Bill Text: IL SB0660 | 2017-2018 | 100th General Assembly | Introduced


Bill Title: Amends the Veterans' Health Insurance Program Act of 2008. Changes the short title of the Act to the Veterans' Supplemental Health Insurance Program Act of 2008. Makes conforming changes in the Illinois Public Aid Code and State Finance Act. Changes references in the Act from "Veterans' Health Insurance Program" to "Veterans' Supplemental Health Insurance Program". Provides that enrollment in the Program is limited to individuals at or below 200% of the federal poverty level (currently, enrollment is based on the availability of funds and may be capped based on the availability of funds appropriated for the Program). Makes conforming changes in eligibility provisions concerning household income requirements. Provides that the Department of Healthcare and Family Services shall adopt rules concerning covered services that must include dental preventative and restorative services. Removes a provision providing that the spouse of a veteran is ineligible for coverage under the Program for a minimum period of 3 months if the required monthly premium is not paid. Removes a provision stating that the Program is not an entitlement. Makes changes to provisions concerning legislative intent.

Spectrum: Partisan Bill (Democrat 9-0)

Status: (Introduced) 2017-08-04 - Pursuant to Senate Rule 3-9(b) / Referred to Assignments [SB0660 Detail]

Download: Illinois-2017-SB0660-Introduced.html


100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
SB0660

Introduced 1/25/2017, by Sen. Michael E. Hastings

SYNOPSIS AS INTRODUCED:
30 ILCS 105/6z-52
305 ILCS 5/11-22 from Ch. 23, par. 11-22
305 ILCS 5/11-22a from Ch. 23, par. 11-22a
305 ILCS 5/11-22b from Ch. 23, par. 11-22b
305 ILCS 5/11-22c from Ch. 23, par. 11-22c
330 ILCS 126/1
330 ILCS 126/3
330 ILCS 126/5
330 ILCS 126/10
330 ILCS 126/15

Amends the Veterans' Health Insurance Program Act of 2008. Changes the short title of the Act to the Veterans' Supplemental Health Insurance Program Act of 2008. Makes conforming changes in the Illinois Public Aid Code and State Finance Act. Changes references in the Act from "Veterans' Health Insurance Program" to "Veterans' Supplemental Health Insurance Program". Provides that enrollment in the Program is limited to individuals at or below 200% of the federal poverty level (currently, enrollment is based on the availability of funds and may be capped based on the availability of funds appropriated for the Program). Makes conforming changes in eligibility provisions concerning household income requirements. Provides that the Department of Healthcare and Family Services shall adopt rules concerning covered services that must include dental preventative and restorative services. Removes a provision providing that the spouse of a veteran is ineligible for coverage under the Program for a minimum period of 3 months if the required monthly premium is not paid. Removes a provision stating that the Program is not an entitlement. Makes changes to provisions concerning legislative intent.
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A BILL FOR

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1 AN ACT concerning military service.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The State Finance Act is amended by changing
5Section 6z-52 as follows:
6 (30 ILCS 105/6z-52)
7 Sec. 6z-52. Drug Rebate Fund.
8 (a) There is created in the State Treasury a special fund
9to be known as the Drug Rebate Fund.
10 (b) The Fund is created for the purpose of receiving and
11disbursing moneys in accordance with this Section.
12Disbursements from the Fund shall be made, subject to
13appropriation, only as follows:
14 (1) For payments for reimbursement or coverage for
15 prescription drugs and other pharmacy products provided to
16 a recipient of medical assistance under the Illinois Public
17 Aid Code, the Children's Health Insurance Program Act, the
18 Covering ALL KIDS Health Insurance Act, and the Veterans'
19 Supplemental Health Insurance Program Act of 2008.
20 (2) For reimbursement of moneys collected by the
21 Department of Healthcare and Family Services (formerly
22 Illinois Department of Public Aid) through error or
23 mistake.

