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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 1. Findings. The General Assembly finds it is in | ||||||||||||||||||||||||||||
5 | the best interests of the State to take advantage of the | ||||||||||||||||||||||||||||
6 | Patient Protection and Affordable Care Act to enable Illinois | ||||||||||||||||||||||||||||
7 | to receive enhanced federal revenue to cover the costs of | ||||||||||||||||||||||||||||
8 | health care for low-income adults who are otherwise not | ||||||||||||||||||||||||||||
9 | eligible for Medicaid. The General Assembly further finds that | ||||||||||||||||||||||||||||
10 | the administration and financing of the Medicaid program must | ||||||||||||||||||||||||||||
11 | be sound to ensure Illinois may take full advantage of national | ||||||||||||||||||||||||||||
12 | health care reform to keep people healthier; reimburse | ||||||||||||||||||||||||||||
13 | hospitals and clinics for uncompensated and charity care for | ||||||||||||||||||||||||||||
14 | the uninsured; and replace spending by county and local | ||||||||||||||||||||||||||||
15 | governments for healthcare costs now borne by local health | ||||||||||||||||||||||||||||
16 | departments, social service agencies, homeless shelters, | ||||||||||||||||||||||||||||
17 | mental health clinics, drug treatment centers, township | ||||||||||||||||||||||||||||
18 | organizations, and others for the care of the uninsured. | ||||||||||||||||||||||||||||
19 | Accordingly, the General Assembly finds that, while filling the | ||||||||||||||||||||||||||||
20 | current gap in Medicaid coverage, it is essential that the | ||||||||||||||||||||||||||||
21 | State preserve and extend recent efforts to reform Illinois' | ||||||||||||||||||||||||||||
22 | Medicaid program. Changes designed to increase efficiencies | ||||||||||||||||||||||||||||
23 | and enhance program integrity must continue to prevent client | ||||||||||||||||||||||||||||
24 | and provider fraud and abuse; to impose controls on use of |
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| |||||||
1 | Medicaid services to prevent over-use or waste; to rationalize | ||||||
2 | the Medicaid health care delivery system by adopting care | ||||||
3 | coordination models wherever feasible to achieve effective and | ||||||
4 | efficient care delivery across all covered services; and to | ||||||
5 | operate the program within budget limits.
| ||||||
6 | Section 5. The Illinois Public Aid Code is amended by | ||||||
7 | changing Sections 5-1.1, 5-1.4, and 5-2 as follows:
| ||||||
8 | (305 ILCS 5/5-1.1) (from Ch. 23, par. 5-1.1)
| ||||||
9 | Sec. 5-1.1. Definitions. The terms defined in this Section
| ||||||
10 | shall have the meanings ascribed to them, except when the
| ||||||
11 | context otherwise requires.
| ||||||
12 | (a) "Nursing facility" means a facility, licensed by the | ||||||
13 | Department of Public Health under the Nursing Home Care Act, | ||||||
14 | that provides nursing facility services within the meaning of | ||||||
15 | Title XIX of
the federal Social Security Act.
| ||||||
16 | (b) "Intermediate care facility for the developmentally | ||||||
17 | disabled" or "ICF/DD" means a facility, licensed by the | ||||||
18 | Department of Public Health under the ID/DD Community Care Act, | ||||||
19 | that is an intermediate care facility for the mentally retarded | ||||||
20 | within the meaning of Title XIX
of the federal Social Security | ||||||
21 | Act.
| ||||||
22 | (c) "Standard services" means those services required for
| ||||||
23 | the care of all patients in the facility and shall, as a
| ||||||
24 | minimum, include the following: (1) administration; (2)
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| |||||||
1 | dietary (standard); (3) housekeeping; (4) laundry and linen;
| ||||||
2 | (5) maintenance of property and equipment, including | ||||||
3 | utilities;
(6) medical records; (7) training of employees; (8) | ||||||
4 | utilization
review; (9) activities services; (10) social | ||||||
5 | services; (11)
disability services; and all other similar | ||||||
6 | services required
by either the laws of the State of Illinois | ||||||
7 | or one of its
political subdivisions or municipalities or by | ||||||
8 | Title XIX of
the Social Security Act.
