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Public Act 097-0687 | ||||
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AN ACT concerning public aid.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. If and only if both Senate Bill 2840, AS | ||||
AMENDED, of the 97th General Assembly and Senate Bill 3397, AS | ||||
AMENDED, of
the 97th General Assembly become law, then the | ||||
Illinois Public Aid Code is amended by changing Sections 5-1.4, | ||||
5-2, 5-2.03, 15-1, 15-2, 15-5, and 15-11 as follows: | ||||
(305 ILCS 5/5-1.4) | ||||
Sec. 5-1.4. Moratorium on eligibility expansions. | ||||
Beginning on January 25, 2011 ( the effective date of Public Act | ||||
96-1501) this amendatory Act of the 96th General Assembly , | ||||
there shall be a 4-year 2-year moratorium on the expansion of | ||||
eligibility through increasing financial eligibility | ||||
standards, or through increasing income disregards, or through | ||||
the creation of new programs which would add new categories of | ||||
eligible individuals under the medical assistance program in | ||||
addition to those categories covered on January 1, 2011 or | ||||
above the level of any subsequent reduction in eligibility . | ||||
This moratorium shall not apply to expansions required as a | ||||
federal condition of State participation in the medical | ||||
assistance program or to expansions approved by the federal | ||||
government that are financed entirely by units of local |
government and federal matching funds. If the State of Illinois | ||
finds that the State has borne a cost related to such an | ||
expansion, the unit of local government shall reimburse the | ||
State. All federal funds associated with an expansion funded by | ||
a unit of local government shall be returned to the local | ||
government entity funding the expansion, pursuant to an | ||
intergovernmental agreement between the Department of | ||
Healthcare and Family Services and the local government entity. | ||
Within 10 calendar days of the effective date of this | ||
amendatory Act of the 97th General Assembly, the Department of | ||
Healthcare and Family Services shall formally advise the | ||
Centers for Medicare and Medicaid Services of the passage of | ||
this amendatory Act of the 97th General Assembly. The State is | ||
prohibited from submitting additional waiver requests that | ||
expand or allow for an increase in the classes of persons | ||
eligible for medical assistance under this Article to the | ||
federal government for its consideration beginning on the 20th | ||
calendar day following the effective date of this amendatory | ||
Act of the 97th General Assembly until January 25, 2015 .
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(Source: P.A. 96-1501, eff. 1-25-11.)
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(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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Sec. 5-2. Classes of Persons Eligible. Medical assistance | ||
under this
Article shall be available to any of the following | ||
classes of persons in
respect to whom a plan for coverage has | ||
been submitted to the Governor
by the Illinois Department and |
approved by him:
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1. Recipients of basic maintenance grants under | ||
Articles III and IV.
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2. Persons otherwise eligible for basic maintenance | ||
under Articles
III and IV, excluding any eligibility | ||
requirements that are inconsistent with any federal law or | ||
federal regulation, as interpreted by the U.S. Department | ||
of Health and Human Services, but who fail to qualify | ||
thereunder on the basis of need or who qualify but are not | ||
receiving basic maintenance under Article IV, and
who have | ||
insufficient income and resources to meet the costs of
| ||
necessary medical care, including but not limited to the | ||
following:
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(a) All persons otherwise eligible for basic | ||
maintenance under Article
III but who fail to qualify | ||
under that Article on the basis of need and who
meet | ||
either of the following requirements:
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(i) their income, as determined by the | ||
Illinois Department in
accordance with any federal | ||
requirements, is equal to or less than 70% in
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fiscal year 2001, equal to or less than 85% in | ||
fiscal year 2002 and until
a date to be determined | ||
by the Department by rule, and equal to or less
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than 100% beginning on the date determined by the | ||
Department by rule, of the nonfarm income official | ||
poverty
line, as defined by the federal Office of |
Management and Budget and revised
annually in | ||
accordance with Section 673(2) of the Omnibus | ||
Budget Reconciliation
Act of 1981, applicable to | ||
families of the same size; or
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(ii) their income, after the deduction of | ||
costs incurred for medical
care and for other types | ||
of remedial care, is equal to or less than 70% in
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fiscal year 2001, equal to or less than 85% in | ||
fiscal year 2002 and until
a date to be determined | ||
by the Department by rule, and equal to or less
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than 100% beginning on the date determined by the | ||
Department by rule, of the nonfarm income official | ||
poverty
line, as defined in item (i) of this | ||
subparagraph (a).