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1 (3) For payments of any amounts that are reimbursable
2 to the federal government resulting from a payment into
3 this Fund.
4 (4) For payments of operational and administrative
5 expenses related to providing and managing coverage for
6 prescription drugs and other pharmacy products provided to
7 a recipient of medical assistance under the Illinois Public
8 Aid Code, the Children's Health Insurance Program Act, the
9 Covering ALL KIDS Health Insurance Act, the Veterans'
10 Supplemental Health Insurance Program Act of 2008, and the
11 Senior Citizens and Disabled Persons Property Tax Relief
12 and Pharmaceutical Assistance Act.
13 (c) The Fund shall consist of the following:
14 (1) Upon notification from the Director of Healthcare
15 and Family Services, the Comptroller shall direct and the
16 Treasurer shall transfer the net State share (disregarding
17 the reduction in net State share attributable to the
18 American Recovery and Reinvestment Act of 2009 or any other
19 federal economic stimulus program) of all moneys received
20 by the Department of Healthcare and Family Services
21 (formerly Illinois Department of Public Aid) from drug
22 rebate agreements with pharmaceutical manufacturers
23 pursuant to Title XIX of the federal Social Security Act,
24 including any portion of the balance in the Public Aid
25 Recoveries Trust Fund on July 1, 2001 that is attributable
26 to such receipts.

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1 (2) All federal matching funds received by the Illinois
2 Department as a result of expenditures made by the
3 Department that are attributable to moneys deposited in the
4 Fund.
5 (3) Any premium collected by the Illinois Department
6 from participants under a waiver approved by the federal
7 government relating to provision of pharmaceutical
8 services.
9 (4) All other moneys received for the Fund from any
10 other source, including interest earned thereon.
11(Source: P.A. 96-8, eff. 4-28-09; 96-1100, eff. 1-1-11; 97-689,
12eff. 7-1-12.)
13 Section 10. The Illinois Public Aid Code is amended by
14changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
15 (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
16 Sec. 11-22. Charge upon claims and causes of action for
17injuries. The Illinois Department shall have a charge upon all
18claims, demands and causes of action for injuries to an
19applicant for or recipient of (i) financial aid under Articles
20III, IV, and V, (ii) health care benefits provided under the
21Covering ALL KIDS Health Insurance Act, or (iii) health care
22benefits provided under the Veterans' Health Insurance Program
23Act or the Veterans' Supplemental Health Insurance Program Act
24of 2008 for the total amount of medical assistance provided the

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1recipient from the time of injury to the date of recovery upon
2such claim, demand or cause of action. In addition, if the
3applicant or recipient was employable, as defined by the
4Department, at the time of the injury, the Department shall
5also have a charge upon any such claims, demands and causes of
6action for the total amount of aid provided to the recipient
7and his dependents, including all cash assistance and medical
8assistance only to the extent includable in the claimant's
9action, from the time of injury to the date of recovery upon
10such claim, demand or cause of action. Any definition of
11"employable" adopted by the Department shall apply only to
12persons above the age of compulsory school attendance.
13 If the injured person was employable at the time of the
14injury and is provided aid under Articles III, IV, or V and any
15dependent or member of his family is provided aid under Article
16VI, or vice versa, both the Illinois Department and the local
17governmental unit shall have a charge upon such claims, demands
18and causes of action for the aid provided to the injured person
19and any dependent member of his family, including all cash
20assistance, medical assistance and food stamps, from the time
21of the injury to the date of recovery.
22 "Recipient", as used herein, means (i) in the case of
23financial aid provided under this Code, the grantee of record
24and any persons whose needs are included in the financial aid
25provided to the grantee of record or otherwise met by grants
26under the appropriate Article of this Code for which such