| ||||||
9 | (d) "Patient services" means those which vary with the
| ||||||
10 | number of personnel; professional and para-professional
skills | ||||||
11 | of the personnel; specialized equipment, and reflect
the | ||||||
12 | intensity of the medical and psycho-social needs of the
| ||||||
13 | patients. Patient services shall as a minimum include:
(1) | ||||||
14 | physical services; (2) nursing services, including
restorative | ||||||
15 | nursing; (3) medical direction and patient care
planning; (4) | ||||||
16 | health related supportive and habilitative
services and all | ||||||
17 | similar services required by either the
laws of the State of | ||||||
18 | Illinois or one of its political
subdivisions or municipalities | ||||||
19 | or by Title XIX of the
Social Security Act.
| ||||||
20 | (e) "Ancillary services" means those services which
| ||||||
21 | require a specific physician's order and defined as under
the | ||||||
22 | medical assistance program as not being routine in
nature for | ||||||
23 | skilled nursing facilities and ICF/DDs.
Such services | ||||||
24 | generally must be authorized prior to delivery
and payment as | ||||||
25 | provided for under the rules of the Department
of Healthcare | ||||||
26 | and Family Services.
|
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| |||||||
1 | (f) "Capital" means the investment in a facility's assets
| ||||||
2 | for both debt and non-debt funds. Non-debt capital is the
| ||||||
3 | difference between an adjusted replacement value of the assets
| ||||||
4 | and the actual amount of debt capital.
| ||||||
5 | (g) "Profit" means the amount which shall accrue to a
| ||||||
6 | facility as a result of its revenues exceeding its expenses
as | ||||||
7 | determined in accordance with generally accepted accounting
| ||||||
8 | principles.
| ||||||
9 | (h) "Non-institutional services" means those services | ||||||
10 | provided under
paragraph (f) of Section 3 of the Disabled | ||||||
11 | Persons Rehabilitation Act and those services provided under | ||||||
12 | Section 4.02 of the Illinois Act on the Aging.
| ||||||
13 | (i) (Blank).
| ||||||
14 | (j) "Institutionalized person" means an individual who is | ||||||
15 | an inpatient
in an ICF/DD or nursing facility, or who is an | ||||||
16 | inpatient in
a medical
institution receiving a level of care | ||||||
17 | equivalent to that of an ICF/DD or nursing facility, or who is | ||||||
18 | receiving services under
Section 1915(c) of the Social Security | ||||||
19 | Act.
| ||||||
20 | (k) "Institutionalized spouse" means an institutionalized | ||||||
21 | person who is
expected to receive services at the same level of | ||||||
22 | care for at least 30 days
and is married to a spouse who is not | ||||||
23 | an institutionalized person.
| ||||||
24 | (l) "Community spouse" is the spouse of an | ||||||
25 | institutionalized spouse.
| ||||||
26 | (m) "Health Benefits Service Package" means, subject to |
| |||||||
| |||||||
1 | federal approval, benefits covered by the medical assistance | ||||||
2 | program as determined by the Department by rule for individuals | ||||||
3 | eligible for medical assistance under paragraph 18 of Section | ||||||
4 | 5-2 of this Code. | ||||||
5 | (Source: P.A. 96-1530, eff. 2-16-11; 97-227, eff. 1-1-12; | ||||||
6 | 97-820, eff. 7-17-12.)
