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90_HB0442
305 ILCS 5/5-2 from Ch. 23, par. 5-2
Amends the Public Aid Code. Requires the Department of
Public Aid and the Governor to provide a plan for Medicaid
coverage of women during and up to 60 days after pregnancy by
July 1, 1997 (now, April 1, 1990). Requires that the plan
establish an income eligibility standard equal to 185% (now,
133%) of the federal poverty line. Effective immediately.
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1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 5-2.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Section 5-2 as follows:
7 (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
8 Sec. 5-2. Classes of Persons Eligible. Medical
9 assistance under this Article shall be available to any of
10 the following classes of persons in respect to whom a plan
11 for coverage has been submitted to the Governor by the
12 Illinois Department and approved by him:
13 1. Recipients of basic maintenance grants under Articles
14 III and IV.
15 2. Persons otherwise eligible for basic maintenance
16 under Articles III and IV but who fail to qualify thereunder
17 on the basis of need, and who have insufficient income and
18 resources to meet the costs of necessary medical care,
19 including but not limited to, all persons who would be
20 determined eligible for such basic maintenance under Article
21 IV by disregarding the maximum earned income permitted by
22 federal law.
23 3. Persons who would otherwise qualify for Aid to the
24 Medically Indigent under Article VII.
25 4. Persons not eligible under any of the preceding
26 paragraphs who fall sick, are injured, or die, not having
27 sufficient money, property or other resources to meet the
28 costs of necessary medical care or funeral and burial
29 expenses.
30 5. (a) Women during pregnancy, after the fact of
31 pregnancy has been determined by medical diagnosis, and
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1 during the 60-day period beginning on the last day of the
2 pregnancy, together with their infants and children born
3 after September 30, 1983, whose income and resources are
4 insufficient to meet the costs of necessary medical care
5 to the maximum extent possible under Title XIX of the
6 Federal Social Security Act.
7 (b) The Illinois Department and the Governor shall
8 provide a plan for coverage of the persons eligible under
9 paragraph 5(a) by July April 1, 1997 1990. Such plan
10 shall provide ambulatory prenatal care to pregnant women
11 during a presumptive eligibility period and establish an
12 income eligibility standard that is equal to 185% 133% of
13 the nonfarm income official poverty line, as defined by
14 the federal Office of Management and Budget and revised
15 annually in accordance with Section 673(2) of the Omnibus
16 Budget Reconciliation Act of 1981, applicable to families
17 of the same size, provided that costs incurred for
18 medical care are not taken into account in determining
19 such income eligibility.
20 (c) The Illinois Department may conduct a
21 demonstration in at least one county that will provide
22 medical assistance to pregnant women, together with their
23 infants and children up to one year of age, where the
24 income eligibility standard is set up to 185% of the
25 nonfarm income official poverty line, as defined by the
26 federal Office of Management and Budget. The Illinois
27 Department shall seek and obtain necessary authorization
28 provided under federal law to implement such a
29 demonstration. Such demonstration may establish resource
30 standards that are not more restrictive than those
31 established under Article IV of this Code.
32 6. Persons under the age of 18 who fail to qualify as
33 dependent under Article IV and who have insufficient income
34 and resources to meet the costs of necessary medical care to
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1 the maximum extent permitted under Title XIX of the Federal
2 Social Security Act.
3 7. Persons who are 18 years of age or younger and would
4 qualify as disabled as defined under the Federal Supplemental
5 Security Income Program, provided medical service for such
6 persons would be eligible for Federal Financial
7 Participation, and provided the Illinois Department
8 determines that:
9 (a) the person requires a level of care provided by
10 a hospital, skilled nursing facility, or intermediate
11 care facility, as determined by a physician licensed to
12 practice medicine in all its branches;
13 (b) it is appropriate to provide such care outside
14 of an institution, as determined by a physician licensed
15 to practice medicine in all its branches;
16 (c) the estimated amount which would be expended
17 for care outside the institution is not greater than the
18 estimated amount which would be expended in an
19 institution.
20 8. Persons who become ineligible for basic maintenance
21 assistance under Article IV of this Code in programs
22 administered by the Illinois Department due to employment
23 earnings and persons in assistance units comprised of adults
24 and children who become ineligible for basic maintenance
25 assistance under Article VI of this Code due to employment
26 earnings. The plan for coverage for this class of persons
27 shall:
28 (a) extend the medical assistance coverage for up
29 to 12 months following termination of basic maintenance
30 assistance; and
31 (b) offer persons who have initially received 6
32 months of the coverage provided in paragraph (a) above,
33 the option of receiving an additional 6 months of
34 coverage, subject to the following:
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1 (i) such coverage shall be pursuant to
2 provisions of the federal Social Security Act;
3 (ii) such coverage shall include all services
4 covered while the person was eligible for basic
5 maintenance assistance;
6 (iii) no premium shall be charged for such
7 coverage; and
8 (iv) such coverage shall be suspended in the
9 event of a person's failure without good cause to
10 file in a timely fashion reports required for this
11 coverage under the Social Security Act and coverage
12 shall be reinstated upon the filing of such reports
13 if the person remains otherwise eligible.
14 9. Persons with acquired immunodeficiency syndrome
15 (AIDS) or with AIDS-related conditions with respect to whom
16 there has been a determination that but for home or
17 community-based services such individuals would require the
18 level of care provided in an inpatient hospital, skilled
19 nursing facility or intermediate care facility the cost of
20 which is reimbursed under this Article. Assistance shall be
21 provided to such persons to the maximum extent permitted
22 under Title XIX of the Federal Social Security Act.
23 10. Participants in the long-term care insurance
24 partnership program established under the Partnership for
25 Long-Term Care Act who meet the qualifications for protection
26 of resources described in Section 25 of that Act.
27 The Illinois Department and the Governor shall provide a
28 plan for coverage of the persons eligible under paragraph 7
29 as soon as possible after July 1, 1984.
30 The eligibility of any such person for medical assistance
31 under this Article is not affected by the payment of any
32 grant under the Senior Citizens and Disabled Persons Property
33 Tax Relief and Pharmaceutical Assistance Act. The Department
34 shall by rule establish the amounts of assets to be
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1 disregarded in determining eligibility for medical
2 assistance, which shall at a minimum equal the amounts to be
3 disregarded under the Federal Supplemental Security Income
4 Program. The amount of assets of a single person to be
5 disregarded shall not be less than $2,000, and the amount of
6 assets of a married couple to be disregarded shall not be
7 less than $3,000.
8 To the extent permitted under federal law, any person
9 found guilty of a second violation of Article VIIIA shall be
10 ineligible for medical assistance under this Article, as
11 provided in Section 8A-8.
12 The eligibility of any person for medical assistance
13 under this Article shall not be affected by the receipt by
14 the person of donations or benefits from fundraisers held for
15 the person in cases of serious illness, as long as neither
16 the person nor members of the person's family have actual
17 control over the donations or benefits or the disbursement of
18 the donations or benefits.
19 (Source: P.A. 89-525, eff. 7-19-96.)
20 Section 99. Effective date. This Act takes effect upon
21 becoming law.