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1person is eligible, (ii) in the case of health care benefits
2provided under the Covering ALL KIDS Health Insurance Act, the
3child to whom those benefits are provided, and (iii) in the
4case of health care benefits provided under the Veterans'
5Health Insurance Program Act or the Veterans' Supplemental
6Health Insurance Program Act of 2008, the veteran to whom
7benefits are provided.
8 In each case, the notice shall be served by certified mail
9or registered mail, or by facsimile or electronic messaging
10when requested by the party or parties against whom the
11applicant or recipient has a claim, demand, or cause of action,
12upon the party or parties against whom the applicant or
13recipient has a claim, demand or cause of action. The notice
14shall claim the charge and describe the interest the Illinois
15Department, the local governmental unit, or the county, has in
16the claim, demand, or cause of action. The charge shall attach
17to any verdict or judgment entered and to any money or property
18which may be recovered on account of such claim, demand, cause
19of action or suit from and after the time of the service of the
20notice.
21 On petition filed by the Illinois Department, or by the
22local governmental unit or county if either is claiming a
23charge, or by the recipient, or by the defendant, the court, on
24written notice to all interested parties, may adjudicate the
25rights of the parties and enforce the charge. The court may
26approve the settlement of any claim, demand or cause of action

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1either before or after a verdict, and nothing in this Section
2shall be construed as requiring the actual trial or final
3adjudication of any claim, demand or cause of action upon which
4the Illinois Department, the local governmental unit or county
5has charge. The court may determine what portion of the
6recovery shall be paid to the injured person and what portion
7shall be paid to the Illinois Department, the local
8governmental unit or county having a charge against the
9recovery. In making this determination, the court shall conduct
10an evidentiary hearing and shall consider competent evidence
11pertaining to the following matters:
12 (1) the amount of the charge sought to be enforced
13 against the recovery when expressed as a percentage of the
14 gross amount of the recovery; the amount of the charge
15 sought to be enforced against the recovery when expressed
16 as a percentage of the amount obtained by subtracting from
17 the gross amount of the recovery the total attorney's fees
18 and other costs incurred by the recipient incident to the
19 recovery; and whether the Department, unit of local
20 government or county seeking to enforce the charge against
21 the recovery should as a matter of fairness and equity bear
22 its proportionate share of the fees and costs incurred to
23 generate the recovery from which the charge is sought to be
24 satisfied;
25 (2) the amount, if any, of the attorney's fees and
26 other costs incurred by the recipient incident to the

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1 recovery and paid by the recipient up to the time of
2 recovery, and the amount of such fees and costs remaining
3 unpaid at the time of recovery;
4 (3) the total hospital, doctor and other medical
5 expenses incurred for care and treatment of the injury to
6 the date of recovery therefor, the portion of such expenses
7 theretofore paid by the recipient, by insurance provided by
8 the recipient, and by the Department, unit of local
9 government and county seeking to enforce a charge against
10 the recovery, and the amount of such previously incurred
11 expenses which remain unpaid at the time of recovery and by
12 whom such incurred, unpaid expenses are to be paid;
13 (4) whether the recovery represents less than
14 substantially full recompense for the injury and the
15 hospital, doctor and other medical expenses incurred to the
16 date of recovery for the care and treatment of the injury,
17 so that reduction of the charge sought to be enforced
18 against the recovery would not likely result in a double
19 recovery or unjust enrichment to the recipient;
20 (5) the age of the recipient and of persons dependent
21 for support upon the recipient, the nature and permanency
22 of the recipient's injuries as they affect not only the
23 future employability and education of the recipient but
24 also the reasonably necessary and foreseeable future
25 material, maintenance, medical, rehabilitative and
26 training needs of the recipient, the cost of such

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1 reasonably necessary and foreseeable future needs, and the
2 resources available to meet such needs and pay such costs;
3 (6) the realistic ability of the recipient to repay in
4 whole or in part the charge sought to be enforced against
5 the recovery when judged in light of the factors enumerated
6 above.
7 The burden of producing evidence sufficient to support the
8exercise by the court of its discretion to reduce the amount of
9a proven charge sought to be enforced against the recovery
10shall rest with the party seeking such reduction.
11 The court may reduce and apportion the Illinois
12Department's lien proportionate to the recovery of the
13claimant. The court may consider the nature and extent of the
14injury, economic and noneconomic loss, settlement offers,
15comparative negligence as it applies to the case at hand,
16hospital costs, physician costs, and all other appropriate
17costs. The Illinois Department shall pay its pro rata share of
18the attorney fees based on the Illinois Department's lien as it
19compares to the total settlement agreed upon. This Section
20shall not affect the priority of an attorney's lien under the
21Attorneys Lien Act. The charges of the Illinois Department
22described in this Section, however, shall take priority over
23all other liens and charges existing under the laws of the
24State of Illinois with the exception of the attorney's lien
25under said statute.
26 Whenever the Department or any unit of local government has