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(b) All persons who, excluding any eligibility | ||
requirements that are inconsistent with any federal | ||
law or federal regulation, as interpreted by the U.S. | ||
Department of Health and Human Services, would be | ||
determined eligible for such basic
maintenance under | ||
Article IV by disregarding the maximum earned income
| ||
permitted by federal law.
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3. Persons who would otherwise qualify for Aid to the | ||
Medically
Indigent under Article VII.
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4. Persons not eligible under any of the preceding | ||
paragraphs who fall
sick, are injured, or die, not having | ||
sufficient money, property or other
resources to meet the |
costs of necessary medical care or funeral and burial
| ||
expenses.
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5.(a) Women during pregnancy, after the fact
of | ||
pregnancy has been determined by medical diagnosis, and | ||
during the
60-day period beginning on the last day of the | ||
pregnancy, together with
their infants and children born | ||
after September 30, 1983,
whose income and
resources are | ||
insufficient to meet the costs of necessary medical care to
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the maximum extent possible under Title XIX of the
Federal | ||
Social Security Act.
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(b) The Illinois Department and the Governor shall | ||
provide a plan for
coverage of the persons eligible under | ||
paragraph 5(a) by April 1, 1990. Such
plan shall provide | ||
ambulatory prenatal care to pregnant women during a
| ||
presumptive eligibility period and establish an income | ||
eligibility standard
that is equal to 133%
of the nonfarm | ||
income official poverty line, as defined by
the federal | ||
Office of Management and Budget and revised annually in
| ||
accordance with Section 673(2) of the Omnibus Budget | ||
Reconciliation Act of
1981, applicable to families of the | ||
same size, provided that costs incurred
for medical care | ||
are not taken into account in determining such income
| ||
eligibility.
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(c) The Illinois Department may conduct a | ||
demonstration in at least one
county that will provide | ||
medical assistance to pregnant women, together
with their |
infants and children up to one year of age,
where the | ||
income
eligibility standard is set up to 185% of the | ||
nonfarm income official
poverty line, as defined by the | ||
federal Office of Management and Budget.
The Illinois | ||
Department shall seek and obtain necessary authorization
| ||
provided under federal law to implement such a | ||
demonstration. Such
demonstration may establish resource | ||
standards that are not more
restrictive than those | ||
established under Article IV of this Code.
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6. Persons under the age of 18 who fail to qualify as | ||
dependent under
Article IV and who have insufficient income | ||
and resources to meet the costs
of necessary medical care | ||
to the maximum extent permitted under Title XIX
of the | ||
Federal Social Security Act.
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7. Persons who are under 21 years of age and would
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qualify as
disabled as defined under the Federal | ||
Supplemental Security Income Program,
provided medical | ||
service for such persons would be eligible for Federal
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Financial Participation, and provided the Illinois | ||
Department determines that:
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(a) the person requires a level of care provided by | ||
a hospital, skilled
nursing facility, or intermediate | ||
care facility, as determined by a physician
licensed to | ||
practice medicine in all its branches;
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(b) it is appropriate to provide such care outside | ||
of an institution, as
determined by a physician |
licensed to practice medicine in all its branches;
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(c) the estimated amount which would be expended | ||
for care outside the
institution is not greater than | ||
the estimated amount which would be
expended in an | ||
institution.