| ||||||
7 | (305 ILCS 5/5-1.4) | ||||||
8 | Sec. 5-1.4. Moratorium on eligibility expansions. | ||||||
9 | Beginning on January 25, 2011 (the effective date of Public Act | ||||||
10 | 96-1501), there shall be a 4-year moratorium on the expansion | ||||||
11 | of eligibility through increasing financial eligibility | ||||||
12 | standards, or through increasing income disregards, or through | ||||||
13 | the creation of new programs which would add new categories of | ||||||
14 | eligible individuals under the medical assistance program in | ||||||
15 | addition to those categories covered on January 1, 2011 or | ||||||
16 | above the level of any subsequent reduction in eligibility. | ||||||
17 | This moratorium shall not apply to expansions required as a | ||||||
18 | federal condition of State participation in the medical | ||||||
19 | assistance program or to expansions approved by the federal | ||||||
20 | government that are financed entirely by units of local | ||||||
21 | government and federal matching funds. If the State of Illinois | ||||||
22 | finds that the State has borne a cost related to such an | ||||||
23 | expansion, the unit of local government shall reimburse the | ||||||
24 | State. All federal funds associated with an expansion funded by | ||||||
25 | a unit of local government shall be returned to the local |
| |||||||
| |||||||
1 | government entity funding the expansion, pursuant to an | ||||||
2 | intergovernmental agreement between the Department of | ||||||
3 | Healthcare and Family Services and the local government entity. | ||||||
4 | Within 10 calendar days of the effective date of this | ||||||
5 | amendatory Act of the 97th General Assembly, the Department of | ||||||
6 | Healthcare and Family Services shall formally advise the | ||||||
7 | Centers for Medicare and Medicaid Services of the passage of | ||||||
8 | this amendatory Act of the 97th General Assembly. The State is | ||||||
9 | prohibited from submitting additional waiver requests that | ||||||
10 | expand or allow for an increase in the classes of persons | ||||||
11 | eligible for medical assistance under this Article to the | ||||||
12 | federal government for its consideration beginning on the 20th | ||||||
13 | calendar day following the effective date of this amendatory | ||||||
14 | Act of the 97th General Assembly until January 25, 2015. This | ||||||
15 | moratorium shall not apply to those persons eligible for | ||||||
16 | medical assistance pursuant to 42 U.S.C. | ||||||
17 | 1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of | ||||||
18 | Section 5-2 of this Code.
| ||||||
19 | (Source: P.A. 96-1501, eff. 1-25-11; 97-687, eff. 6-14-12.)
| ||||||
20 | (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
| ||||||
21 | Sec. 5-2. Classes of Persons Eligible. Medical assistance | ||||||
22 | under this
Article shall be available to any of the following | ||||||
23 | classes of persons in
respect to whom a plan for coverage has | ||||||
24 | been submitted to the Governor
by the Illinois Department and | ||||||
25 | approved by him:
|
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| |||||||
1 | 1. Recipients of basic maintenance grants under | ||||||
2 | Articles III and IV.
| ||||||
3 | 2. Persons otherwise eligible for basic maintenance | ||||||
4 | under Articles
III and IV, excluding any eligibility | ||||||
5 | requirements that are inconsistent with any federal law or | ||||||
6 | federal regulation, as interpreted by the U.S. Department | ||||||
7 | of Health and Human Services, but who fail to qualify | ||||||
8 | thereunder on the basis of need or who qualify but are not | ||||||
9 | receiving basic maintenance under Article IV, and
who have | ||||||
10 | insufficient income and resources to meet the costs of
| ||||||
11 | necessary medical care, including but not limited to the | ||||||
12 | following:
| ||||||
13 | (a) All persons otherwise eligible for basic | ||||||
14 | maintenance under Article
III but who fail to qualify | ||||||
15 | under that Article on the basis of need and who
meet | ||||||
16 | either of the following requirements:
| ||||||
17 | (i) their income, as determined by the | ||||||
18 | Illinois Department in
accordance with any federal | ||||||
19 | requirements, is equal to or less than 70% in
| ||||||
20 | fiscal year 2001, equal to or less than 85% in | ||||||
21 | fiscal year 2002 and until
a date to be determined | ||||||
22 | by the Department by rule, and equal to or less
| ||||||
23 | than 100% beginning on the date determined by the | ||||||
24 | Department by rule, of the nonfarm income official | ||||||
25 | poverty
line, as defined by the federal Office of | ||||||
26 | Management and Budget and revised
annually in |
| |||||||
| |||||||
1 | accordance with Section 673(2) of the Omnibus | ||||||
2 | Budget Reconciliation
Act of 1981, applicable to | ||||||
3 | families of the same size; or
| ||||||
4 | (ii) their income, after the deduction of | ||||||
5 | costs incurred for medical
care and for other types | ||||||
6 | of remedial care, is equal to or less than 70% in
| ||||||
7 | fiscal year 2001, equal to or less than 85% in | ||||||
8 | fiscal year 2002 and until
a date to be determined | ||||||
9 | by the Department by rule, and equal to or less
| ||||||
10 | than 100% beginning on the date determined by the | ||||||
11 | Department by rule, of the nonfarm income official | ||||||
12 | poverty
line, as defined in item (i) of this | ||||||
13 | subparagraph (a).