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1a statutory charge under this Section against a recovery for
2damages incurred by a recipient because of its advancement of
3any assistance, such charge shall not be satisfied out of any
4recovery until the attorney's claim for fees is satisfied,
5irrespective of whether or not an action based on recipient's
6claim has been filed in court.
7 This Section shall be inapplicable to any claim, demand or
8cause of action arising under (a) the Workers' Compensation Act
9or the predecessor Workers' Compensation Act of June 28, 1913,
10(b) the Workers' Occupational Diseases Act or the predecessor
11Workers' Occupational Diseases Act of March 16, 1936; and (c)
12the Wrongful Death Act.
13(Source: P.A. 98-73, eff. 7-15-13.)
14 (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
15 Sec. 11-22a. Right of Subrogation. To the extent of the
16amount of (i) medical assistance provided by the Department to
17or on behalf of a recipient under Article V or VI, (ii) health
18care benefits provided for a child under the Covering ALL KIDS
19Health Insurance Act, or (iii) health care benefits provided to
20a veteran under the Veterans' Health Insurance Program Act or
21the Veterans' Supplemental Health Insurance Program Act of
222008, the Department shall be subrogated to any right of
23recovery such recipient may have under the terms of any private
24or public health care coverage or casualty coverage, including
25coverage under the "Workers' Compensation Act", approved July

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19, 1951, as amended, or the "Workers' Occupational Diseases
2Act", approved July 9, 1951, as amended, without the necessity
3of assignment of claim or other authorization to secure the
4right of recovery to the Department. To enforce its subrogation
5right, the Department may (i) intervene or join in an action or
6proceeding brought by the recipient, his or her guardian,
7personal representative, estate, dependents, or survivors
8against any person or public or private entity that may be
9liable; (ii) institute and prosecute legal proceedings against
10any person or public or private entity that may be liable for
11the cost of such services; or (iii) institute and prosecute
12legal proceedings, to the extent necessary to reimburse the
13Illinois Department for its costs, against any noncustodial
14parent who (A) is required by court or administrative order to
15provide insurance or other coverage of the cost of health care
16services for a child eligible for medical assistance under this
17Code and (B) has received payment from a third party for the
18costs of those services but has not used the payments to
19reimburse either the other parent or the guardian of the child
20or the provider of the services.
21(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06;
2295-755, eff. 7-25-08.)
23 (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
24 Sec. 11-22b. Recoveries.
25 (a) As used in this Section:

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1 (1) "Carrier" means any insurer, including any private
2 company, corporation, mutual association, trust fund,
3 reciprocal or interinsurance exchange authorized under the
4 laws of this State to insure persons against liability or
5 injuries caused to another and any insurer providing
6 benefits under a policy of bodily injury liability
7 insurance covering liability arising out of the ownership,
8 maintenance or use of a motor vehicle which provides
9 uninsured motorist endorsement or coverage.
10 (2) "Beneficiary" means any person or their dependents
11 who has received benefits or will be provided benefits
12 under this Code, under the Covering ALL KIDS Health
13 Insurance Act, or under the Veterans' Health Insurance
14 Program Act or the Veterans' Supplemental Health Insurance
15 Program Act of 2008 because of an injury for which another
16 person may be liable. It includes such beneficiary's
17 guardian, conservator or other personal representative,
18 his estate or survivors.
19 (b)(1) When benefits are provided or will be provided to a
20beneficiary under this Code, under the Covering ALL KIDS Health
21Insurance Act, or under the Veterans' Health Insurance Program
22Act or the Veterans' Supplemental Health Insurance Program Act
23of 2008 because of an injury for which another person is
24liable, or for which a carrier is liable in accordance with the
25provisions of any policy of insurance issued pursuant to the
26Illinois Insurance Code, the Illinois Department shall have a