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8. Persons who become ineligible for basic maintenance | ||
assistance
under Article IV of this Code in programs | ||
administered by the Illinois
Department due to employment | ||
earnings and persons in
assistance units comprised of | ||
adults and children who become ineligible for
basic | ||
maintenance assistance under Article VI of this Code due to
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employment earnings. The plan for coverage for this class | ||
of persons shall:
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(a) extend the medical assistance coverage for up | ||
to 12 months following
termination of basic | ||
maintenance assistance; and
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(b) offer persons who have initially received 6 | ||
months of the
coverage provided in paragraph (a) above, | ||
the option of receiving an
additional 6 months of | ||
coverage, subject to the following:
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(i) such coverage shall be pursuant to | ||
provisions of the federal
Social Security Act;
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(ii) such coverage shall include all services | ||
covered while the person
was eligible for basic | ||
maintenance assistance;
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(iii) no premium shall be charged for such |
coverage; and
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(iv) such coverage shall be suspended in the | ||
event of a person's
failure without good cause to | ||
file in a timely fashion reports required for
this | ||
coverage under the Social Security Act and | ||
coverage shall be reinstated
upon the filing of | ||
such reports if the person remains otherwise | ||
eligible.
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9. Persons with acquired immunodeficiency syndrome | ||
(AIDS) or with
AIDS-related conditions with respect to whom | ||
there has been a determination
that but for home or | ||
community-based services such individuals would
require | ||
the level of care provided in an inpatient hospital, | ||
skilled
nursing facility or intermediate care facility the | ||
cost of which is
reimbursed under this Article. Assistance | ||
shall be provided to such
persons to the maximum extent | ||
permitted under Title
XIX of the Federal Social Security | ||
Act.
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10. Participants in the long-term care insurance | ||
partnership program
established under the Illinois | ||
Long-Term Care Partnership Program Act who meet the
| ||
qualifications for protection of resources described in | ||
Section 15 of that
Act.
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11. Persons with disabilities who are employed and | ||
eligible for Medicaid,
pursuant to Section | ||
1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, |
subject to federal approval, persons with a medically | ||
improved disability who are employed and eligible for | ||
Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | ||
the Social Security Act, as
provided by the Illinois | ||
Department by rule. In establishing eligibility standards | ||
under this paragraph 11, the Department shall, subject to | ||
federal approval: | ||
(a) set the income eligibility standard at not | ||
lower than 350% of the federal poverty level; | ||
(b) exempt retirement accounts that the person | ||
cannot access without penalty before the age
of 59 1/2, | ||
and medical savings accounts established pursuant to | ||
26 U.S.C. 220; | ||
(c) allow non-exempt assets up to $25,000 as to | ||
those assets accumulated during periods of eligibility | ||
under this paragraph 11; and
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(d) continue to apply subparagraphs (b) and (c) in | ||
determining the eligibility of the person under this | ||
Article even if the person loses eligibility under this | ||
paragraph 11.
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12. Subject to federal approval, persons who are | ||
eligible for medical
assistance coverage under applicable | ||
provisions of the federal Social Security
Act and the | ||
federal Breast and Cervical Cancer Prevention and | ||
Treatment Act of
2000. Those eligible persons are defined | ||
to include, but not be limited to,
the following persons:
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(1) persons who have been screened for breast or | ||
cervical cancer under
the U.S. Centers for Disease | ||
Control and Prevention Breast and Cervical Cancer
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Program established under Title XV of the federal | ||
Public Health Services Act in
accordance with the | ||
requirements of Section 1504 of that Act as | ||
administered by
the Illinois Department of Public | ||
Health; and
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(2) persons whose screenings under the above | ||
program were funded in whole
or in part by funds | ||
appropriated to the Illinois Department of Public | ||
Health
for breast or cervical cancer screening.
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"Medical assistance" under this paragraph 12 shall be | ||
identical to the benefits
provided under the State's | ||
approved plan under Title XIX of the Social Security
Act. | ||
The Department must request federal approval of the | ||
coverage under this
paragraph 12 within 30 days after the | ||
effective date of this amendatory Act of
the 92nd General | ||
Assembly.