| ||||||
14 | (b) All persons who, excluding any eligibility | ||||||
15 | requirements that are inconsistent with any federal | ||||||
16 | law or federal regulation, as interpreted by the U.S. | ||||||
17 | Department of Health and Human Services, would be | ||||||
18 | determined eligible for such basic
maintenance under | ||||||
19 | Article IV by disregarding the maximum earned income
| ||||||
20 | permitted by federal law.
| ||||||
21 | 3. Persons who would otherwise qualify for Aid to the | ||||||
22 | Medically
Indigent under Article VII.
| ||||||
23 | 4. Persons not eligible under any of the preceding | ||||||
24 | paragraphs who fall
sick, are injured, or die, not having | ||||||
25 | sufficient money, property or other
resources to meet the | ||||||
26 | costs of necessary medical care or funeral and burial
|
| |||||||
| |||||||
1 | expenses.
| ||||||
2 | 5.(a) Women during pregnancy, after the fact
of | ||||||
3 | pregnancy has been determined by medical diagnosis, and | ||||||
4 | during the
60-day period beginning on the last day of the | ||||||
5 | pregnancy, together with
their infants and children born | ||||||
6 | after September 30, 1983,
whose income and
resources are | ||||||
7 | insufficient to meet the costs of necessary medical care to
| ||||||
8 | the maximum extent possible under Title XIX of the
Federal | ||||||
9 | Social Security Act.
| ||||||
10 | (b) The Illinois Department and the Governor shall | ||||||
11 | provide a plan for
coverage of the persons eligible under | ||||||
12 | paragraph 5(a) by April 1, 1990. Such
plan shall provide | ||||||
13 | ambulatory prenatal care to pregnant women during a
| ||||||
14 | presumptive eligibility period and establish an income | ||||||
15 | eligibility standard
that is equal to 133%
of the nonfarm | ||||||
16 | income official poverty line, as defined by
the federal | ||||||
17 | Office of Management and Budget and revised annually in
| ||||||
18 | accordance with Section 673(2) of the Omnibus Budget | ||||||
19 | Reconciliation Act of
1981, applicable to families of the | ||||||
20 | same size, provided that costs incurred
for medical care | ||||||
21 | are not taken into account in determining such income
| ||||||
22 | eligibility.
| ||||||
23 | (c) The Illinois Department may conduct a | ||||||
24 | demonstration in at least one
county that will provide | ||||||
25 | medical assistance to pregnant women, together
with their | ||||||
26 | infants and children up to one year of age,
where the |
| |||||||
| |||||||
1 | income
eligibility standard is set up to 185% of the | ||||||
2 | nonfarm income official
poverty line, as defined by the | ||||||
3 | federal Office of Management and Budget.
The Illinois | ||||||
4 | Department shall seek and obtain necessary authorization
| ||||||
5 | provided under federal law to implement such a | ||||||
6 | demonstration. Such
demonstration may establish resource | ||||||
7 | standards that are not more
restrictive than those | ||||||
8 | established under Article IV of this Code.
| ||||||
9 | 6. Persons under the age of 18 who fail to qualify as | ||||||
10 | dependent under
Article IV and who have insufficient income | ||||||
11 | and resources to meet the costs
of necessary medical care | ||||||
12 | to the maximum extent permitted under Title XIX
of the | ||||||
13 | Federal Social Security Act.
| ||||||
14 | 7. (Blank).
| ||||||
15 | 8. Persons who become ineligible for basic maintenance | ||||||
16 | assistance
under Article IV of this Code in programs | ||||||
17 | administered by the Illinois
Department due to employment | ||||||
18 | earnings and persons in
assistance units comprised of | ||||||
19 | adults and children who become ineligible for
basic | ||||||
20 | maintenance assistance under Article VI of this Code due to
| ||||||
21 | employment earnings. The plan for coverage for this class | ||||||
22 | of persons shall:
| ||||||
23 | (a) extend the medical assistance coverage for up | ||||||
24 | to 12 months following
termination of basic | ||||||
25 | maintenance assistance; and
| ||||||
26 | (b) offer persons who have initially received 6 |
| |||||||
| |||||||
1 | months of the
coverage provided in paragraph (a) above, | ||||||
2 | the option of receiving an
additional 6 months of | ||||||
3 | coverage, subject to the following:
| ||||||
4 | (i) such coverage shall be pursuant to | ||||||
5 | provisions of the federal
Social Security Act;
| ||||||
6 | (ii) such coverage shall include all services | ||||||
7 | covered while the person
was eligible for basic | ||||||
8 | maintenance assistance;
| ||||||
9 | (iii) no premium shall be charged for such | ||||||
10 | coverage; and
| ||||||
11 | (iv) such coverage shall be suspended in the | ||||||
12 | event of a person's
failure without good cause to | ||||||
13 | file in a timely fashion reports required for
this | ||||||
14 | coverage under the Social Security Act and | ||||||
15 | coverage shall be reinstated
upon the filing of | ||||||
16 | such reports if the person remains otherwise | ||||||
17 | eligible.
