Section 118.790  Post Kidney Transplantation Services for Noncitizens

Pursuant to Public Act 102-0043, which amended Section 5/12-4.35 of the Public Aid Code, any noncitizen is eligible for post-transplant drugs and related services after 12 months from the date of kidney transplant, when each of the following criteria are met:

a)         The noncitizen:

1)         provides proof that they received a kidney transplant, at least 12 months prior, at a certified transplant center in Illinois, and now require medically necessary post-transplant drugs and related services. Acceptable proof shall include medical records and operative report confirming the date of and location where the transplant occurred;

2)         is not eligible for comprehensive medical benefits under any government funded or private insurance plan;

3)         otherwise meets the income, asset, and categorical requirements of the medical assistance program; and,

4)         meets the residency requirements of Section 5-3 of the Code.

b)         Requests for post kidney transplant services for noncitizens shall be reviewed for eligibility and prior authorized by the Department for medical necessity initially and annually thereafter.

c)         Covered benefits shall include, to the extent covered under the medical assistance program, immunosuppressant drugs; other drugs as necessary for treatment of condition(s) resulting from a kidney transplant, or those pre-existing condition(s) which necessitated a kidney transplant; an annual evaluation by patient’s primary care physician, a nephrologist, and a transplant surgeon in Illinois; and a standard battery of diagnostic tests for post-transplant patients, including blood tests, urine tests, kidney ultrasound, and kidney biopsy.

d)         Providers may request exceptions for additional medically necessary post kidney transplant related services, which will be reviewed by the Department on a case-by-case basis.

e)         As in case of other partial benefits programs for special populations covered by the Department, the programs of Kidney Transplantation for Noncitizens with End-Stage Renal Disease, and Post Kidney Transplantation Services for Noncitizens will be managed directly by the Department.

(Source:  Added at 46 Ill. Reg. 14541, effective August 8, 2022)