Illinois General Assembly - Full Text of HB1041
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Full Text of HB1041  103rd General Assembly




State of Illinois
2023 and 2024


Introduced 1/12/2023, by Rep. Mary E. Flowers


305 ILCS 5/5-2  from Ch. 23, par. 5-2

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Extends medical assistance coverage to all women of childbearing age regardless of income level. Requires a hospital licensed under the Hospital Licensing Act or organized under the University of Illinois Hospital Act to complete and submit an application for medical assistance on behalf of every uninsured woman of childbearing age who is admitted to the hospital for inpatient or outpatient services. Provides that upon receipt of an application for medical assistance for a woman of childbearing age, the Department of Human Services shall as soon as practicable enroll the woman into the medical assistance program. Grants the Department of Healthcare and Family Services and the Department of Human Services rulemaking authority to implement the amendatory Act. Requires the Department of Healthcare and Family Services to apply for any federal waivers or State Plan amendments, if required, to implement the amendatory Act. Provides that implementation is contingent on federal approval. Effective immediately.

LRB103 04703 KTG 49712 b





HB1041LRB103 04703 KTG 49712 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 5-2 as follows:
6    (305 ILCS 5/5-2)  (from Ch. 23, par. 5-2)
7    Sec. 5-2. Classes of persons eligible. Medical assistance
8under this Article shall be available to any of the following
9classes of persons in respect to whom a plan for coverage has
10been submitted to the Governor by the Illinois Department and
11approved by him. If changes made in this Section 5-2 require
12federal approval, they shall not take effect until such
13approval has been received:
14        1. Recipients of basic maintenance grants under
15    Articles III and IV.
16        2. Beginning January 1, 2014, persons otherwise
17    eligible for basic maintenance under Article III,
18    excluding any eligibility requirements that are
19    inconsistent with any federal law or federal regulation,
20    as interpreted by the U.S. Department of Health and Human
21    Services, but who fail to qualify thereunder on the basis
22    of need, and who have insufficient income and resources to
23    meet the costs of necessary medical care, including, but



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1    not limited to, the following:
2            (a) All persons otherwise eligible for basic
3        maintenance under Article III but who fail to qualify
4        under that Article on the basis of need and who meet
5        either of the following requirements:
6                (i) their income, as determined by the
7            Illinois Department in accordance with any federal
8            requirements, is equal to or less than 100% of the
9            federal poverty level; or
10                (ii) their income, after the deduction of
11            costs incurred for medical care and for other
12            types of remedial care, is equal to or less than
13            100% of the federal poverty level.
14            (b) (Blank).
15        3. (Blank).
16        4. Persons not eligible under any of the preceding
17    paragraphs who fall sick, are injured, or die, not having
18    sufficient money, property or other resources to meet the
19    costs of necessary medical care or funeral and burial
20    expenses.
21        5.(a) Beginning January 1, 2020, individuals during
22    pregnancy and during the 12-month period beginning on the
23    last day of the pregnancy, together with their infants,
24    whose income is at or below 200% of the federal poverty
25    level. Until September 30, 2019, or sooner if the
26    maintenance of effort requirements under the Patient



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1    Protection and Affordable Care Act are eliminated or may
2    be waived before then, individuals during pregnancy and
3    during the 12-month period beginning on the last day of
4    the pregnancy, whose countable monthly income, after the
5    deduction of costs incurred for medical care and for other
6    types of remedial care as specified in administrative
7    rule, is equal to or less than the Medical Assistance-No
8    Grant(C) (MANG(C)) Income Standard in effect on April 1,
9    2013 as set forth in administrative rule.
10        (b) The plan for coverage shall provide ambulatory
11    prenatal care to pregnant individuals during a presumptive
12    eligibility period and establish an income eligibility
13    standard that is equal to 200% of the federal poverty
14    level, provided that costs incurred for medical care are
15    not taken into account in determining such income
16    eligibility.
17        (c) The Illinois Department may conduct a
18    demonstration in at least one county that will provide
19    medical assistance to pregnant individuals together with
20    their infants and children up to one year of age, where the
21    income eligibility standard is set up to 185% of the
22    nonfarm income official poverty line, as defined by the
23    federal Office of Management and Budget. The Illinois
24    Department shall seek and obtain necessary authorization
25    provided under federal law to implement such a
26    demonstration. Such demonstration may establish resource