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1right to recover from such person or carrier the reasonable
2value of benefits so provided. The Attorney General may, to
3enforce such right, institute and prosecute legal proceedings
4against the third person or carrier who may be liable for the
5injury in an appropriate court, either in the name of the
6Illinois Department or in the name of the injured person, his
7guardian, personal representative, estate, or survivors.
8 (2) The Department may:
9 (A) compromise or settle and release any such claim for
10 benefits provided under this Code, or
11 (B) waive any such claims for benefits provided under
12 this Code, in whole or in part, for the convenience of the
13 Department or if the Department determines that collection
14 would result in undue hardship upon the person who suffered
15 the injury or, in a wrongful death action, upon the heirs
16 of the deceased.
17 (3) No action taken on behalf of the Department pursuant to
18this Section or any judgment rendered in such action shall be a
19bar to any action upon the claim or cause of action of the
20beneficiary, his guardian, conservator, personal
21representative, estate, dependents or survivors against the
22third person who may be liable for the injury, or shall operate
23to deny to the beneficiary the recovery for that portion of any
24damages not covered hereunder.
25 (c)(1) When an action is brought by the Department pursuant
26to subsection (b), it shall be commenced within the period

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1prescribed by Article XIII of the Code of Civil Procedure.
2 However, the Department may not commence the action prior
3to 5 months before the end of the applicable period prescribed
4by Article XIII of the Code of Civil Procedure. Thirty days
5prior to commencing an action, the Department shall notify the
6beneficiary of the Department's intent to commence such an
7action.
8 (2) The death of the beneficiary does not abate any right
9of action established by subsection (b).
10 (3) When an action or claim is brought by persons entitled
11to bring such actions or assert such claims against a third
12person who may be liable for causing the death of a
13beneficiary, any settlement, judgment or award obtained is
14subject to the Department's claim for reimbursement of the
15benefits provided to the beneficiary under this Code, under the
16Covering ALL KIDS Health Insurance Act, or under the Veterans'
17Health Insurance Program Act or the Veterans' Supplemental
18Health Insurance Program Act of 2008.
19 (4) When the action or claim is brought by the beneficiary
20alone and the beneficiary incurs a personal liability to pay
21attorney's fees and costs of litigation, the Department's claim
22for reimbursement of the benefits provided to the beneficiary
23shall be the full amount of benefits paid on behalf of the
24beneficiary under this Code, under the Covering ALL KIDS Health
25Insurance Act, or under the Veterans' Health Insurance Program
26Act or the Veterans' Supplemental Health Insurance Program Act

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1of 2008 less a pro rata share which represents the Department's
2reasonable share of attorney's fees paid by the beneficiary and
3that portion of the cost of litigation expenses determined by
4multiplying by the ratio of the full amount of the expenditures
5of the full amount of the judgment, award or settlement.
6 (d)(1) If either the beneficiary or the Department brings
7an action or claim against such third party or carrier, the
8beneficiary or the Department shall within 30 days of filing
9the action give to the other written notice by personal service
10or registered mail of the action or claim and of the name of
11the court in which the action or claim is brought. Proof of
12such notice shall be filed in such action or claim. If an
13action or claim is brought by either the Department or the
14beneficiary, the other may, at any time before trial on the
15facts, become a party to such action or claim or shall
16consolidate his action or claim with the other if brought
17independently.
18 (2) If an action or claim is brought by the Department
19pursuant to subsection (b)(1), written notice to the
20beneficiary, guardian, personal representative, estate or
21survivor given pursuant to this Section shall advise him of his
22right to intervene in the proceeding, his right to obtain a
23private attorney of his choice and the Department's right to
24recover the reasonable value of the benefits provided.
25 (e) In the event of judgment or award in a suit or claim
26against such third person or carrier:

