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91_SB0677
LRB9103095DJcd
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 the following:,
20 (a) All persons otherwise eligible for basic
21 maintenance under Article III but who fail to qualify
22 under that Article on the basis of need and who meet
23 either of the following requirements:
24 (i) their income, as determined by the
25 Illinois Department, is equal to or less that 100%
26 of the nonfarm income official poverty line, as
27 defined by the federal Office of Management and
28 Budget and revised annually in accordance with
29 Section 673(2) of the Omnibus Budget Reconciliation
30 Act of 1981, applicable to families of the same
31 size; or
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1 (ii) their income, after the deduction of
2 costs incurred for medical care and for other types
3 of remedial care, is equal to or less than 100% of
4 the nonfarm income official poverty line, as defined
5 in item (i) of this subparagraph (a).
6 (b) All persons who would be determined eligible
7 for such basic maintenance under Article IV by
8 disregarding the maximum earned income permitted by
9 federal law.
10 The Illinois Department shall apply for all waivers of
11 federal law and regulations necessary to implement the
12 changes made to this paragraph (2) by this amendatory Act of
13 the 91st General Assembly, and implementation of those
14 changes is contingent on the Illinois Department's receipt of
15 those waivers.
16 3. Persons who would otherwise qualify for Aid to the
17 Medically Indigent under Article VII.
18 4. Persons not eligible under any of the preceding
19 paragraphs who fall sick, are injured, or die, not having
20 sufficient money, property or other resources to meet the
21 costs of necessary medical care or funeral and burial
22 expenses.
23 5. (a) Women during pregnancy, after the fact of
24 pregnancy has been determined by medical diagnosis, and
25 during the 60-day period beginning on the last day of the
26 pregnancy, together with their infants and children born
27 after September 30, 1983, whose income and resources are
28 insufficient to meet the costs of necessary medical care
29 to the maximum extent possible under Title XIX of the
30 Federal Social Security Act.
31 (b) The Illinois Department and the Governor shall
32 provide a plan for coverage of the persons eligible under
33 paragraph 5(a) by April 1, 1990. Such plan shall provide
34 ambulatory prenatal care to pregnant women during a
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1 presumptive eligibility period and establish an income
2 eligibility standard that is equal to 133% of the nonfarm
3 income official poverty line, as defined by the federal
4 Office of Management and Budget and revised annually in
5 accordance with Section 673(2) of the Omnibus Budget
6 Reconciliation Act of 1981, applicable to families of the
7 same size, provided that costs incurred for medical care
8 are not taken into account in determining such income
9 eligibility.
10 (c) The Illinois Department may conduct a
11 demonstration in at least one county that will provide
12 medical assistance to pregnant women, together with their
13 infants and children up to one year of age, where the
14 income eligibility standard is set up to 185% of the
15 nonfarm income official poverty line, as defined by the
16 federal Office of Management and Budget. The Illinois
17 Department shall seek and obtain necessary authorization
18 provided under federal law to implement such a
19 demonstration. Such demonstration may establish resource
20 standards that are not more restrictive than those
21 established under Article IV of this Code.
22 6. Persons under the age of 18 who fail to qualify as
23 dependent under Article IV and who have insufficient income
24 and resources to meet the costs of necessary medical care to
25 the maximum extent permitted under Title XIX of the Federal
26 Social Security Act.
27 7. Persons who are 18 years of age or younger and would
28 qualify as disabled as defined under the Federal Supplemental
29 Security Income Program, provided medical service for such
30 persons would be eligible for Federal Financial
31 Participation, and provided the Illinois Department
32 determines that:
33 (a) the person requires a level of care provided by
34 a hospital, skilled nursing facility, or intermediate
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1 care facility, as determined by a physician licensed to
2 practice medicine in all its branches;
3 (b) it is appropriate to provide such care outside
4 of an institution, as determined by a physician licensed
5 to practice medicine in all its branches;
6 (c) the estimated amount which would be expended
7 for care outside the institution is not greater than the
8 estimated amount which would be expended in an
9 institution.
10 8. Persons who become ineligible for basic maintenance
11 assistance under Article IV of this Code in programs
12 administered by the Illinois Department due to employment
13 earnings and persons in assistance units comprised of adults
14 and children who become ineligible for basic maintenance
15 assistance under Article VI of this Code due to employment
16 earnings. The plan for coverage for this class of persons
17 shall:
18 (a) extend the medical assistance coverage for up
19 to 12 months following termination of basic maintenance
20 assistance; and
21 (b) offer persons who have initially received 6
22 months of the coverage provided in paragraph (a) above,
23 the option of receiving an additional 6 months of
24 coverage, subject to the following:
25 (i) such coverage shall be pursuant to
26 provisions of the federal Social Security Act;
27 (ii) such coverage shall include all services
28 covered while the person was eligible for basic
29 maintenance assistance;
30 (iii) no premium shall be charged for such
31 coverage; and
32 (iv) such coverage shall be suspended in the
33 event of a person's failure without good cause to
34 file in a timely fashion reports required for this
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1 coverage under the Social Security Act and coverage
2 shall be reinstated upon the filing of such reports
3 if the person remains otherwise eligible.
4 9. Persons with acquired immunodeficiency syndrome
5 (AIDS) or with AIDS-related conditions with respect to whom
6 there has been a determination that but for home or
7 community-based services such individuals would require the
8 level of care provided in an inpatient hospital, skilled
9 nursing facility or intermediate care facility the cost of
10 which is reimbursed under this Article. Assistance shall be
11 provided to such persons to the maximum extent permitted
12 under Title XIX of the Federal Social Security Act.
13 10. Participants in the long-term care insurance
14 partnership program established under the Partnership for
15 Long-Term Care Act who meet the qualifications for protection
16 of resources described in Section 25 of that Act.
17 The Illinois Department and the Governor shall provide a
18 plan for coverage of the persons eligible under paragraph 7
19 as soon as possible after July 1, 1984.
20 The eligibility of any such person for medical assistance
21 under this Article is not affected by the payment of any
22 grant under the Senior Citizens and Disabled Persons Property
23 Tax Relief and Pharmaceutical Assistance Act. The Department
24 shall by rule establish the amounts of assets to be
25 disregarded in determining eligibility for medical
26 assistance, which shall at a minimum equal the amounts to be
27 disregarded under the Federal Supplemental Security Income
28 Program. The amount of assets of a single person to be
29 disregarded shall not be less than $2,000, and the amount of
30 assets of a married couple to be disregarded shall not be
31 less than $3,000.
32 To the extent permitted under federal law, any person
33 found guilty of a second violation of Article VIIIA shall be
34 ineligible for medical assistance under this Article, as
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1 provided in Section 8A-8.
2 The eligibility of any person for medical assistance
3 under this Article shall not be affected by the receipt by
4 the person of donations or benefits from fundraisers held for
5 the person in cases of serious illness, as long as neither
6 the person nor members of the person's family have actual
7 control over the donations or benefits or the disbursement of
8 the donations or benefits.
9 (Source: P.A. 89-525, eff. 7-19-96.)
10 Section 99. Effective date. This Act takes effect upon
11 becoming law.