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In addition to the persons who are eligible for medical | ||
assistance pursuant to subparagraphs (1) and (2) of this | ||
paragraph 12, and to be paid from funds appropriated to the | ||
Department for its medical programs, any uninsured person | ||
as defined by the Department in rules residing in Illinois | ||
who is younger than 65 years of age, who has been screened | ||
for breast and cervical cancer in accordance with standards |
and procedures adopted by the Department of Public Health | ||
for screening, and who is referred to the Department by the | ||
Department of Public Health as being in need of treatment | ||
for breast or cervical cancer is eligible for medical | ||
assistance benefits that are consistent with the benefits | ||
provided to those persons described in subparagraphs (1) | ||
and (2). Medical assistance coverage for the persons who | ||
are eligible under the preceding sentence is not dependent | ||
on federal approval, but federal moneys may be used to pay | ||
for services provided under that coverage upon federal | ||
approval. | ||
13. Subject to appropriation and to federal approval, | ||
persons living with HIV/AIDS who are not otherwise eligible | ||
under this Article and who qualify for services covered | ||
under Section 5-5.04 as provided by the Illinois Department | ||
by rule.
| ||
14. Subject to the availability of funds for this | ||
purpose, the Department may provide coverage under this | ||
Article to persons who reside in Illinois who are not | ||
eligible under any of the preceding paragraphs and who meet | ||
the income guidelines of paragraph 2(a) of this Section and | ||
(i) have an application for asylum pending before the | ||
federal Department of Homeland Security or on appeal before | ||
a court of competent jurisdiction and are represented | ||
either by counsel or by an advocate accredited by the | ||
federal Department of Homeland Security and employed by a |
not-for-profit organization in regard to that application | ||
or appeal, or (ii) are receiving services through a | ||
federally funded torture treatment center. Medical | ||
coverage under this paragraph 14 may be provided for up to | ||
24 continuous months from the initial eligibility date so | ||
long as an individual continues to satisfy the criteria of | ||
this paragraph 14. If an individual has an appeal pending | ||
regarding an application for asylum before the Department | ||
of Homeland Security, eligibility under this paragraph 14 | ||
may be extended until a final decision is rendered on the | ||
appeal. The Department may adopt rules governing the | ||
implementation of this paragraph 14.
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15. Family Care Eligibility. | ||
(a) Through December 31, 2013, a caretaker | ||
relative who is 19 years of age or older when countable | ||
income is at or below 185% of the Federal Poverty Level | ||
Guidelines, as published annually in the Federal | ||
Register, for the appropriate family size. Beginning | ||
January 1, 2014, a caretaker relative who is 19 years | ||
of age or older when countable income is at or below | ||
133% of the Federal Poverty Level Guidelines, as | ||
published annually in the Federal Register, for the | ||
appropriate family size. A person may not spend down to | ||
become eligible under this paragraph 15. | ||
(b) Eligibility shall be reviewed annually. | ||
(c) Caretaker relatives enrolled under this |
paragraph 15 in families with countable income above | ||
150% and at or below 185% of the Federal Poverty Level | ||
Guidelines shall be counted as family members and pay | ||
premiums as established under the Children's Health | ||
Insurance Program Act. | ||
(d) Premiums shall be billed by and payable to the | ||
Department or its authorized agent, on a monthly basis. | ||
(e) The premium due date is the last day of the | ||
month preceding the month of coverage. | ||
(f) Individuals shall have a grace period through | ||
60 days of coverage to pay the premium. | ||
(g) Failure to pay the full monthly premium by the | ||
last day of the grace period shall result in | ||
termination of coverage. | ||
(h) Partial premium payments shall not be | ||
refunded. | ||
(i) Following termination of an individual's | ||
coverage under this paragraph 15, the following action | ||
is required before the individual can be re-enrolled: | ||
(1) A new application must be completed and the | ||
individual must be determined otherwise eligible. | ||
(2) There must be full payment of premiums due | ||
under this Code, the Children's Health Insurance | ||
Program Act, the Covering ALL KIDS Health | ||
Insurance Act, or any other healthcare program | ||
administered by the Department for periods in |