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1 (1) If the action or claim is prosecuted by the
2 beneficiary alone, the court shall first order paid from
3 any judgment or award the reasonable litigation expenses
4 incurred in preparation and prosecution of such action or
5 claim, together with reasonable attorney's fees, when an
6 attorney has been retained. After payment of such expenses
7 and attorney's fees the court shall, on the application of
8 the Department, allow as a first lien against the amount of
9 such judgment or award the amount of the Department's
10 expenditures for the benefit of the beneficiary under this
11 Code, under the Covering ALL KIDS Health Insurance Act, or
12 under the Veterans' Health Insurance Program Act or the
13 Veterans' Supplemental Health Insurance Program Act of
14 2008, as provided in subsection (c)(4).
15 (2) If the action or claim is prosecuted both by the
16 beneficiary and the Department, the court shall first order
17 paid from any judgment or award the reasonable litigation
18 expenses incurred in preparation and prosecution of such
19 action or claim, together with reasonable attorney's fees
20 for plaintiffs attorneys based solely on the services
21 rendered for the benefit of the beneficiary. After payment
22 of such expenses and attorney's fees, the court shall apply
23 out of the balance of such judgment or award an amount
24 sufficient to reimburse the Department the full amount of
25 benefits paid on behalf of the beneficiary under this Code,
26 under the Covering ALL KIDS Health Insurance Act, or under

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1 the Veterans' Health Insurance Program Act or the Veterans'
2 Supplemental Health Insurance Program Act of 2008.
3 (f) The court shall, upon further application at any time
4before the judgment or award is satisfied, allow as a further
5lien the amount of any expenditures of the Department in
6payment of additional benefits arising out of the same cause of
7action or claim provided on behalf of the beneficiary under
8this Code, under the Covering ALL KIDS Health Insurance Act, or
9under the Veterans' Health Insurance Program Act or the
10Veterans' Supplemental Health Insurance Program Act of 2008,
11when such benefits were provided or became payable subsequent
12to the original order.
13 (g) No judgment, award, or settlement in any action or
14claim by a beneficiary to recover damages for injuries, when
15the Department has an interest, shall be satisfied without
16first giving the Department notice and a reasonable opportunity
17to perfect and satisfy its lien.
18 (h) When the Department has perfected a lien upon a
19judgment or award in favor of a beneficiary against any third
20party for an injury for which the beneficiary has received
21benefits under this Code, under the Covering ALL KIDS Health
22Insurance Act, or under the Veterans' Health Insurance Program
23Act or the Veterans' Supplemental Health Insurance Program Act
24of 2008, the Department shall be entitled to a writ of
25execution as lien claimant to enforce payment of said lien
26against such third party with interest and other accruing costs

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1as in the case of other executions. In the event the amount of
2such judgment or award so recovered has been paid to the
3beneficiary, the Department shall be entitled to a writ of
4execution against such beneficiary to the extent of the
5Department's lien, with interest and other accruing costs as in
6the case of other executions.
7 (i) Except as otherwise provided in this Section,
8notwithstanding any other provision of law, the entire amount
9of any settlement of the injured beneficiary's action or claim,
10with or without suit, is subject to the Department's claim for
11reimbursement of the benefits provided and any lien filed
12pursuant thereto to the same extent and subject to the same
13limitations as in Section 11-22 of this Code.
14(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06;
1595-755, eff. 7-25-08.)
16 (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
17 Sec. 11-22c. Recovery of back wages.
18 (a) As used in this Section, "recipient" means any person
19receiving financial assistance under Article IV or Article VI
20of this Code, receiving health care benefits under the Covering
21ALL KIDS Health Insurance Act, or receiving health care
22benefits under the Veterans' Health Insurance Program Act or
23the Veterans' Supplemental Health Insurance Program Act of
242008.
25 (b) If a recipient maintains any suit, charge or other