| ||||||
18 | 9. Persons with acquired immunodeficiency syndrome | ||||||
19 | (AIDS) or with
AIDS-related conditions with respect to whom | ||||||
20 | there has been a determination
that but for home or | ||||||
21 | community-based services such individuals would
require | ||||||
22 | the level of care provided in an inpatient hospital, | ||||||
23 | skilled
nursing facility or intermediate care facility the | ||||||
24 | cost of which is
reimbursed under this Article. Assistance | ||||||
25 | shall be provided to such
persons to the maximum extent | ||||||
26 | permitted under Title
XIX of the Federal Social Security |
| |||||||
| |||||||
1 | Act.
| ||||||
2 | 10. Participants in the long-term care insurance | ||||||
3 | partnership program
established under the Illinois | ||||||
4 | Long-Term Care Partnership Program Act who meet the
| ||||||
5 | qualifications for protection of resources described in | ||||||
6 | Section 15 of that
Act.
| ||||||
7 | 11. Persons with disabilities who are employed and | ||||||
8 | eligible for Medicaid,
pursuant to Section | ||||||
9 | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | ||||||
10 | subject to federal approval, persons with a medically | ||||||
11 | improved disability who are employed and eligible for | ||||||
12 | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | ||||||
13 | the Social Security Act, as
provided by the Illinois | ||||||
14 | Department by rule. In establishing eligibility standards | ||||||
15 | under this paragraph 11, the Department shall, subject to | ||||||
16 | federal approval: | ||||||
17 | (a) set the income eligibility standard at not | ||||||
18 | lower than 350% of the federal poverty level; | ||||||
19 | (b) exempt retirement accounts that the person | ||||||
20 | cannot access without penalty before the age
of 59 1/2, | ||||||
21 | and medical savings accounts established pursuant to | ||||||
22 | 26 U.S.C. 220; | ||||||
23 | (c) allow non-exempt assets up to $25,000 as to | ||||||
24 | those assets accumulated during periods of eligibility | ||||||
25 | under this paragraph 11; and
| ||||||
26 | (d) continue to apply subparagraphs (b) and (c) in |
| |||||||
| |||||||
1 | determining the eligibility of the person under this | ||||||
2 | Article even if the person loses eligibility under this | ||||||
3 | paragraph 11.
| ||||||
4 | 12. Subject to federal approval, persons who are | ||||||
5 | eligible for medical
assistance coverage under applicable | ||||||
6 | provisions of the federal Social Security
Act and the | ||||||
7 | federal Breast and Cervical Cancer Prevention and | ||||||
8 | Treatment Act of
2000. Those eligible persons are defined | ||||||
9 | to include, but not be limited to,
the following persons:
| ||||||
10 | (1) persons who have been screened for breast or | ||||||
11 | cervical cancer under
the U.S. Centers for Disease | ||||||
12 | Control and Prevention Breast and Cervical Cancer
| ||||||
13 | Program established under Title XV of the federal | ||||||
14 | Public Health Services Act in
accordance with the | ||||||
15 | requirements of Section 1504 of that Act as | ||||||
16 | administered by
the Illinois Department of Public | ||||||
17 | Health; and
| ||||||
18 | (2) persons whose screenings under the above | ||||||
19 | program were funded in whole
or in part by funds | ||||||
20 | appropriated to the Illinois Department of Public | ||||||
21 | Health
for breast or cervical cancer screening.
| ||||||
22 | "Medical assistance" under this paragraph 12 shall be | ||||||
23 | identical to the benefits
provided under the State's | ||||||
24 | approved plan under Title XIX of the Social Security
Act. | ||||||
25 | The Department must request federal approval of the | ||||||
26 | coverage under this
paragraph 12 within 30 days after the |
| |||||||
| |||||||
1 | effective date of this amendatory Act of
the 92nd General | ||||||
2 | Assembly.