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1    standards that are not more restrictive than those
2    established under Article IV of this Code.
3        6. (a) Subject to federal approval, children younger
4    than age 19 when countable income is at or below 313% of
5    the federal poverty level, as determined by the Department
6    and in accordance with all applicable federal
7    requirements. The Department is authorized to adopt
8    emergency rules to implement the changes made to this
9    paragraph by Public Act 102-43. Until September 30, 2019,
10    or sooner if the maintenance of effort requirements under
11    the Patient Protection and Affordable Care Act are
12    eliminated or may be waived before then, children younger
13    than age 19 whose countable monthly income, after the
14    deduction of costs incurred for medical care and for other
15    types of remedial care as specified in administrative
16    rule, is equal to or less than the Medical Assistance-No
17    Grant(C) (MANG(C)) Income Standard in effect on April 1,
18    2013 as set forth in administrative rule.
19        (b) Children and youth who are under temporary custody
20    or guardianship of the Department of Children and Family
21    Services or who receive financial assistance in support of
22    an adoption or guardianship placement from the Department
23    of Children and Family Services.
24        7. (Blank).
25        8. As required under federal law, persons who are
26    eligible for Transitional Medical Assistance as a result



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



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



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1        to 26 U.S.C. 220;
2            (c) allow non-exempt assets up to $25,000 as to
3        those assets accumulated during periods of eligibility
4        under this paragraph 11; and
5            (d) continue to apply subparagraphs (b) and (c) in
6        determining the eligibility of the person under this
7        Article even if the person loses eligibility under
8        this paragraph 11.
9        12. Subject to federal approval, persons who are
10    eligible for medical assistance coverage under applicable
11    provisions of the federal Social Security Act and the
12    federal Breast and Cervical Cancer Prevention and
13    Treatment Act of 2000. Those eligible persons are defined
14    to include, but not be limited to, the following persons:
15            (1) persons who have been screened for breast or
16        cervical cancer under the U.S. Centers for Disease
17        Control and Prevention Breast and Cervical Cancer
18        Program established under Title XV of the federal
19        Public Health Service Act in accordance with the
20        requirements of Section 1504 of that Act as
21        administered by the Illinois Department of Public
22        Health; and
23            (2) persons whose screenings under the above
24        program were funded in whole or in part by funds
25        appropriated to the Illinois Department of Public
26        Health for breast or cervical cancer screening.



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1        "Medical assistance" under this paragraph 12 shall be
2    identical to the benefits provided under the State's
3    approved plan under Title XIX of the Social Security Act.
4    The Department must request federal approval of the
5    coverage under this paragraph 12 within 30 days after July
6    3, 2001 (the effective date of Public Act 92-47).
7        In addition to the persons who are eligible for
8    medical assistance pursuant to subparagraphs (1) and (2)
9    of this paragraph 12, and to be paid from funds
10    appropriated to the Department for its medical programs,
11    any uninsured person as defined by the Department in rules
12    residing in Illinois who is younger than 65 years of age,
13    who has been screened for breast and cervical cancer in
14    accordance with standards and procedures adopted by the
15    Department of Public Health for screening, and who is
16    referred to the Department by the Department of Public
17    Health as being in need of treatment for breast or
18    cervical cancer is eligible for medical assistance
19    benefits that are consistent with the benefits provided to
20    those persons described in subparagraphs (1) and (2).
21    Medical assistance coverage for the persons who are
22    eligible under the preceding sentence is not dependent on
23    federal approval, but federal moneys may be used to pay
24    for services provided under that coverage upon federal
25    approval.
26        13. Subject to appropriation and to federal approval,