which a premium was owed and not paid for the | ||
individual. | ||
(3) The first month's premium must be paid if | ||
there was an unpaid premium on the date the | ||
individual's previous coverage was canceled. | ||
The Department is authorized to implement the | ||
provisions of this amendatory Act of the 95th General | ||
Assembly by adopting the medical assistance rules in effect | ||
as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | ||
89 Ill. Admin. Code 120.32 along with only those changes | ||
necessary to conform to federal Medicaid requirements, | ||
federal laws, and federal regulations, including but not | ||
limited to Section 1931 of the Social Security Act (42 | ||
U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | ||
of Health and Human Services, and the countable income | ||
eligibility standard authorized by this paragraph 15. The | ||
Department may not otherwise adopt any rule to implement | ||
this increase except as authorized by law, to meet the | ||
eligibility standards authorized by the federal government | ||
in the Medicaid State Plan or the Title XXI Plan, or to | ||
meet an order from the federal government or any court. | ||
16. Subject to appropriation, uninsured persons who | ||
are not otherwise eligible under this Section who have been | ||
certified and referred by the Department of Public Health | ||
as having been screened and found to need diagnostic | ||
evaluation or treatment, or both diagnostic evaluation and |
treatment, for prostate or testicular cancer. For the | ||
purposes of this paragraph 16, uninsured persons are those | ||
who do not have creditable coverage, as defined under the | ||
Health Insurance Portability and Accountability Act, or | ||
have otherwise exhausted any insurance benefits they may | ||
have had, for prostate or testicular cancer diagnostic | ||
evaluation or treatment, or both diagnostic evaluation and | ||
treatment.
To be eligible, a person must furnish a Social | ||
Security number.
A person's assets are exempt from | ||
consideration in determining eligibility under this | ||
paragraph 16.
Such persons shall be eligible for medical | ||
assistance under this paragraph 16 for so long as they need | ||
treatment for the cancer. A person shall be considered to | ||
need treatment if, in the opinion of the person's treating | ||
physician, the person requires therapy directed toward | ||
cure or palliation of prostate or testicular cancer, | ||
including recurrent metastatic cancer that is a known or | ||
presumed complication of prostate or testicular cancer and | ||
complications resulting from the treatment modalities | ||
themselves. Persons who require only routine monitoring | ||
services are not considered to need treatment.
"Medical | ||
assistance" under this paragraph 16 shall be identical to | ||
the benefits provided under the State's approved plan under | ||
Title XIX of the Social Security Act.
Notwithstanding any | ||
other provision of law, the Department (i) does not have a | ||
claim against the estate of a deceased recipient of |
services under this paragraph 16 and (ii) does not have a | ||
lien against any homestead property or other legal or | ||
equitable real property interest owned by a recipient of | ||
services under this paragraph 16. | ||
17. Persons who, pursuant to a waiver approved by the | ||
Secretary of the U.S. Department of Health and Human | ||
Services, are eligible for medical assistance under Title | ||
XIX or XXI of the federal Social Security Act. | ||
Notwithstanding any other provision of this Code and | ||
consistent with the terms of the approved waiver, the | ||
Illinois Department, may by rule: | ||
(a) Limit the geographic areas in which the waiver | ||
program operates. | ||
(b) Determine the scope, quantity, duration, and | ||
quality, and the rate and method of reimbursement, of | ||
the medical services to be provided, which may differ | ||
from those for other classes of persons eligible for | ||
assistance under this Article. | ||
(c) Restrict the persons' freedom in choice of | ||
providers. | ||
In implementing the provisions of Public Act 96-20, the | ||
Department is authorized to adopt only those rules necessary, | ||
including emergency rules. Nothing in Public Act 96-20 permits | ||
the Department to adopt rules or issue a decision that expands | ||
eligibility for the FamilyCare Program to a person whose income | ||
exceeds 185% of the Federal Poverty Level as determined from |
time to time by the U.S. Department of Health and Human | ||
Services, unless the Department is provided with express | ||
statutory authority. | ||
The Illinois Department and the Governor shall provide a | ||
plan for
coverage of the persons eligible under paragraph 7 as | ||
soon as possible after
July 1, 1984.
