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91_HB2677
LRB9102968SMdv
1 AN ACT to provide for access to health coverage for
2 certain uninsured low income residents of the State of
3 Illinois.
4 Be it enacted by the People of the State of Illinois,
5 represented in the General Assembly:
6 Section 1. Short title. This Act may be cited as the Low
7 Income Uninsured Health Coverage Act.
8 Section 5. Legislative intent. The General Assembly finds
9 that, for the economic and social benefit of all citizens of
10 the State, it is important to enable low-income residents of
11 this State, to the extent funding permits, to access health
12 care coverage, especially for preventive healthcare. The
13 General Assembly recognizes that assistance to help low
14 income individuals and families purchase health care coverage
15 is essential in helping them transition from a health care
16 system where government partners with families to provide
17 health benefits to a system where individuals and families
18 with higher incomes eventually transition into private or
19 employer based health plans. This Act is not intended to
20 create an entitlement.
21 Section 10. Definitions. As used in this Act:
22 "Department" means the Illinois Department of Public Aid.
23 "Director" means the Director of Public Aid.
24 "Health care coverage" means a demonstration project that
25 provides a specific package of health care services to
26 eligible persons utilizing a combination of donated in-kind
27 services and services purchased with funding from a variety
28 of sources including public and private sources and patient
29 co-payments. The package of services need not be identical
30 to the benefits provided under the State's approved plan
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1 under Title XIX of the Social Security Act. The
2 demonstration projects shall be exempt from regulation by the
3 Department of Insurance as though they were directly operated
4 by the Department of Public Aid.
5 "Low income" means a resident with a pro-rata annual
6 family income under 200% of the Federal Poverty Level for the
7 family size.
8 "Resident" means a person who meets the residency
9 requirements as defined in Section 5-3 of the Illinois Public
10 Aid Code.
11 "Uninsured" means a resident who:
12 (1) does not have at the time of application and has not
13 had, for a period of 30 days prior to application, health
14 insurance through another source; and
15 (2) is not eligible for any other health insurance
16 program including KidCare, Medicaid, Medicare, Veteran's
17 Administration insurance, Workers' Compensation, employer
18 sponsored insurance, and others.
19 (3) a person who is otherwise eligible under this Act
20 shall be considered uninsured if that person has access to
21 employer sponsored or other health insurance, but the cost to
22 the employee is greater than 10% of his or her adjusted
23 taxable income.
24 Section 15. Operation of the Program. There is hereby
25 created a program to provide for grants to at least 5
26 communities around the State for development of demonstration
27 projects providing access to health care coverage for low
28 income uninsured residents of the State of Illinois. The
29 Program shall operate subject to appropriation and shall be
30 administered by the Department. The Department shall have
31 the powers and authority granted to the Department under the
32 Illinois Public Aid Code.
33 The necessary funds for the demonstration projects and
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1 for full implementation will be obtained from the settlement
2 of the litigation against the tobacco industry or from such
3 sums as may become available through other means.
4 Section 20. Plan for health care coverage for low income
5 uninsured residents. By the end of the demonstration period,
6 the Governor shall submit to the General Assembly a plan for
7 providing for the health insurance needs of low income,
8 uninsured residents of the State of Illinois. The plan shall
9 include a description of how the proposed plan for the low
10 income uninsured will integrate with the existing programs
11 operated under Title XIX (Medicaid) and Title XXI (KidCare)
12 of the Social Security Act, as amended, as well as a
13 description of how the proposed plan will cover those
14 individuals eligible for services from units of local
15 government pursuant to Article VI of the Illinois Public Aid
16 Code.
17 Section 25. Eligible applicants. Eligible applicants for
18 such projects may include:
19 (1) Local health departments.
20 (2) Not for profit corporations, including those formed
21 for the express purpose of providing health care for the
22 low-income uninsured.
23 (3) Health care providers and consortia of providers.
24 (4) Other organizations subject to the approval of the
25 Director.
26 Section 30. Selection of projects. Criteria for the
27 selection of projects under this Act shall:
28 (1) Build on existing assets including relationships
29 with physicians and other providers who are willing to help.
30 (2) Include continuity of care and an array of services
31 appropriate for the population.
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1 (3) Include a cost-effective package of services
2 including prevention, consumer education, and care
3 management. The package of services may or may not include
4 the services included in the State Medicaid Plan.
5 (4) Contribute toward building a system of care.
6 (5) Describe how the plan will include cost sharing by
7 patients.
8 (6) Allow small employers to purchase coverage at
9 reasonable rates and minimize disincentives for employers to
10 provide coverage.
11 (7) Provide services that are reasonably accessible in
12 terms of time and place.
13 (8) Optimize assets, both money and in kind.
14 (9) Shift location of services from services provided in
15 a high cost setting to services provided in a cost efficient
16 manner.
17 (10) Demonstrate involvement in planning of potential
18 consumers, providers of health care, employers, local health
19 departments, and local government.
20 (11) Provide high quality services.
21 (12) Include a variety of public and private sources of
22 funding.
23 Section 35. Funding for projects. Each approved
24 demonstration project shall receive funding for a one year
25 planning phase and, subject to the Director's approval of a
26 satisfactory plan, for a 3 year implementation phase, not to
27 exceed $100,000 for the planning phase and $250,000 per year
28 for the implementation phase. The health coverage provided
29 by the demonstration projects to be developed with the funds
30 appropriated for the purposes of this Act is not an
31 entitlement and shall not be construed to create an
32 entitlement.
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1 Section 40. Waivers. The Department shall request any
2 necessary waivers of federal requirements in order to allow
3 receipt of federal funding to provide funding for the
4 services to be developed under this Act, or for the services
5 to be described under the statewide plan to be developed
6 under this Act.
7 Section 50. Program evaluation. During this
8 demonstration period, the Department is charged with
9 monitoring and evaluating the results of the 5 pilots and any
10 other ongoing models that may exist within the State.
11 Section 99. Effective date. This Act takes effect upon
12 becoming law.