Assembly to ease the
6burden of liens and estate recovery for correctly paid
7benefits for participants, applicants, and their families and
8heirs, and to make information about waivers more widely
10    (b) The Department shall waive estate recovery under
11Sections 3-9 and 5-13 where recovery would not be
12cost-effective, would work an undue hardship, or for any other
13just reason, and shall make information about waivers and
14estate recovery easily accessible.
15        (1) Cost-effectiveness waiver. The Department shall
16    waive recovery in cases in which it is not cost-effective
17    for the Department to recover from an estate. The estate
18    does not need to assert undue hardship. When the estate is
19    not valued at a minimum cost-effectiveness threshold of
20    $25,000, it is not cost-effective to pursue recovery. When
21    this cost-effectiveness threshold is not met, the
22    Department shall not file a claim or otherwise pursue
23    recovery. In determining whether an estate meets this
24    cost-effectiveness threshold, the Department shall
25    consider the gross assets in the estate, including, but



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1    not limited to, the net value of real estate less
2    mortgages or liens with priority over the Department's
3    claims. The Department shall pursue a State Plan amendment
4    to establish this cost-effectiveness threshold of $25,000,
5    and may increase the cost-effectiveness threshold in the
6    future.
7        (2) Undue hardship waiver. The estate may apply for a
8    waiver of estate recovery due to undue hardship. The
9    Department shall find that an undue hardship exists when:
10    (i) the estate subject to recovery is an income-producing
11    asset of survivors, such as a family farm, day care,
12    barbershop, or other family business; (ii) the estate
13    subject to recovery is a homestead of modest value defined
14    as roughly half the average home value in the county;
15    (iii) pursuing recovery would cause an heir or beneficiary
16    of the estate to become or remain eligible for a public
17    benefit program, such as the Supplemental Security Income
18    program, the Temporary Assistance for Needy Families
19    Program, or the Supplemental Nutrition Assistance Program;
20    or (iv) any other circumstance justifies such waiver,
21    including, but not limited to, harms posed to any
22    remaining heirs or beneficiaries. The Department shall
23    develop additional hardship waiver standards in addition
24    to those set forth in this paragraph, including waivers to
25    ensure that the Department does not force the sale of a
26    home but instead works to find solutions that allow family



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1    members to remain in a home.
2        (3) Accessible information. The Department shall make
3    information about estate recovery and hardship waivers
4    easily accessible. The Department shall maintain
5    information about how to request a hardship waiver on its
6    website in English, Spanish, and the next 4 most commonly
7    used languages, including a short guide and simple form to
8    facilitate requesting hardship exemptions in each
9    language. The Department shall publicly report on the
10    Department's estate recovery and waiver activities on its
11    website.
12    (305 ILCS 5/11-5.1)
13    Sec. 11-5.1. Eligibility verification. Notwithstanding any
14other provision of this Code, with respect to applications for
15medical assistance provided under Article V of this Code,
16eligibility shall be determined in a manner that ensures
17program integrity and complies with federal laws and
18regulations while minimizing unnecessary barriers to
19enrollment. To this end, as soon as practicable, and unless
20the Department receives written denial from the federal
21government, this Section shall be implemented:
22    (a) The Department of Healthcare and Family Services or
23its designees shall:
24        (1) By no later than July 1, 2011, require
25    verification of, at a minimum, one month's income from all



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



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1    records for self-employed persons, letters from employers,
2    and any other valid documentation of income including data
3    obtained electronically by the Department or its designees
4    from other sources as described in subsection (b) of this
5    Section. A month's income may be verified by a single pay
6    stub with the monthly income extrapolated from the time
7    period covered by the pay stub. The Department shall send
8    a notice to recipients at least 60 days prior to the end of
9    their period of eligibility that informs them of the
10    requirements for continued eligibility. If a recipient
11    does not fulfill the requirements for continued
12    eligibility by the deadline established in the notice a
13    notice of cancellation shall be issued to the recipient
14    and coverage shall end no later than the last day of the
15    month following the last day of the eligibility period. A
16    recipient's eligibility may be reinstated without
17    requiring a new application if the recipient fulfills the
18    requirements for continued eligibility prior to the end of
19    the third month following the last date of coverage (or
20    longer period if required by federal regulations). Nothing
21    in this Section shall prevent an individual whose coverage
22    has been cancelled from reapplying for health benefits at
23    any time.
24        (3) By no later than July 1, 2011, require
25    verification of Illinois residency.
26    The Department, with federal approval, may choose to adopt



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1continuous financial eligibility for a full 12 months for
2adults on Medicaid.
3    (b) The Department shall establish or continue cooperative
4arrangements with the Social Security Administration, the
5Illinois Secretary of State, the Department of Human Services,
6the Department of Revenue, the Department of Employment
7Security, and any other appropriate entity to gain electronic
8access, to the extent allowed by law, to information available
9to those entities that may be appropriate for electronically
10verifying any factor of eligibility for benefits under the
11Program. Data relevant to eligibility shall be provided for no
12other purpose than to verify the eligibility of new applicants
13or current recipients of health benefits under the Program.
14Data shall be requested or provided for any new applicant or
15current recipient only insofar as that individual's
16circumstances are relevant to that individual's or another
17individual's eligibility.
18    (c) Within 90 days of the effective date of this
19amendatory Act of the 96th General Assembly, the Department of
20Healthcare and Family Services shall send notice to current
21recipients informing them of the changes regarding their
22eligibility verification.
23    (d) As soon as practical if the data is reasonably
24available, but no later than January 1, 2017, the Department
25shall compile on a monthly basis data on eligibility
26redeterminations of beneficiaries of medical assistance



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1provided under Article V of this Code. In additional to the
2other data required under this subsection, the Department
3shall compile on a monthly basis data on the percentage of
4beneficiaries whose eligibility is renewed through ex parte
5redeterminations as described in subsection (b) of Section
65-1.6 of this Code, subject to federal approval of the changes
7made in subsection (b) of Section 5-1.6 by this amendatory Act
8of the 102nd General Assembly. This data shall be posted on the
9Department's website, and data from prior months shall be
10retained and available on the Department's website. The data
11compiled 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.".