reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 117 - RELATED PROGRAM PROVISIONS › Section 117.92 - Electronic Finger Imaging

Current through Register Vol. 48, No. 28, July 12, 2024
The Department will operate the electronic finger imaging
				system on a statewide basis. The system will be used in the administration of
				the Food Stamp Program and the Temporary Assistance for Needy Families (TANF)
				program. In addition, in the City of Chicago, the system will be used in the
				administration of the two General Assistance (GA) programs (the Family and
				Children Assistance program and the Transitional Assistance program).
a) Unless exempt, the Department will require
			 the following persons to undergo electronic finger imaging:
1) All adult applicants for food stamps, TANF
			 cash assistance, and City of Chicago General Assistance.
2) All adult recipients of food stamps, TANF
			 cash assistance, and City of Chicago General Assistance, including:
A) second parents; in 2-parent cases
			 and
B) minor grantees for TANF cash
			 cases in which the minor parent is considered an adult; and
C) all payees for food stamps, TANF cash
			 assistance, and City of Chicago General Assistance who do not receive cash
			 and/or food stamp benefits in the case (this does not apply to protective payee
			 cases for any category of assistance or representative payee for teens (RPT)
			 TANF cash cases).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart A - DISABLED ADULT CHILDREN › Section 118.100 - Disabled Adult Children

Current through Register Vol. 48, No. 28, July 12, 2024
Individuals who meet the following criteria are eligible,
				  without regard to income eligibility requirements, for medical assistance under
				  the AABD program. The individual:
a)
				is 18 years of age or older;
b)
				received Supplemental Security Income (SSI) and/or State Supplemental Payments
				(SSP) due to disability or blindness. Receipt of SSP from another State will
				serve to meet this subsection;
c)
				became blind or disabled before he or she reached age 22; and
d) lost Supplemental Security Income and/or
				State Supplemental Payments on or after July 1, 1987 as a result of entitlement
				to or increase in the Title II benefits under
				42 U.S.C.
				402(d) (child
				insurance).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart B - MEDICAL PAYMENTS FOR DRUGS FOR PERSONS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) OR AIDS RELATED COMPLEXES (ARC) › Section 118.150 - Continuation of Health Insurance Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
a) The continuation of health insurance
				coverage program is a pilot program to assist persons with AIDS or disability
				as a result of having the human immunodeficiency virus (HIV) who are eligible
				for insurance coverage under the federal Consolidated Omnibus Budget
				Reconciliation Act (COBRA) of 1985. The program will cover a maximum of about
				100 persons, subject to available funds. Under the program, the Department will
				pay a maximum monthly health insurance premium of $300 for eligible persons for
				individual or family (spouse and dependent children) health insurance
				coverage.
b) Eligibility. Persons
				eligible for coverage under this program must meet each of the following
				requirements:
1) Be diagnosed with AIDS or be
				disabled due to HIV;
2) Be a
				resident of Illinois;
3) Be unable
				to continue employment and be eligible for continuation of insurance coverage
				under the provisions of COBRA;
4)
				Be covered by an individual or family health insurance plan which includes
				coverage of prescribed drugs;
5)
				Have assets of not more than $10,000; and
6) Have income of not more than 200% of the
				federal poverty level.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart B - MEDICAL PAYMENTS FOR DRUGS FOR PERSONS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) OR AIDS RELATED COMPLEXES (ARC) › Section 118.200 - Drugs to Prolong the Lives of Persons With Acquired Immunodeficiency Syndrome (AIDS) or AIDS Related Complexes (ARC)

Current through Register Vol. 48, No. 28, July 12, 2024
The Department's program for funding of drugs to prolong the
				  lives of persons with Acquired Immunodeficiency Syndrome (AIDS) or AIDS Related
				  Complexes (ARC) has been replaced by a program operated by the Department of
				  Public Health (see 77 Ill. Adm. Code 692).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart C - WIDOWS AND WIDOWERS › Section 118.300 - Widows and Widowers

Current through Register Vol. 48, No. 28, July 12, 2024
Individuals who meet the following criteria are eligible,
				  without regard to income eligibility requirements, for medical assistance under
				  the Aid to the Aged, Blind or Disabled (AABD) Program.
a) Disabled widows and widowers who:
1) were entitled to benefits under Title II
				of the Social Security Act (SSA) for December 1983;
2) were entitled to and received SSA disabled
				widow's/widower's benefits for January 1984;
3) are ineligible for Supplemental Security
				Income (SSI) and/or State Supplemental Payment (SSP) due to the increase in
				widow's or widower's benefits;
4)
				have been continuously entitled to widow's or widower's benefits since the
				first month of the benefit increase; and
5) would be eligible for SSI and/or SSP if
				the amount of the increase and any subsequent cost of living adjustments in
				widow's or widower's benefits were disregarded.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart C - WIDOWS AND WIDOWERS › Section 118.400 - Incorporation By Reference

