Bill Text: IL HB5593 | 2021-2022 | 102nd General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Extends medical assistance coverage to all women of childbearing age regardless of income level. Requires a hospital licensed under the Hospital Licensing Act or organized under the University of Illinois Hospital Act to complete and submit an application for medical assistance on behalf of every uninsured woman of childbearing age who is admitted to the hospital for inpatient or outpatient services. Provides that upon receipt of an application for medical assistance for a woman of childbearing age, the Department of Human Services shall as soon as practicable enroll the woman into the medical assistance program. Grants the Department of Healthcare and Family Services and the Department of Human Services rulemaking authority to implement the amendatory Act. Requires the Department of Healthcare and Family Services to apply for any federal waivers or State Plan amendments, if required, to implement the amendatory Act. Provides that implementation is contingent on federal approval. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2022-02-25 - Rule 19(a) / Re-referred to Rules Committee [HB5593 Detail]

Download: Illinois-2021-HB5593-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB5593 Introduced , by Rep. Mary E. Flowers SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-2 from Ch. 23, par. 5-2
Amends the Medical Assistance Article of the Illinois Public Aid Code. Extends medical assistance coverage to all women of childbearing age regardless of income level. Requires a hospital licensed under the Hospital Licensing Act or organized under the University of Illinois Hospital Act to complete and submit an application for medical assistance on behalf of every uninsured woman of childbearing age who is admitted to the hospital for inpatient or outpatient services. Provides that upon receipt of an application for medical assistance for a woman of childbearing age, the Department of Human Services shall as soon as practicable enroll the woman into the medical assistance program. Grants the Department of Healthcare and Family Services and the Department of Human Services rulemaking authority to implement the amendatory Act. Requires the Department of Healthcare and Family Services to apply for any federal waivers or State Plan amendments, if required, to implement the amendatory Act. Provides that implementation is contingent on federal approval. Effective immediately.
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A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 5-2 as follows:
(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
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. If changes made in this Section 5-2 require
federal approval, they shall not take effect until such
approval has been received:
1. Recipients of basic maintenance grants under
Articles III and IV.
2. Beginning January 1, 2014, persons otherwise
eligible for basic maintenance under Article III,
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, and who have insufficient income and resources to
meet the costs of necessary medical care, including, but

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not limited to, the following:
(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:
(i) their income, as determined by the
Illinois Department in accordance with any federal
requirements, is equal to or less than 100% of the
federal poverty level; or
(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
100% of the federal poverty level.
(b) (Blank).
3. (Blank).
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.
5.(a) Beginning January 1, 2020, individuals during
pregnancy and during the 12-month period beginning on the
last day of the pregnancy, together with their infants,
whose income is at or below 200% of the federal poverty
level. Until September 30, 2019, or sooner if the
maintenance of effort requirements under the Patient

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Protection and Affordable Care Act are eliminated or may
be waived before then, individuals during pregnancy and
during the 12-month period beginning on the last day of
the pregnancy, whose countable monthly income, after the
deduction of costs incurred for medical care and for other
types of remedial care as specified in administrative
rule, is equal to or less than the Medical Assistance-No
Grant(C) (MANG(C)) Income Standard in effect on April 1,
2013 as set forth in administrative rule.
(b) The plan for coverage shall provide ambulatory
prenatal care to pregnant individuals during a presumptive
eligibility period and establish an income eligibility
standard that is equal to 200% of the federal poverty
level, provided that costs incurred for medical care are
not taken into account in determining such income
eligibility.
(c) The Illinois Department may conduct a
demonstration in at least one county that will provide
medical assistance to pregnant individuals 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

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standards that are not more restrictive than those
established under Article IV of this Code.
6. (a) Subject to federal approval, children younger
than age 19 when countable income is at or below 313% of
the federal poverty level, as determined by the Department
and in accordance with all applicable federal
requirements. The Department is authorized to adopt
emergency rules to implement the changes made to this
paragraph by Public Act 102-43 this amendatory Act of the
102nd General Assembly. Until September 30, 2019, or
sooner if the maintenance of effort requirements under the
Patient Protection and Affordable Care Act are eliminated
or may be waived before then, children younger than age 19
whose countable monthly income, after the deduction of
costs incurred for medical care and for other types of
remedial care as specified in administrative rule, is
equal to or less than the Medical Assistance-No Grant(C)
(MANG(C)) Income Standard in effect on April 1, 2013 as
set forth in administrative rule.
(b) Children and youth who are under temporary custody
or guardianship of the Department of Children and Family
Services or who receive financial assistance in support of
an adoption or guardianship placement from the Department
of Children and Family Services.
7. (Blank).
8. As required under federal law, persons who are

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eligible for Transitional Medical Assistance as a result
of an increase in earnings or child or spousal support
received. The plan for coverage for this class of persons
shall:
(a) extend the medical assistance coverage to the
extent required by federal law; and
(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:
(i) such coverage shall be pursuant to
provisions of the federal Social Security Act;
(ii) such coverage shall include all services
covered under Illinois' State Medicaid Plan;
(iii) no premium shall be charged for such
coverage; and
(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.
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

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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.
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.
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

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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
(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.
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:
(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
Program established under Title XV of the federal
Public Health Service Act in accordance with the
requirements of Section 1504 of that Act as
administered by the Illinois Department of Public
Health; and
(2) persons whose screenings under the above
program were funded in whole or in part by funds
appropriated to the Illinois Department of Public

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Health for breast or cervical cancer screening.
"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 July
3, 2001 (the effective date of Public Act 92-47).
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.