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1    persons living with HIV/AIDS who are not otherwise
2    eligible under this Article and who qualify for services
3    covered under Section 5-5.04 as provided by the Illinois
4    Department by rule.
5        14. Subject to the availability of funds for this
6    purpose, the Department may provide coverage under this
7    Article to persons who reside in Illinois who are not
8    eligible under any of the preceding paragraphs and who
9    meet the income guidelines of paragraph 2(a) of this
10    Section and (i) have an application for asylum pending
11    before the federal Department of Homeland Security or on
12    appeal before a court of competent jurisdiction and are
13    represented either by counsel or by an advocate accredited
14    by the federal Department of Homeland Security and
15    employed by a not-for-profit organization in regard to
16    that application or appeal, or (ii) are receiving services
17    through a federally funded torture treatment center.
18    Medical coverage under this paragraph 14 may be provided
19    for up to 24 continuous months from the initial
20    eligibility date so long as an individual continues to
21    satisfy the criteria of this paragraph 14. If an
22    individual has an appeal pending regarding an application
23    for asylum before the Department of Homeland Security,
24    eligibility under this paragraph 14 may be extended until
25    a final decision is rendered on the appeal. The Department
26    may adopt rules governing the implementation of this



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1    paragraph 14.
2        15. Family Care Eligibility.
3            (a) On and after July 1, 2012, a parent or other
4        caretaker relative who is 19 years of age or older when
5        countable income is at or below 133% of the federal
6        poverty level. A person may not spend down to become
7        eligible under this paragraph 15.
8            (b) Eligibility shall be reviewed annually.
9            (c) (Blank).
10            (d) (Blank).
11            (e) (Blank).
12            (f) (Blank).
13            (g) (Blank).
14            (h) (Blank).
15            (i) Following termination of an individual's
16        coverage under this paragraph 15, the individual must
17        be determined eligible before the person can be
18        re-enrolled.
19        16. Subject to appropriation, uninsured persons who
20    are not otherwise eligible under this Section who have
21    been certified and referred by the Department of Public
22    Health as having been screened and found to need
23    diagnostic evaluation or treatment, or both diagnostic
24    evaluation and treatment, for prostate or testicular
25    cancer. For the purposes of this paragraph 16, uninsured
26    persons are those who do not have creditable coverage, as



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1    defined under the Health Insurance Portability and
2    Accountability Act, or have otherwise exhausted any
3    insurance benefits they may have had, for prostate or
4    testicular cancer diagnostic evaluation or treatment, or
5    both diagnostic evaluation and treatment. To be eligible,
6    a person must furnish a Social Security number. A person's
7    assets are exempt from consideration in determining
8    eligibility under this paragraph 16. Such persons shall be
9    eligible for medical assistance under this paragraph 16
10    for so long as they need treatment for the cancer. A person
11    shall be considered to need treatment if, in the opinion
12    of the person's treating physician, the person requires
13    therapy directed toward cure or palliation of prostate or
14    testicular cancer, including recurrent metastatic cancer
15    that is a known or presumed complication of prostate or
16    testicular cancer and complications resulting from the
17    treatment modalities themselves. Persons who require only
18    routine monitoring services are not considered to need
19    treatment. "Medical assistance" under this paragraph 16
20    shall be identical to the benefits provided under the
21    State's approved plan under Title XIX of the Social
22    Security Act. Notwithstanding any other provision of law,
23    the Department (i) does not have a claim against the
24    estate of a deceased recipient of services under this
25    paragraph 16 and (ii) does not have a lien against any
26    homestead property or other legal or equitable real



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1    property interest owned by a recipient of services under
2    this paragraph 16.
3        17. Persons who, pursuant to a waiver approved by the
4    Secretary of the U.S. Department of Health and Human
5    Services, are eligible for medical assistance under Title
6    XIX or XXI of the federal Social Security Act.
7    Notwithstanding any other provision of this Code and
8    consistent with the terms of the approved waiver, the
9    Illinois Department, may by rule:
10            (a) Limit the geographic areas in which the waiver
11        program operates.
12            (b) Determine the scope, quantity, duration, and
13        quality, and the rate and method of reimbursement, of
14        the medical services to be provided, which may differ
15        from those for other classes of persons eligible for
16        assistance under this Article.
17            (c) Restrict the persons' freedom in choice of
18        providers.
19        18. Beginning January 1, 2014, persons aged 19 or
20    older, but younger than 65, who are not otherwise eligible
21    for medical assistance under this Section 5-2, who qualify
22    for medical assistance pursuant to 42 U.S.C.
23    1396a(a)(10)(A)(i)(VIII) and applicable federal
24    regulations, and who have income at or below 133% of the
25    federal poverty level plus 5% for the applicable family
26    size as determined pursuant to 42 U.S.C. 1396a(e)(14) and



