Rep. Greg Harris

Filed: 3/1/2022





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



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1Department shall secure federal financial participation in
2accordance with this Section for expenditures made by the
3Department in State Fiscal Year 2023 and every State fiscal
4year thereafter.
5    (b) By July 1, 2022, the Department of Healthcare and
6Family Services shall seek a State Plan amendment or any
7federal waivers or approvals necessary to make changes to the
8medical assistance redetermination process for people without
9any income at the time of redetermination. These changes shall
10seek to allow all people without income to be considered for ex
11parte redetermination. If there is no non-income related
12disqualifying information for medical assistance recipients
13without any income, then a person without any income shall be
14redetermined ex parte. Within 60 days after receiving federal
15approval or guidance, the Department of Healthcare and Family
16Services and the Department of Human Services shall make
17necessary technical and rule changes to implement changes to
18the redetermination process. The percentage of medical
19assistance recipients whose eligibility is renewed through the
20ex parte redetermination process shall be reported monthly by
21the Department of Healthcare and Family Services on its
22website in accordance with subsection (d) of Section 11-5.1 of
23this Code as well as shared in all Medicaid Advisory Committee
24meetings and Medicaid Advisory Committee Public Education
25Subcommittee meetings.



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1    (305 ILCS 5/5-13.1 new)
2    Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers,
3and making information about waivers more accessible.
4    (a) It is the intent of the General Assembly to ease the
5burden of liens and estate recovery for correctly paid
6benefits for participants, applicants, and their families and
7heirs, and to make information about waivers more widely
9    (b) The Department shall waive estate recovery under
10Sections 3-9 and 5-13 where recovery would not be
11cost-effective, would work an undue hardship, or for any other
12just reason, and shall make information about waivers and
13estate recovery easily accessible.
14        (1) Cost-effectiveness waiver. Subject to federal
15    approval, the Department shall waive any claim against the
16    first $25,000 of any estate to prevent substantial and
17    unreasonable hardship. The Department shall consider the
18    gross assets in the estate, including, but not limited to,
19    the net value of real estate less mortgages or liens with
20    priority over the Department's claims. The Department may
21    increase the cost-effectiveness threshold in the future.
22        (2) Undue hardship waiver. The Department may develop
23    additional hardship waiver standards in addition to those
24    already employed, including, but not limited to, waivers
25    aimed at preserving income-producing real property or a
26    modest home as defined by rule.



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



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



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



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



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1redeterminations of beneficiaries of medical assistance
2provided under Article V of this Code. In addition to the other
3data required under this subsection, the Department shall
4compile on a monthly basis data on the percentage of
5beneficiaries whose eligibility is renewed through ex parte
6redeterminations as described in subsection (b) of Section
75-1.6 of this Code, subject to federal approval of the changes
8made in subsection (b) of Section 5-1.6 by this amendatory Act
9of the 102nd General Assembly. This data shall be posted on the
10Department's website, and data from prior months shall be
11retained and available on the Department's website. The data
12compiled and reported shall include the following:
13        (1) The total number of redetermination decisions made
14    in a month and, of that total number, the number of
15    decisions to continue or change benefits and the number of
16    decisions to cancel benefits.
17        (2) A breakdown of enrollee language preference for
18    the total number of redetermination decisions made in a
19    month and, of that total number, a breakdown of enrollee
20    language preference for the number of decisions to
21    continue or change benefits, and a breakdown of enrollee
22    language preference for the number of decisions to cancel
23    benefits. The language breakdown shall include, at a
24    minimum, English, Spanish, and the next 4 most commonly
25    used languages.
26        (3) The percentage of cancellation decisions made in a



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1    month due to each of the following:
2            (A) The beneficiary's ineligibility due to excess
3        income.
4            (B) The beneficiary's ineligibility due to not
5        being an Illinois resident.
6            (C) The beneficiary's ineligibility due to being
7        deceased.
8            (D) The beneficiary's request to cancel benefits.
9            (E) The beneficiary's lack of response after
10        notices mailed to the beneficiary are returned to the
11        Department as undeliverable by the United States
12        Postal Service.
13            (F) The beneficiary's lack of response to a
14        request for additional information when reliable
15        information in the beneficiary's account, or other
16        more current information, is unavailable to the
17        Department to make a decision on whether to continue
18        benefits.
19            (G) Other reasons tracked by the Department for
20        the purpose of ensuring program integrity.
21        (4) If a vendor is utilized to provide services in
22    support of the Department's redetermination decision
23    process, the total number of redetermination decisions
24    made in a month and, of that total number, the number of
25    decisions to continue or change benefits, and the number
26    of decisions to cancel benefits (i) with the involvement