Current through Register Vol. 48, No. 28, July 12, 2024
Any rules or regulations of an agency of the United States or
				  of a nationally recognized organization or association that are incorporated by
				  reference in this Part are incorporated as of the date specified, and do not
				  include any later amendments or editions.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart E - CERTAIN NON-CITIZEN CHILDREN › Section 118.500 - Medical Services for Certain Non-Citizen Children

Current through Register Vol. 48, No. 28, July 12, 2024
a) Certain non-citizen children under 19
				years of age may be eligible for certain medical services. Such non-citizen
				children include:
1) Children defined at 89
				Ill. Adm. Code
				120.310(b)
				or 89 Ill. Adm. Code
				125.200(e)
				who are excluded from receiving medical services under Article V of the Public
				Aid Code because of the application of 89 Ill. Adm. Code
				120.310(b)(2)
				or health care benefits or rebates under the Children's Health Insurance
				Program (89 Ill. Adm. Code 125) because of the application of 89 Ill. Adm. Code
				125.205(a)(4);
2) Children who are Permanently Residing in
				the United States Under Color of Law (PRUCOL); and
3) Children who do not meet requirements as
				defined at 89 Ill. Adm. Code
				120.310(b)
				and 89 Ill. Adm. Code
				125.200(e).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.700 - General Description

Current through Register Vol. 48, No. 28, July 12, 2024
This Subpart implements Section 12-4.35(a-5) of the Code that
				  authorizes the Department to administer in Illinois the Health Benefits for
				  Immigrant Seniors Program to noncitizens 65 years of age or older who are not
				  eligible for medical assistance receiving federal financial participation due
				  to immigration status. Eligible individuals are not eligible for medical
				  assistance under Article V of the Public Aid Code.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.705 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For the purposes of this Subpart, the following terms have
				  the meanings ascribed in this Section:
"Code" means the Public Aid Code [305 ILCS 5].
"Department" means the Department of Healthcare and Family
				  Services and any successor agencies.
"FPL" means the federal poverty income guidelines established
				  by the federal Department of Health and Human Services and published in the
				  Federal Register.
"Health Benefits for Immigrant Seniors" or "Program" means
				  the Program authorized by Section 12-4.35(a-5) of the Code and created by this
				  Subpart.
"Resident" means an individual who has an Illinois residence,
				  as established in Section 5-3 of the Code.
"Medical assistance receiving federal financial
				  participation" does not include emergency medical for certain
				  non-citizens.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.710 - Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
An individual may be eligible for Health Benefits for
				  Immigrant Seniors provided that all of the following eligibility criteria are
				  met:
a) The individual is not eligible
				for medical assistance receiving federal financial participation other than
				emergency medical for certain non-citizens;
b) The individual is not:
1) A U.S. citizen;
2) A person lawfully admitted for permanent
				residence under the Immigration and Nationality Act (INA) who lawfully resided
				in the United States for five years or more; or
3) Effective May 1, 2024, a person lawfully
				admitted for permanent residence under the INA, regardless of length of
				residency.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.710 - Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
An individual may be eligible for Health Benefits for
				  Immigrant Seniors provided that all of the following eligibility criteria are
				  met:
a) The individual is not eligible
				for medical assistance receiving federal financial participation other than
				emergency medical for certain non-citizens;
b) The individual is not:
1) A U.S. citizen; or
2) A person:
A) Lawfully admitted for permanent residence
				under the Immigration and Nationality Act (INA); and
B) Who has lawfully resided in the United
				States for five years or more;
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.715 - Eligibility Exclusions and Terminations