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1    applicable federal regulations. Persons eligible for
2    medical assistance under this paragraph 18 shall receive
3    coverage for the Health Benefits Service Package as that
4    term is defined in subsection (m) of Section 5-1.1 of this
5    Code. If Illinois' federal medical assistance percentage
6    (FMAP) is reduced below 90% for persons eligible for
7    medical assistance under this paragraph 18, eligibility
8    under this paragraph 18 shall cease no later than the end
9    of the third month following the month in which the
10    reduction in FMAP takes effect.
11        19. Beginning January 1, 2014, as required under 42
12    U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
13    and younger than age 26 who are not otherwise eligible for
14    medical assistance under paragraphs (1) through (17) of
15    this Section who (i) were in foster care under the
16    responsibility of the State on the date of attaining age
17    18 or on the date of attaining age 21 when a court has
18    continued wardship for good cause as provided in Section
19    2-31 of the Juvenile Court Act of 1987 and (ii) received
20    medical assistance under the Illinois Title XIX State Plan
21    or waiver of such plan while in foster care.
22        20. Beginning January 1, 2018, persons who are
23    foreign-born victims of human trafficking, torture, or
24    other serious crimes as defined in Section 2-19 of this
25    Code and their derivative family members if such persons:
26    (i) reside in Illinois; (ii) are not eligible under any of



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1    the preceding paragraphs; (iii) meet the income guidelines
2    of subparagraph (a) of paragraph 2; and (iv) meet the
3    nonfinancial eligibility requirements of Sections 16-2,
4    16-3, and 16-5 of this Code. The Department may extend
5    medical assistance for persons who are foreign-born
6    victims of human trafficking, torture, or other serious
7    crimes whose medical assistance would be terminated
8    pursuant to subsection (b) of Section 16-5 if the
9    Department determines that the person, during the year of
10    initial eligibility (1) experienced a health crisis, (2)
11    has been unable, after reasonable attempts, to obtain
12    necessary information from a third party, or (3) has other
13    extenuating circumstances that prevented the person from
14    completing his or her application for status. The
15    Department may adopt any rules necessary to implement the
16    provisions of this paragraph.
17        21. Persons who are not otherwise eligible for medical
18    assistance under this Section who may qualify for medical
19    assistance pursuant to 42 U.S.C.
20    1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the
21    duration of any federal or State declared emergency due to
22    COVID-19. Medical assistance to persons eligible for
23    medical assistance solely pursuant to this paragraph 21
24    shall be limited to any in vitro diagnostic product (and
25    the administration of such product) described in 42 U.S.C.
26    1396d(a)(3)(B) on or after March 18, 2020, any visit



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1    described in 42 U.S.C. 1396o(a)(2)(G), or any other
2    medical assistance that may be federally authorized for
3    this class of persons. The Department may also cover
4    treatment of COVID-19 for this class of persons, or any
5    similar category of uninsured individuals, to the extent
6    authorized under a federally approved 1115 Waiver or other
7    federal authority. Notwithstanding the provisions of
8    Section 1-11 of this Code, due to the nature of the
9    COVID-19 public health emergency, the Department may cover
10    and provide the medical assistance described in this
11    paragraph 21 to noncitizens who would otherwise meet the
12    eligibility requirements for the class of persons
13    described in this paragraph 21 for the duration of the
14    State emergency period.
15        22. All women of childbearing age regardless of income
16    level. A hospital licensed under the Hospital Licensing
17    Act or organized under the University of Illinois Hospital
18    Act must complete and submit an application for medical
19    assistance on behalf of every uninsured woman of
20    childbearing age who is admitted to the hospital for
21    inpatient or outpatient services. Upon receipt of an
22    application for medical assistance for a woman of
23    childbearing age, the Department of Human Services shall
24    as soon as practicable enroll the woman into the medical
25    assistance program. The Department of Healthcare and
26    Family Services and the Department of Human Services may