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1    of the vendor and (ii) without the involvement of the
2    vendor.
3        (5) Of the total number of benefit cancellations in a
4    month, the number of beneficiaries who return from
5    cancellation within one month, the number of beneficiaries
6    who return from cancellation within 2 months, and the
7    number of beneficiaries who return from cancellation
8    within 3 months. Of the number of beneficiaries who return
9    from cancellation within 3 months, the percentage of those
10    cancellations due to each of the reasons listed under
11    paragraph (3) of this subsection.
12    (e) The Department shall conduct a complete review of the
13Medicaid redetermination process in order to identify changes
14that can increase the use of ex parte redetermination
15processing. This review shall be completed within 90 days
16after the effective date of this amendatory Act of the 101st
17General Assembly. Within 90 days of completion of the review,
18the Department shall seek written federal approval of policy
19changes the review recommended and implement once approved.
20The review shall specifically include, but not be limited to,
21use of ex parte redeterminations of the following populations:
22        (1) Recipients of developmental disabilities services.
23        (2) Recipients of benefits under the State's Aid to
24    the Aged, Blind, or Disabled program.
25        (3) Recipients of Medicaid long-term care services and
26    supports, including waiver services.



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1        (4) All Modified Adjusted Gross Income (MAGI)
2    populations.
3        (5) Populations with no verifiable income.
4        (6) Self-employed people.
5    The report shall also outline populations and
6circumstances in which an ex parte redetermination is not a
7recommended option.
8    (f) The Department shall explore and implement, as
9practical and technologically possible, roles that
10stakeholders outside State agencies can play to assist in
11expediting eligibility determinations and redeterminations
12within 24 months after the effective date of this amendatory
13Act of the 101st General Assembly. Such practical roles to be
14explored to expedite the eligibility determination processes
15shall include the implementation of hospital presumptive
16eligibility, as authorized by the Patient Protection and
17Affordable Care Act.
18    (g) The Department or its designee shall seek federal
19approval to enhance the reasonable compatibility standard from
205% to 10%.
21    (h) Reporting. The Department of Healthcare and Family
22Services and the Department of Human Services shall publish
23quarterly reports on their progress in implementing policies
24and practices pursuant to this Section as modified by this
25amendatory Act of the 101st General Assembly.
26        (1) The reports shall include, but not be limited to,



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



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1verification system to assist in the determination of whether
2an individual's coverage can be renewed using the ex parte
3process. If a State Plan amendment is required, the Department
4shall pursue such State Plan amendment by July 1, 2022. Within
560 days after receiving federal approval or guidance, the
6Department of Healthcare and Family Services and the
7Department of Human Services shall make necessary technical
8and rule changes to implement these changes to the
9redetermination process.
10(Source: P.A. 101-209, eff. 8-5-19; 101-649, eff. 7-7-20.)
11    (305 ILCS 5/11-5.5 new)
12    Sec. 11-5.5. Streamlining enrollment into the Medicare
13Savings Program.
14    (a) The Department shall investigate how to align the
15Medicare Part D Low-Income Subsidy and Medicare Savings
16Program eligibility criteria.
17    (b) The Department shall issue a report making
18recommendations on how to streamline enrollment into Medicare
19Savings Program benefits by July 1, 2022.
20    (c) Within 90 days after issuing its report, the
21Department shall seek public feedback on those recommendations
22and plans.
23    (d) By July 1, 2023, the Department shall implement the
24necessary changes to streamline enrollment into the Medicare
25Savings Program. The Department may adopt any rules necessary



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1to implement the provisions of this paragraph.
2    (305 ILCS 5/3-10 rep.)
3    (305 ILCS 5/3-10.1 rep.)
4    (305 ILCS 5/3-10.2 rep.)
5    (305 ILCS 5/3-10.3 rep.)
6    (305 ILCS 5/3-10.4 rep.)
7    (305 ILCS 5/3-10.5 rep.)
8    (305 ILCS 5/3-10.6 rep.)
9    (305 ILCS 5/3-10.7 rep.)
10    (305 ILCS 5/3-10.8 rep.)
11    (305 ILCS 5/3-10.9 rep.)
12    (305 ILCS 5/3-10.10 rep.)
13    (305 ILCS 5/5-13.5 rep.)
14    Section 10. The Illinois Public Aid Code is amended by
15repealing Sections 3-10, 3-10.1, 3-10.2, 3-10.3, 3-10.4,
163-10.5, 3-10.6, 3-10.7, 3-10.8, 3-10.9, and 3-10.10, and
18    Section 99. Effective date. This Act takes effect upon
19becoming law.".