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The eligibility of any such person for medical assistance | ||
under this
Article is not affected by the payment of any grant | ||
under the Senior
Citizens and Disabled Persons Property Tax | ||
Relief and Pharmaceutical
Assistance Act or any distributions | ||
or items of income described under
subparagraph (X) of
| ||
paragraph (2) of subsection (a) of Section 203 of the Illinois | ||
Income Tax
Act. The Department shall by rule establish the | ||
amounts of
assets to be disregarded in determining eligibility | ||
for medical assistance,
which shall at a minimum equal the | ||
amounts to be disregarded under the
Federal Supplemental | ||
Security Income Program. The amount of assets of a
single | ||
person to be disregarded
shall not be less than $2,000, and the | ||
amount of assets of a married couple
to be disregarded shall | ||
not be less than $3,000.
| ||
To the extent permitted under federal law, any person found | ||
guilty of a
second violation of Article VIIIA
shall be | ||
ineligible for medical assistance under this Article, as | ||
provided
in Section 8A-8.
| ||
The eligibility of any person for medical assistance under | ||
this Article
shall not be affected by the receipt by the person |
of donations or benefits
from fundraisers held for the person | ||
in cases of serious illness,
as long as neither the person nor | ||
members of the person's family
have actual control over the | ||
donations or benefits or the disbursement
of the donations or | ||
benefits.
| ||
Notwithstanding any other provision of this Code, if the | ||
United States Supreme Court holds Title II, Subtitle A, Section | ||
2001(a) of Public Law 111-148 to be unconstitutional, or if a | ||
holding of Public Law 111-148 makes Medicaid eligibility | ||
allowed under Section 2001(a) inoperable, the State or a unit | ||
of local government shall be prohibited from enrolling | ||
individuals in the Medical Assistance Program as the result of | ||
federal approval of a State Medicaid waiver on or after the | ||
effective date of this amendatory Act of the 97th General | ||
Assembly, and any individuals enrolled in the Medical | ||
Assistance Program pursuant to eligibility permitted as a | ||
result of such a State Medicaid waiver shall become immediately | ||
ineligible. | ||
Notwithstanding any other provision of this Code, if an Act | ||
of Congress that becomes a Public Law eliminates Section | ||
2001(a) of Public Law 111-148, the State or a unit of local | ||
government shall be prohibited from enrolling individuals in | ||
the Medical Assistance Program as the result of federal | ||
approval of a State Medicaid waiver on or after the effective | ||
date of this amendatory Act of the 97th General Assembly, and | ||
any individuals enrolled in the Medical Assistance Program |
pursuant to eligibility permitted as a result of such a State | ||
Medicaid waiver shall become immediately ineligible. | ||
(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; | ||
96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff. | ||
7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48, | ||
eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11; | ||
revised 10-4-11.)
| ||
(305 ILCS 5/5-2.03) | ||
Sec. 5-2.03. Presumptive eligibility. Beginning on the | ||
effective date of this amendatory Act of the 96th General | ||
Assembly and except where federal law requires presumptive | ||
eligibility, no adult may be presumed eligible for medical | ||
assistance under this Code and the Department may not cover any | ||
service rendered to an adult unless the adult has completed an | ||
application for benefits, all required verifications have been | ||
received, and the Department or its designee has found the | ||
adult eligible for the date on which that service was provided. | ||
Nothing in this Section shall apply to pregnant women or to | ||
persons enrolled under the medical assistance program due to | ||
expansions approved by the federal government that are financed | ||
entirely by units of local government and federal matching | ||
funds .
| ||
(Source: P.A. 96-1501, eff. 1-25-11.)
| ||
(305 ILCS 5/15-1) (from Ch. 23, par. 15-1)
|
Sec. 15-1. Definitions. As used in this Article, unless the | ||
context
requires otherwise:
| ||
(a) (Blank). "Base amount" means $108,800,000 multiplied | ||
by a
fraction, the numerator of which is the number of days | ||
represented by the
payments in question and the denominator of | ||
which is 365.
| ||
(a-5) "County provider" means a health care provider that | ||
is, or is
operated by, a county with a population greater than | ||
3,000,000.
| ||
(b) "Fund" means the County Provider Trust Fund.
| ||
(c) "Hospital" or "County hospital" means a hospital, as | ||
defined in Section
14-1 of this Code, which is a county | ||
hospital located in a county of over
3,000,000 population.
| ||
(Source: P.A. 87-13; 88-85; 88-554, eff. 7-26-94.)
| ||
(305 ILCS 5/15-2) (from Ch. 23, par. 15-2)
| ||
Sec. 15-2. County Provider Trust Fund.
| ||
(a) There is created in the State Treasury the County | ||
Provider
Trust Fund. Interest earned by the Fund shall be | ||
credited to the Fund.