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1    adopt any rules necessary to implement this paragraph. The
2    Department of Healthcare and Family Services shall apply
3    for any federal waivers or State Plan amendments, if
4    required, to implement this paragraph. Implementation of
5    this paragraph is contingent on federal approval.
6    In implementing the provisions of Public Act 96-20, the
7Department is authorized to adopt only those rules necessary,
8including emergency rules. Nothing in Public Act 96-20 permits
9the Department to adopt rules or issue a decision that expands
10eligibility for the FamilyCare Program to a person whose
11income exceeds 185% of the Federal Poverty Level as determined
12from time to time by the U.S. Department of Health and Human
13Services, unless the Department is provided with express
14statutory authority.
15    The eligibility of any such person for medical assistance
16under this Article is not affected by the payment of any grant
17under the Senior Citizens and Persons with Disabilities
18Property Tax Relief Act or any distributions or items of
19income described under subparagraph (X) of paragraph (2) of
20subsection (a) of Section 203 of the Illinois Income Tax Act.
21    The Department shall by rule establish the amounts of
22assets to be disregarded in determining eligibility for
23medical assistance, which shall at a minimum equal the amounts
24to be disregarded under the Federal Supplemental Security
25Income Program. The amount of assets of a single person to be
26disregarded shall not be less than $2,000, and the amount of



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1assets of a married couple to be disregarded shall not be less
2than $3,000.
3    To the extent permitted under federal law, any person
4found guilty of a second violation of Article VIIIA shall be
5ineligible for medical assistance under this Article, as
6provided in Section 8A-8.
7    The eligibility of any person for medical assistance under
8this Article shall not be affected by the receipt by the person
9of donations or benefits from fundraisers held for the person
10in cases of serious illness, as long as neither the person nor
11members of the person's family have actual control over the
12donations or benefits or the disbursement of the donations or
14    Notwithstanding any other provision of this Code, if the
15United States Supreme Court holds Title II, Subtitle A,
16Section 2001(a) of Public Law 111-148 to be unconstitutional,
17or if a holding of Public Law 111-148 makes Medicaid
18eligibility allowed under Section 2001(a) inoperable, the
19State or a unit of local government shall be prohibited from
20enrolling individuals in the Medical Assistance Program as the
21result of federal approval of a State Medicaid waiver on or
22after June 14, 2012 (the effective date of Public Act 97-687),
23and any individuals enrolled in the Medical Assistance Program
24pursuant to eligibility permitted as a result of such a State
25Medicaid waiver shall become immediately ineligible.
26    Notwithstanding any other provision of this Code, if an



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1Act of Congress that becomes a Public Law eliminates Section
22001(a) of Public Law 111-148, the State or a unit of local
3government shall be prohibited from enrolling individuals in
4the Medical Assistance Program as the result of federal
5approval of a State Medicaid waiver on or after June 14, 2012
6(the effective date of Public Act 97-687), and any individuals
7enrolled in the Medical Assistance Program pursuant to
8eligibility permitted as a result of such a State Medicaid
9waiver shall become immediately ineligible.
10    Effective October 1, 2013, the determination of
11eligibility of persons who qualify under paragraphs 5, 6, 8,
1215, 17, and 18 of this Section shall comply with the
13requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
15    The Department of Healthcare and Family Services, the
16Department of Human Services, and the Illinois health
17insurance marketplace shall work cooperatively to assist
18persons who would otherwise lose health benefits as a result
19of changes made under Public Act 98-104 to transition to other
20health insurance coverage.
21(Source: P.A. 101-10, eff. 6-5-19; 101-649, eff. 7-7-20;
22102-43, eff. 7-6-21; 102-558, eff. 8-20-21; 102-665, eff.
2310-8-21; 102-813, eff. 5-13-22.)
24    Section 99. Effective date. This Act takes effect upon
25becoming law.