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1court or administrative action against an employer seeking back
2pay for a period during which the recipient received financial
3assistance under Article IV or Article VI of this Code, health
4care benefits under the Covering ALL KIDS Health Insurance Act,
5or health care benefits under the Veterans' Health Insurance
6Program Act or the Veterans' Supplemental Health Insurance
7Program Act of 2008, the recipient shall report such fact to
8the Department. To the extent of the amount of assistance
9provided to or on behalf of the recipient under Article IV or
10Article VI, health care benefits provided under the Covering
11ALL KIDS Health Insurance Act, or health care benefits provided
12under the Veterans' Health Insurance Program Act or the
13Veterans' Supplemental Health Insurance Program Act of 2008,
14the Department may by intervention or otherwise without the
15necessity of assignment of claim, attach a lien on the recovery
16of back wages equal to the amount of assistance provided by the
17Department to the recipient under Article IV or Article VI,
18under the Covering ALL KIDS Health Insurance Act, or under the
19Veterans' Health Insurance Program Act or the Veterans'
20Supplemental Health Insurance Program Act of 2008.
21(Source: P.A. 94-693, eff. 7-1-06; 94-816, eff. 5-30-06;
2295-755, eff. 7-25-08.)
23 Section 15. The Veterans' Health Insurance Program Act of
242008 is amended by changing Sections 1, 3, 5, 10, and 15 as
25follows:

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1 (330 ILCS 126/1)
2 Sec. 1. Short title. This Act may be cited as the Veterans'
3Supplemental Health Insurance Program Act of 2008.
4(Source: P.A. 95-755, eff. 7-25-08.)
5 (330 ILCS 126/3)
6 Sec. 3. Legislative intent. The General Assembly finds that
7those who have served their country honorably in military
8service and who are residing in this State deserve access to
9affordable, comprehensive health insurance. Many veterans are
10uninsured and unable to afford healthcare. This lack of
11healthcare, including medical and dental preventative care,
12often exacerbates health conditions. The effects of lack of
13insurance negatively impact those residents of the State who
14are insured because the cost of paying for care to the
15uninsured is often shifted to those who have insurance in the
16form of higher health insurance premiums. It is, therefore, the
17intent of this legislation to provide access to affordable
18health and dental insurance for veterans and their spouses
19residing in Illinois who are unable to afford such coverage.
20However, the State has only a limited amount of resources, and
21the General Assembly therefore declares that while it intends
22to cover as many such veterans and spouses as possible, the
23State may not be able to cover every eligible person who
24qualifies for this Program as a matter of entitlement due to

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1limited funding.
2(Source: P.A. 95-755, eff. 7-25-08; 96-45, eff. 7-15-09.)
3 (330 ILCS 126/5)
4 Sec. 5. Definitions. The following words have the following
5meanings:
6 "Department" means the Department of Healthcare and Family
7Services, or any successor agency.
8 "Director" means the Director of Healthcare and Family
9Services, or any successor agency.
10 "Medical assistance" means health care benefits provided
11under Article V of the Illinois Public Aid Code.
12 "Program" means the Veterans' Supplemental Health
13Insurance Program.
14 "Resident" means an individual who has an Illinois
15residence, as provided in Section 5-3 of the Illinois Public
16Aid Code.
17 "Spouse" means the person who is the person who, under the
18laws of the State of Illinois, is married to an eligible
19veteran at the time of application and subsequent
20re-determinations for the Program and includes enrolled
21spouses surviving the death of veteran spouses.
22 "Veteran" means any person who has served in a branch of
23the United States military for greater than 180 days after
24initial training.
25 "Veterans Affairs" or "VA" means the United States

