Bill Text: IL HB6253 | 2011-2012 | 97th General Assembly | Amended

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Beginning January 1, 2014, extends benefits under the State's medical assistance program to persons aged 19 or older, but younger than 65, who are not otherwise eligible for medical assistance under the Code, who qualify for medical assistance under specified provisions of the Social Security Act, and who have income at or below 133% of the federal poverty level plus 5% for the applicable family size. Provides that the 4-year moratorium on the expansion of medical assistance eligibility through increasing financial eligibility standards shall not apply to this new class of persons. Provides that such persons shall receive coverage for the Health Benefits Service Package. Defines "Health Benefits Service Package". Effective immediately.

Spectrum: Strong Partisan Bill (Democrat 35-2)

Status: (Failed) 2013-01-08 - Session Sine Die [HB6253 Detail]

Download: Illinois-2011-HB6253-Amended.html

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Rep. Sara Feigenholtz

Filed: 1/8/2013

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AMENDMENT TO HOUSE BILL 6253
AMENDMENT NO. ______. Amend House Bill 6253 by replacing
everything after the enacting clause with the following:
"Section 1. Findings. The General Assembly finds it is in
the best interests of the State to take advantage of the
Patient Protection and Affordable Care Act to enable Illinois
to receive enhanced federal revenue to cover the costs of
health care for low-income adults who are otherwise not
eligible for Medicaid. The General Assembly further finds that
the administration and financing of the Medicaid program must
be sound to ensure Illinois may take full advantage of national
health care reform to keep people healthier; reimburse
hospitals and clinics for uncompensated and charity care for
the uninsured; and replace spending by county and local
governments for healthcare costs now borne by local health
departments, social service agencies, homeless shelters,
mental health clinics, drug treatment centers, township

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organizations, and others for the care of the uninsured.
Accordingly, the General Assembly finds that, while filling the
current gap in Medicaid coverage, it is essential that the
State preserve and extend recent efforts to reform Illinois'
Medicaid program. Changes designed to increase efficiencies
and enhance program integrity must continue to prevent client
and provider fraud and abuse; to impose controls on use of
Medicaid services to prevent over-use or waste; to rationalize
the Medicaid health care delivery system by adopting care
coordination models wherever feasible to achieve effective and
efficient care delivery across all covered services; and to
operate the program within budget limits.
Section 5. The Illinois Public Aid Code is amended by
changing Sections 5-1.1, 5-1.4, and 5-2 as follows:
(305 ILCS 5/5-1.1) (from Ch. 23, par. 5-1.1)
Sec. 5-1.1. Definitions. The terms defined in this Section
shall have the meanings ascribed to them, except when the
context otherwise requires.
(a) "Nursing facility" means a facility, licensed by the
Department of Public Health under the Nursing Home Care Act,
that provides nursing facility services within the meaning of
Title XIX of the federal Social Security Act.
(b) "Intermediate care facility for the developmentally
disabled" or "ICF/DD" means a facility, licensed by the

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Department of Public Health under the ID/DD Community Care Act,
that is an intermediate care facility for the mentally retarded
within the meaning of Title XIX of the federal Social Security
Act.
(c) "Standard services" means those services required for
the care of all patients in the facility and shall, as a
minimum, include the following: (1) administration; (2)
dietary (standard); (3) housekeeping; (4) laundry and linen;
(5) maintenance of property and equipment, including
utilities; (6) medical records; (7) training of employees; (8)
utilization review; (9) activities services; (10) social
services; (11) disability services; and all other similar
services required by either the laws of the State of Illinois
or one of its political subdivisions or municipalities or by
Title XIX of the Social Security Act.
(d) "Patient services" means those which vary with the
number of personnel; professional and para-professional skills
of the personnel; specialized equipment, and reflect the
intensity of the medical and psycho-social needs of the
patients. Patient services shall as a minimum include: (1)
physical services; (2) nursing services, including restorative
nursing; (3) medical direction and patient care planning; (4)
health related supportive and habilitative services and all
similar services required by either the laws of the State of
Illinois or one of its political subdivisions or municipalities
or by Title XIX of the Social Security Act.

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(e) "Ancillary services" means those services which
require a specific physician's order and defined as under the
medical assistance program as not being routine in nature for
skilled nursing facilities and ICF/DDs. Such services
generally must be authorized prior to delivery and payment as
provided for under the rules of the Department of Healthcare
and Family Services.
(f) "Capital" means the investment in a facility's assets
for both debt and non-debt funds. Non-debt capital is the
difference between an adjusted replacement value of the assets
and the actual amount of debt capital.
(g) "Profit" means the amount which shall accrue to a
facility as a result of its revenues exceeding its expenses as
determined in accordance with generally accepted accounting
principles.
(h) "Non-institutional services" means those services
provided under paragraph (f) of Section 3 of the Disabled
Persons Rehabilitation Act and those services provided under
Section 4.02 of the Illinois Act on the Aging.
(i) (Blank).
(j) "Institutionalized person" means an individual who is
an inpatient in an ICF/DD or nursing facility, or who is an
inpatient in a medical institution receiving a level of care
equivalent to that of an ICF/DD or nursing facility, or who is
receiving services under Section 1915(c) of the Social Security
Act.

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(k) "Institutionalized spouse" means an institutionalized
person who is expected to receive services at the same level of
care for at least 30 days and is married to a spouse who is not
an institutionalized person.
(l) "Community spouse" is the spouse of an
institutionalized spouse.
(m) "Health Benefits Service Package" means, subject to
federal approval, benefits covered by the medical assistance
program as determined by the Department by rule for individuals
eligible for medical assistance under paragraph 18 of Section
5-2 of this Code.
(Source: P.A. 96-1530, eff. 2-16-11; 97-227, eff. 1-1-12;
97-820, eff. 7-17-12.)
(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), there shall be a 4-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

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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. This
moratorium shall not apply to those persons eligible for
medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
Section 5-2 of this Code.
(Source: P.A. 96-1501, eff. 1-25-11; 97-687, eff. 6-14-12.)

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(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:
1. Recipients of basic maintenance grants under
Articles III and IV.
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:
(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 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
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
(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
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
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).
(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

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permitted by federal law.
3. Persons who would otherwise qualify for Aid to the
Medically Indigent under Article VII.
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) 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
the maximum extent possible under Title XIX of the Federal
Social Security Act.
(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

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same size, 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 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.
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.
7. (Blank).
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

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maintenance assistance under Article VI of this Code due to
employment earnings. The plan for coverage for this class
of persons shall:
(a) extend the medical assistance coverage for up
to 12 months following termination of basic
maintenance assistance; 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 while the person was eligible for basic
maintenance assistance;
(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

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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.
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

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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
(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 Services 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

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appropriated to the Illinois Department of Public
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 the
effective date of this amendatory Act of the 92nd General
Assembly.
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

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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

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appeal. The Department may adopt rules governing the
implementation of this paragraph 14.
15. Family Care Eligibility.
(a) On and after July 1, 2012, 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) (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

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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

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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.
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 as set forth in 42 CFR
435.119, and who have income at or below 133% of the

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federal poverty level plus 5% for the applicable family
size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
as set forth in 42 CFR 435.603. 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.
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.
The eligibility of any such person for medical assistance
under this Article is not affected by the payment of any grant

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under the Senior Citizens and Disabled Persons 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 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

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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;
97-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff.
7-13-12; revised 7-23-12.)

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Section 99. Effective date. This Act takes effect upon
becoming law.".