| ||||||
3 | In addition to the persons who are eligible for medical | ||||||
4 | assistance pursuant to subparagraphs (1) and (2) of this | ||||||
5 | paragraph 12, and to be paid from funds appropriated to the | ||||||
6 | Department for its medical programs, any uninsured person | ||||||
7 | as defined by the Department in rules residing in Illinois | ||||||
8 | who is younger than 65 years of age, who has been screened | ||||||
9 | for breast and cervical cancer in accordance with standards | ||||||
10 | and procedures adopted by the Department of Public Health | ||||||
11 | for screening, and who is referred to the Department by the | ||||||
12 | Department of Public Health as being in need of treatment | ||||||
13 | for breast or cervical cancer is eligible for medical | ||||||
14 | assistance benefits that are consistent with the benefits | ||||||
15 | provided to those persons described in subparagraphs (1) | ||||||
16 | and (2). Medical assistance coverage for the persons who | ||||||
17 | are eligible under the preceding sentence is not dependent | ||||||
18 | on federal approval, but federal moneys may be used to pay | ||||||
19 | for services provided under that coverage upon federal | ||||||
20 | approval. | ||||||
21 | 13. Subject to appropriation and to federal approval, | ||||||
22 | persons living with HIV/AIDS who are not otherwise eligible | ||||||
23 | under this Article and who qualify for services covered | ||||||
24 | under Section 5-5.04 as provided by the Illinois Department | ||||||
25 | by rule.
| ||||||
26 | 14. Subject to the availability of funds for this |
| |||||||
| |||||||
1 | purpose, the Department may provide coverage under this | ||||||
2 | Article to persons who reside in Illinois who are not | ||||||
3 | eligible under any of the preceding paragraphs and who meet | ||||||
4 | the income guidelines of paragraph 2(a) of this Section and | ||||||
5 | (i) have an application for asylum pending before the | ||||||
6 | federal Department of Homeland Security or on appeal before | ||||||
7 | a court of competent jurisdiction and are represented | ||||||
8 | either by counsel or by an advocate accredited by the | ||||||
9 | federal Department of Homeland Security and employed by a | ||||||
10 | not-for-profit organization in regard to that application | ||||||
11 | or appeal, or (ii) are receiving services through a | ||||||
12 | federally funded torture treatment center. Medical | ||||||
13 | coverage under this paragraph 14 may be provided for up to | ||||||
14 | 24 continuous months from the initial eligibility date so | ||||||
15 | long as an individual continues to satisfy the criteria of | ||||||
16 | this paragraph 14. If an individual has an appeal pending | ||||||
17 | regarding an application for asylum before the Department | ||||||
18 | of Homeland Security, eligibility under this paragraph 14 | ||||||
19 | may be extended until a final decision is rendered on the | ||||||
20 | appeal. The Department may adopt rules governing the | ||||||
21 | implementation of this paragraph 14.
| ||||||
22 | 15. Family Care Eligibility. | ||||||
23 | (a) On and after July 1, 2012, a caretaker relative | ||||||
24 | who is 19 years of age or older when countable income | ||||||
25 | is at or below 133% of the Federal Poverty Level | ||||||
26 | Guidelines, as published annually in the Federal |
| |||||||
| |||||||
1 | Register, for the appropriate family size. A person may | ||||||
2 | not spend down to become eligible under this paragraph | ||||||
3 | 15. | ||||||
4 | (b) Eligibility shall be reviewed annually. | ||||||
5 | (c) (Blank). | ||||||
6 | (d) (Blank). | ||||||
7 | (e) (Blank). | ||||||
8 | (f) (Blank). | ||||||
9 | (g) (Blank). | ||||||
10 | (h) (Blank). | ||||||
11 | (i) Following termination of an individual's | ||||||
12 | coverage under this paragraph 15, the individual must | ||||||
13 | be determined eligible before the person can be | ||||||
14 | re-enrolled. | ||||||
15 | 16. Subject to appropriation, uninsured persons who | ||||||
16 | are not otherwise eligible under this Section who have been | ||||||
17 | certified and referred by the Department of Public Health | ||||||
18 | as having been screened and found to need diagnostic | ||||||
19 | evaluation or treatment, or both diagnostic evaluation and | ||||||
20 | treatment, for prostate or testicular cancer. For the | ||||||
21 | purposes of this paragraph 16, uninsured persons are those | ||||||
22 | who do not have creditable coverage, as defined under the | ||||||
23 | Health Insurance Portability and Accountability Act, or | ||||||
24 | have otherwise exhausted any insurance benefits they may | ||||||
25 | have had, for prostate or testicular cancer diagnostic | ||||||
26 | evaluation or treatment, or both diagnostic evaluation and |
| |||||||
| |||||||
1 | treatment.