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1Department of Veterans Affairs.
2(Source: P.A. 95-755, eff. 7-25-08; 96-45, eff. 7-15-09;
396-1000, eff. 7-2-10.)
4 (330 ILCS 126/10)
5 Sec. 10. Operation of the Program.
6 (a) The Veterans' Supplemental Health Insurance Program is
7created. This Program is not an entitlement. Enrollment is
8limited to individuals at or below 200% of the federal poverty
9level based on the availability of funds, and enrollment may be
10capped based on funds appropriated for the Program. As soon as
11practical after the effective date of this Act, coverage for
12this Program shall begin. The Program shall be administered by
13the Department of Healthcare and Family Services in
14collaboration with the Department of Veterans' Affairs. The
15Department shall have the same powers and authority to
16administer the Program as are provided to the Department in
17connection with the Department's administration of the
18Illinois Public Aid Code. The Department shall coordinate the
19Program with other health programs operated by the Department
20and other State and federal agencies.
21 (b) The Department shall operate the Program in a manner so
22that the estimated cost of the Program during the fiscal year
23will not exceed the total appropriation for the Program. The
24Department may take any appropriate action to limit spending or
25enrollment into the Program, including, but not limited to,

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1ceasing to accept or process applications, reviewing
2eligibility more frequently than annually, adjusting
3cost-sharing, or reducing the income threshold for eligibility
4as necessary to control expenditures for the Program.
5 (c) Notwithstanding subsections (a) and (b) and with the
6mutual agreement of the Department of Veterans' Affairs and the
7Department of Healthcare and Family Services, the operation of
8the Program may be changed to simplify its administration and
9to take advantage of health insurance coverage that may be
10available to veterans under the Patient Protection and
11Affordable Care Act.
12(Source: P.A. 98-104, eff. 7-22-13.)
13 (330 ILCS 126/15)
14 Sec. 15. Eligibility.
15 (a) To be eligible for the Program, a person must:
16 (1) be a veteran who is not on active duty and who has
17 not been dishonorably discharged from service or the spouse
18 of such a veteran;
19 (2) be a resident of the State of Illinois;
20 (3) be at least 19 years of age and no older than 64
21 years of age;
22 (4) be uninsured, as defined by the Department by rule,
23 for a period of time established by the Department by rule,
24 which shall be no less than 3 months;
25 (5) not be eligible for medical assistance under the

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1 Illinois Public Aid Code or healthcare benefits under the
2 Children's Health Insurance Program Act or the Covering ALL
3 KIDS Health Insurance Act;
4 (6) not be eligible for medical benefits through the
5 Veterans Health Administration; and
6 (7) have a household income no greater than 200% the
7 sum of (i) an amount equal to 25% of the federal poverty
8 level plus (ii) an amount equal to the Veterans
9 Administration means test income threshold at the
10 initiation of the Program; depending on the availability of
11 funds, this level may be increased to an amount equal to
12 the sum of (iii) an amount equal to 50% of the federal
13 poverty level plus (iv) an amount equal to the Veterans
14 Administration means test income threshold. This means
15 test income threshold is subject to alteration by the
16 Department as set forth in subsection (b) of Section 10.
17 (b) A veteran or spouse who is determined eligible for the
18Program shall remain eligible for 12 months, provided the
19veteran or spouse remains a resident of the State and is not
20excluded under subsection (c) of this Section and provided the
21Department has not limited the enrollment period as set forth
22in subsection (b) of Section 10.
23 (c) A veteran or spouse is not eligible for coverage under
24the Program if:
25 (1) the premium required under Section 35 of this Act
26 has not been timely paid; if the required premiums are not

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1 paid, the liability of the Program shall be limited to
2 benefits incurred under the Program for the time period for
3 which premiums have been paid and for grace periods as
4 established under subsection (d); if the required monthly
5 premium is not paid, the veteran or spouse is ineligible
6 for re-enrollment for a minimum period of 3 months; or
7 (2) the veteran or spouse is a resident of a nursing
8 facility or an inmate of a public institution, as defined
9 by 42 CFR 435.1009.
10 (d) The Department shall adopt rules for the Program,
11including, but not limited to, rules relating to eligibility,
12re-enrollment, grace periods, notice requirements, hearing
13procedures, cost-sharing, covered services, and provider
14requirements. For purposes of this Section, "covered services"
15must include dental preventative and restorative services.
16(Source: P.A. 95-755, eff. 7-25-08; 96-45, eff. 7-15-09.)
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