The Fund shall not be used to replace any | ||
funds appropriated to the
Medicaid program by the General | ||
Assembly.
| ||
(b) The Fund is created solely for the purposes of | ||
receiving, investing,
and distributing monies in accordance | ||
with this Article XV. The Fund shall
consist of:
| ||
(1) All monies collected or received by the Illinois |
Department under
Section 15-3 of this Code;
| ||
(2) All federal financial participation monies | ||
received by the Illinois
Department pursuant to Title XIX | ||
of the Social Security Act, 42 U.S.C.
1396b, attributable | ||
to eligible expenditures made by the Illinois Department
| ||
pursuant to Section 15-5 of this Code;
| ||
(3) All federal moneys received by the
Illinois | ||
Department pursuant to Title XXI of the Social Security Act
| ||
attributable to eligible expenditures made by the Illinois | ||
Department
pursuant to Section 15-5 of this Code; and
| ||
(4) All other monies received by the Fund from any | ||
source, including
interest thereon.
| ||
(c) Disbursements from the Fund shall be by warrants drawn | ||
by the State
Comptroller upon receipt of vouchers duly executed | ||
and certified by the
Illinois Department and shall be made | ||
only:
| ||
(1) For hospital inpatient care, hospital outpatient | ||
care, care
provided by other outpatient facilities | ||
operated by a county, and
disproportionate share hospital | ||
adjustment payments made under Title XIX of the Social
| ||
Security Act and Article V of this Code as required by | ||
Section 15-5 of this
Code;
| ||
(1.5) For services provided or purchased by county | ||
providers pursuant to Section
5-11 of this Code;
| ||
(2) For the reimbursement of administrative expenses | ||
incurred by county
providers on behalf of the Illinois |
Department as permitted by Section 15-4 of
this Code;
| ||
(3) For the reimbursement of monies received by the | ||
Fund through
error or mistake;
| ||
(4) For the payment of administrative expenses | ||
necessarily incurred by the
Illinois Department or its | ||
agent in performing the activities required by this
Article | ||
XV;
| ||
(5) For the payment of any amounts that are | ||
reimbursable to the federal
government, attributable | ||
solely to the Fund, and required to be paid by State
| ||
warrant; and
| ||
(6) For hospital inpatient care, hospital outpatient | ||
care, care provided
by other outpatient facilities | ||
operated by a county, and disproportionate
share hospital | ||
adjustment payments made under Title XXI of the Social | ||
Security Act,
pursuant to Section 15-5 of this Code ; and .
| ||
(7) For medical care and related services provided | ||
pursuant to a contract with a county. | ||
(Source: P.A. 95-859, eff. 8-19-08.)
| ||
(305 ILCS 5/15-5) (from Ch. 23, par. 15-5)
| ||
Sec. 15-5. Disbursements from the Fund.
| ||
(a) The monies in the Fund shall be disbursed only as | ||
provided in
Section 15-2 of this Code and as follows:
| ||
(1) To the extent that such costs are reimbursable | ||
under federal law, to pay the county hospitals' inpatient |
reimbursement rates based on
actual costs incurred, | ||
trended forward annually by an inflation index.
| ||
(2) To the extent that such costs are reimbursable | ||
under federal law, to pay county hospitals and county | ||
operated outpatient
facilities for outpatient services | ||
based on a federally approved
methodology to cover the | ||
maximum allowable costs.
| ||
(3) To pay the county hospitals disproportionate share | ||
hospital adjustment payments as may be specified in the | ||
Illinois Title XIX State plan.