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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

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may adopt rules governing the implementation of this
paragraph 14.
15. Family Care Eligibility.
(a) On and after July 1, 2012, a parent or other
caretaker relative who is 19 years of age or older when
countable income is at or below 133% of the federal
poverty level. A person may not spend down to become
eligible under this paragraph 15.
(b) Eligibility shall be reviewed annually.
(c) (Blank).
(d) (Blank).
(e) (Blank).
(f) (Blank).
(g) (Blank).
(h) (Blank).
(i) Following termination of an individual's
coverage under this paragraph 15, the individual must
be determined eligible before the person can be
re-enrolled.
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

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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

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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.
18. Beginning January 1, 2014, persons aged 19 or
older, but younger than 65, who are not otherwise eligible
for medical assistance under this Section 5-2, who qualify
for medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) and applicable federal
regulations, and who have income at or below 133% of the
federal poverty level plus 5% for the applicable family

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size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
applicable federal regulations. Persons eligible for
medical assistance under this paragraph 18 shall receive
coverage for the Health Benefits Service Package as that
term is defined in subsection (m) of Section 5-1.1 of this
Code. If Illinois' federal medical assistance percentage
(FMAP) is reduced below 90% for persons eligible for
medical assistance under this paragraph 18, eligibility
under this paragraph 18 shall cease no later than the end
of the third month following the month in which the
reduction in FMAP takes effect.
19. Beginning January 1, 2014, as required under 42
U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
and younger than age 26 who are not otherwise eligible for
medical assistance under paragraphs (1) through (17) of
this Section who (i) were in foster care under the
responsibility of the State on the date of attaining age
18 or on the date of attaining age 21 when a court has
continued wardship for good cause as provided in Section
2-31 of the Juvenile Court Act of 1987 and (ii) received
medical assistance under the Illinois Title XIX State Plan
or waiver of such plan while in foster care.
20. Beginning January 1, 2018, persons who are
foreign-born victims of human trafficking, torture, or
other serious crimes as defined in Section 2-19 of this
Code and their derivative family members if such persons:

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(i) reside in Illinois; (ii) are not eligible under any of
the preceding paragraphs; (iii) meet the income guidelines
of subparagraph (a) of paragraph 2; and (iv) meet the
nonfinancial eligibility requirements of Sections 16-2,
16-3, and 16-5 of this Code. The Department may extend
medical assistance for persons who are foreign-born
victims of human trafficking, torture, or other serious
crimes whose medical assistance would be terminated
pursuant to subsection (b) of Section 16-5 if the
Department determines that the person, during the year of
initial eligibility (1) experienced a health crisis, (2)
has been unable, after reasonable attempts, to obtain
necessary information from a third party, or (3) has other
extenuating circumstances that prevented the person from
completing his or her application for status. The
Department may adopt any rules necessary to implement the
provisions of this paragraph.
21. Persons who are not otherwise eligible for medical
assistance under this Section who may qualify for medical
assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the
duration of any federal or State declared emergency due to
COVID-19. Medical assistance to persons eligible for
medical assistance solely pursuant to this paragraph 21
shall be limited to any in vitro diagnostic product (and
the administration of such product) described in 42 U.S.C.

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1396d(a)(3)(B) on or after March 18, 2020, any visit
described in 42 U.S.C. 1396o(a)(2)(G), or any other
medical assistance that may be federally authorized for
this class of persons. The Department may also cover
treatment of COVID-19 for this class of persons, or any
similar category of uninsured individuals, to the extent
authorized under a federally approved 1115 Waiver or other
federal authority. Notwithstanding the provisions of
Section 1-11 of this Code, due to the nature of the
COVID-19 public health emergency, the Department may cover
and provide the medical assistance described in this
paragraph 21 to noncitizens who would otherwise meet the
eligibility requirements for the class of persons
described in this paragraph 21 for the duration of the
State emergency period.
22. All women of childbearing age regardless of income
level. A hospital licensed under the Hospital Licensing
Act or organized under the University of Illinois Hospital
Act must complete and submit an application for medical
assistance on behalf of every uninsured woman of
childbearing age who is admitted to the hospital for
inpatient or outpatient services. Upon receipt of an
application for medical assistance for a woman of
childbearing age, the Department of Human Services shall
as soon as practicable enroll the woman into the medical
assistance program. The Department of Healthcare and

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Family Services and the Department of Human Services may
adopt any rules necessary to implement this paragraph. The
Department of Healthcare and Family Services shall apply
for any federal waivers or State Plan amendments, if
required, to implement this paragraph. Implementation of
this paragraph is contingent on federal approval.
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 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 Persons with Disabilities
Property Tax Relief 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

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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 June 14, 2012 (the effective date of Public Act 97-687),
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.

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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 June 14, 2012
(the effective date of Public Act 97-687), 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.
Effective October 1, 2013, the determination of
eligibility of persons who qualify under paragraphs 5, 6, 8,
15, 17, and 18 of this Section shall comply with the
requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
regulations.
The Department of Healthcare and Family Services, the
Department of Human Services, and the Illinois health
insurance marketplace shall work cooperatively to assist
persons who would otherwise lose health benefits as a result
of changes made under Public Act 98-104 to transition to other
health insurance coverage.
(Source: P.A. 101-10, eff. 6-5-19; 101-649, eff. 7-7-20;
102-43, eff. 7-6-21; 102-558, eff. 8-20-21; 102-665, eff.
10-8-21; revised 11-18-21.)
Section 99. Effective date. This Act takes effect upon
becoming law.