To be eligible, a person must furnish a Social | ||||||
2 | Security number.
A person's assets are exempt from | ||||||
3 | consideration in determining eligibility under this | ||||||
4 | paragraph 16.
Such persons shall be eligible for medical | ||||||
5 | assistance under this paragraph 16 for so long as they need | ||||||
6 | treatment for the cancer. A person shall be considered to | ||||||
7 | need treatment if, in the opinion of the person's treating | ||||||
8 | physician, the person requires therapy directed toward | ||||||
9 | cure or palliation of prostate or testicular cancer, | ||||||
10 | including recurrent metastatic cancer that is a known or | ||||||
11 | presumed complication of prostate or testicular cancer and | ||||||
12 | complications resulting from the treatment modalities | ||||||
13 | themselves. Persons who require only routine monitoring | ||||||
14 | services are not considered to need treatment.
"Medical | ||||||
15 | assistance" under this paragraph 16 shall be identical to | ||||||
16 | the benefits provided under the State's approved plan under | ||||||
17 | Title XIX of the Social Security Act.
Notwithstanding any | ||||||
18 | other provision of law, the Department (i) does not have a | ||||||
19 | claim against the estate of a deceased recipient of | ||||||
20 | services under this paragraph 16 and (ii) does not have a | ||||||
21 | lien against any homestead property or other legal or | ||||||
22 | equitable real property interest owned by a recipient of | ||||||
23 | services under this paragraph 16. | ||||||
24 | 17. Persons who, pursuant to a waiver approved by the | ||||||
25 | Secretary of the U.S. Department of Health and Human | ||||||
26 | Services, are eligible for medical assistance under Title |
| |||||||
| |||||||
1 | XIX or XXI of the federal Social Security Act. | ||||||
2 | Notwithstanding any other provision of this Code and | ||||||
3 | consistent with the terms of the approved waiver, the | ||||||
4 | Illinois Department, may by rule: | ||||||
5 | (a) Limit the geographic areas in which the waiver | ||||||
6 | program operates. | ||||||
7 | (b) Determine the scope, quantity, duration, and | ||||||
8 | quality, and the rate and method of reimbursement, of | ||||||
9 | the medical services to be provided, which may differ | ||||||
10 | from those for other classes of persons eligible for | ||||||
11 | assistance under this Article. | ||||||
12 | (c) Restrict the persons' freedom in choice of | ||||||
13 | providers. | ||||||
14 | 18. Beginning January 1, 2014, persons aged 19 or | ||||||
15 | older, but younger than 65, who are not otherwise eligible | ||||||
16 | for medical assistance under this Section 5-2, who qualify | ||||||
17 | for medical assistance pursuant to 42 U.S.C. | ||||||
18 | 1396a(a)(10)(A)(i)(VIII) and as set forth in 42 CFR | ||||||
19 | 435.119, and who have income at or below 133% of the | ||||||
20 | federal poverty level plus 5% for the applicable family | ||||||
21 | size as determined pursuant to 42 U.S.C. 1396a(e)(14) and | ||||||
22 | as set forth in 42 CFR 435.603. Persons eligible for | ||||||
23 | medical assistance under this paragraph 18 shall receive | ||||||
24 | coverage for the Health Benefits Service Package as that | ||||||
25 | term is defined in subsection (m) of Section 5-1.1 of this | ||||||
26 | Code. If Illinois' federal medical assistance percentage |
| |||||||
| |||||||
1 | (FMAP) is reduced below 90% for persons eligible for | ||||||
2 | medical
assistance under this paragraph 18, eligibility | ||||||
3 | under this paragraph 18 shall cease no later than the end | ||||||
4 | of the third month following the month in which the | ||||||
5 | reduction in FMAP takes effect. | ||||||
6 | In implementing the provisions of Public Act 96-20, the | ||||||
7 | Department is authorized to adopt only those rules necessary, | ||||||
8 | including emergency rules. Nothing in Public Act 96-20 permits | ||||||
9 | the Department to adopt rules or issue a decision that expands | ||||||
10 | eligibility for the FamilyCare Program to a person whose income | ||||||
11 | exceeds 185% of the Federal Poverty Level as determined from | ||||||
12 | time to time by the U.S. Department of Health and Human | ||||||
13 | Services, unless the Department is provided with express | ||||||
14 | statutory authority. | ||||||
15 | The Illinois Department and the Governor shall provide a | ||||||
16 | plan for
coverage of the persons eligible under paragraph 7 as | ||||||
17 | soon as possible after
July 1, 1984.