| ||
(3.5) To pay county providers for services provided or | ||
purchased pursuant to Section
5-11 of this Code.
| ||
(4) To reimburse the county providers for expenses
| ||
contractually
assumed pursuant to Section 15-4 of this | ||
Code.
| ||
(5) To pay the Illinois Department its necessary | ||
administrative
expenses relative to the Fund and other | ||
amounts agreed to, if any, by the
county providers in the | ||
agreement provided for in subsection
(c).
| ||
(6) To pay the county providers any other amount due | ||
according to a federally approved State plan, including
but | ||
not limited to payments made under the provisions of | ||
Section
701(d)(3)(B) of the federal Medicare, Medicaid, | ||
and SCHIP Benefits Improvement
and Protection Act of
2000. | ||
Intergovernmental transfers supporting payments under this | ||
paragraph
(6) shall not be subject to the
computation |
described in subsection (a) of Section 15-3 of this Code, | ||
but
shall be computed as the difference between
the total | ||
of such payments made by the Illinois Department to county
| ||
providers less any amount of federal
financial | ||
participation due the Illinois Department under Titles XIX | ||
and XXI
of the Social Security Act as a
result of such | ||
payments to county providers.
| ||
(b) The Illinois Department shall promptly seek all | ||
appropriate
amendments to the Illinois Title XIX State Plan to | ||
maximize reimbursement, including disproportionate share | ||
hospital adjustment payments, to the county providers.
| ||
(c) (Blank).
| ||
(d) The payments provided for herein are intended to cover | ||
services
rendered on and after July 1, 1991, and any agreement | ||
executed between a
qualifying county and the Illinois | ||
Department pursuant to this Section may
relate back to that | ||
date, provided the Illinois Department obtains federal
| ||
approval. Any changes in payment rates resulting from the | ||
provisions of
Article 3 of this amendatory Act of 1992 are | ||
intended to apply to services
rendered on or after October 1, | ||
1992, and any agreement executed between a
qualifying county | ||
and the Illinois Department pursuant to this Section may
be | ||
effective as of that date.
| ||
(e) If one or more hospitals file suit in any court | ||
challenging any part
of this Article XV, payments to hospitals | ||
from the Fund under this Article
XV shall be made only to the |
extent that sufficient monies are available in
the Fund and | ||
only to the extent that any monies in the Fund are not
| ||
prohibited from disbursement and may be disbursed under any | ||
order of the court.
| ||
(f) All payments under this Section are contingent upon | ||
federal
approval of changes to the Title XIX State plan, if | ||
that approval is required.
| ||
(Source: P.A. 95-859, eff. 8-19-08.)
| ||
(305 ILCS 5/15-11) | ||
Sec. 15-11. Uses of State funds. | ||
(a) At any point, if State revenues referenced in | ||
subsection (b) or (c) of Section 15-10 or additional State | ||
grants are disbursed to the Cook County Health and Hospitals | ||
System, all funds may be used only for the following: | ||
(1) medical services provided at hospitals or clinics | ||
owned and operated by the Cook County Health and Hospitals | ||
System Bureau of Health Services ; or | ||
(2) information technology to enhance billing | ||
capabilities for medical claiming and reimbursement ; or . | ||
(3) services purchased by county providers pursuant to | ||
Section 5-11 of this Code. | ||
(b) State funds may not be used for the following: | ||
(1) non-clinical services, except services that may be | ||
required by accreditation bodies or State or federal | ||
regulatory or licensing authorities; |
(2) non-clinical support staff, except as pursuant to | ||
paragraph (1) of this subsection; or | ||
(3) capital improvements, other than investments in | ||
medical technology, except for capital improvements that | ||
may be required by accreditation bodies or State or federal | ||
regulatory or licensing authorities.
| ||
(Source: P.A. 95-859, eff. 8-19-08.)
| ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law; however, no part of this Act takes effect until | ||
both Senate Bill 2840, AS AMENDED, of the 97th
General Assembly | ||
and Senate Bill 3397, AS AMENDED, of the 97th
General Assembly | ||
have become law.
|