| ||||||
18 | The eligibility of any such person for medical assistance | ||||||
19 | under this
Article is not affected by the payment of any grant | ||||||
20 | under the Senior
Citizens and Disabled Persons Property Tax | ||||||
21 | Relief Act or any distributions or items of income described | ||||||
22 | under
subparagraph (X) of
paragraph (2) of subsection (a) of | ||||||
23 | Section 203 of the Illinois Income Tax
Act. The Department | ||||||
24 | shall by rule establish the amounts of
assets to be disregarded | ||||||
25 | in determining eligibility for medical assistance,
which shall | ||||||
26 | at a minimum equal the amounts to be disregarded under the
|
| |||||||
| |||||||
1 | Federal Supplemental Security Income Program. The amount of | ||||||
2 | assets of a
single person to be disregarded
shall not be less | ||||||
3 | than $2,000, and the amount of assets of a married couple
to be | ||||||
4 | disregarded shall not be less than $3,000.
| ||||||
5 | To the extent permitted under federal law, any person found | ||||||
6 | guilty of a
second violation of Article VIIIA
shall be | ||||||
7 | ineligible for medical assistance under this Article, as | ||||||
8 | provided
in Section 8A-8.
| ||||||
9 | The eligibility of any person for medical assistance under | ||||||
10 | this Article
shall not be affected by the receipt by the person | ||||||
11 | of donations or benefits
from fundraisers held for the person | ||||||
12 | in cases of serious illness,
as long as neither the person nor | ||||||
13 | members of the person's family
have actual control over the | ||||||
14 | donations or benefits or the disbursement
of the donations or | ||||||
15 | benefits.
| ||||||
16 | Notwithstanding any other provision of this Code, if the | ||||||
17 | United States Supreme Court holds Title II, Subtitle A, Section | ||||||
18 | 2001(a) of Public Law 111-148 to be unconstitutional, or if a | ||||||
19 | holding of Public Law 111-148 makes Medicaid eligibility | ||||||
20 | allowed under Section 2001(a) inoperable, the State or a unit | ||||||
21 | of local government shall be prohibited from enrolling | ||||||
22 | individuals in the Medical Assistance Program as the result of | ||||||
23 | federal approval of a State Medicaid waiver on or after the | ||||||
24 | effective date of this amendatory Act of the 97th General | ||||||
25 | Assembly, and any individuals enrolled in the Medical | ||||||
26 | Assistance Program pursuant to eligibility permitted as a |
| |||||||
| |||||||
1 | result of such a State Medicaid waiver shall become immediately | ||||||
2 | ineligible. | ||||||
3 | Notwithstanding any other provision of this Code, if an Act | ||||||
4 | of Congress that becomes a Public Law eliminates Section | ||||||
5 | 2001(a) of Public Law 111-148, the State or a unit of local | ||||||
6 | government shall be prohibited from enrolling individuals in | ||||||
7 | the Medical Assistance Program as the result of federal | ||||||
8 | approval of a State Medicaid waiver on or after the effective | ||||||
9 | date of this amendatory Act of the 97th General Assembly, and | ||||||
10 | any individuals enrolled in the Medical Assistance Program | ||||||
11 | pursuant to eligibility permitted as a result of such a State | ||||||
12 | Medicaid waiver shall become immediately ineligible. | ||||||
13 | (Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; | ||||||
14 | 96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. | ||||||
15 | 7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, | ||||||
16 | eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; | ||||||
17 | 97-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff. | ||||||
18 | 7-13-12; revised 7-23-12.)
| ||||||
19 | Section 99. Effective date. This Act takes effect upon | ||||||
20 | becoming law.
|