Current through Register Vol. 48, No. 28, July 12, 2024
a) An individual shall not be determined
				eligible for Health Benefits for Immigrant Seniors if the individual is an
				inmate of a public institution.
b)
				An individual's coverage under the Program shall be terminated if the
				individual:
1) No longer qualifies as an
				Illinois resident;
2) Becomes
				eligible for medical assistance under the Public Aid Code that receives federal
				financial participation;
3) Fails
				to report to the Department changes that affect eligibility for the
				Program;
4) Asks the Department to
				terminate the coverage;
5) Is no
				longer eligible based on any other applicable State or federal law or
				regulation;
6) Failed to provide
				eligibility information that was truthful and accurate to the best of the
				individual's knowledge and belief and that affected the individual's
				eligibility;
7) Was incorrectly
				determined eligible;
8) Fails to
				complete the redetermination of eligibility within the required timeframes or
				provide proof of on-going eligibility; or
9) Becomes an inmate of a public
				institution.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.720 - Application Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) Individuals
				apply for the Program by submitting an application through any available method
				(see 89 Ill. Adm. Code
				110.5),
				including on-line at ABE.illinois.gov (Illinois Application for Benefits
				Eligibility), by mail, in person, by phone, or another method. The Department
				may designate entities that may assist individuals to submit
				applications.
b) The application
				shall meet all requirements of 89 Ill. Adm. Code
				110.10
				(Application for Medical Assistance), including provisions regarding who may
				apply on behalf of the individual.
c) Applicants are obligated to provide
				truthful and accurate information for determining eligibility and to promptly
				report any change in information provided on the application.
d) The Department may cease enrollment and
				deny applications that meet the eligibility requirements of this Subpart if the
				Department determines this action is necessary to maintain the cost of the
				Program within the available funding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.725 - Determination of Monthly Countable Income

Current through Register Vol. 48, No. 28, July 12, 2024
a) The earned and unearned income of the
				following persons, when included in the applicable standard under 89 Ill. Adm.
				Code
				120.10, shall be counted
				when determining eligibility under Section 118.710, except as specified in
				subsections (b) and (c):
1) Income of the
				individual;
2) Income of the
				individual's spouse; and
3)
				Unearned income of a dependent child under the age of 18 years who is included
				in the income standard as set forth at 89 Ill. Adm. Code
				120.20
				because it is to the advantage of the individual.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.730 - Eligibility Determination and Enrollment Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) The applicant's
				eligibility for medical assistance receiving federal financial participation
				will be considered as a part of the eligibility determination process for this
				Program.
b) If the monthly
				countable income is at or below 100% FPL without, or after deducting, the costs
				of medical or remedial care as determined in accordance with 89 Ill. Adm. Code
				120.60(c), the
				application will be approved if all other factors of eligibility under Section
				118.710, including resource
				limits, are met. The Health Benefits for Immigrant Seniors Program income
				standard is 100% FPL.
c) Applicants
				will be notified, in writing, regarding the outcome of their eligibility
				determination.
d) Eligibility will
				be redetermined at least annually.
e) Individuals may obtain backdated medical
				coverage for up to three months prior to the month of application, unless:
1) the individual does not meet all
				eligibility requirements for one or more backdated months; or
2) the Department determines that it is
				necessary to limit or eliminate the backdated medical coverage in order to
				assure payments for this Program do not exceed available annual
				funding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.730 - Eligibility Determination and Enrollment Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) The applicant's
				eligibility for medical assistance receiving federal financial participation
				will be considered as a part of the eligibility determination process for this
				Program.
b) If the monthly
				countable income is at or below 100% FPL without, or after deducting, the costs
				of medical or remedial care as determined in accordance with 89 Ill. Adm. Code
				120.60(c),
				the application will be approved if all other factors of eligibility under
				Section 118.710, including resource limits, are met. The Health Benefits for
				Immigrant Seniors Program income standard is 100% FPL.
c) Applicants will be notified, in writing,
				regarding the outcome of their eligibility determination.
d) Eligibility will be redetermined at least
				annually.
e) Individuals may obtain
				backdated medical coverage for up to three months prior to the month of
				application unless the individual does not meet all eligibility requirements
				for one or more backdated months.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.735 - Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any person who
				applies for or receives benefits under the Program shall have the right to
				appeal any of the following actions:
1)
				Refusal to accept, or failure to act on, an application or
				reapplication;
2) Denial of an
				application or cancellation at the redetermination of eligibility, including
				denial based on failure to meet one or more of the eligibility requirements
				specified in this Subpart.
A) No eligibility
				exists during the appeal process.
B) If the appeal is upheld, the individual
				will have the opportunity to receive coverage back to the original application
				date, including possible backdated months or the cancellation month;
3) Termination of coverage based
				on failure to continue to meet one or more of the eligibility requirements
				specified in this Subpart.
A) If the
				termination is not upheld on appeal, coverage under the Program shall be
				reinstated retroactive to the termination date.
B) The individual may choose coverage for all
				or some of the months during the appeal process as long as the retroactive
				months are consecutive to the new initial month of regular eligibility;
				and
4) Individuals or
				their representatives do not have the right to appeal Department decisions
				necessary to keep the cost of the Program within the annual appropriations,
				such as a Department decision to:
A) Deny an
				application due to closing of enrollment for the Program;
B) Make a change to the Program pursuant to
				Section 118.760; and
C) Require
				more frequent redeterminations of eligibility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.740 - Renewals of Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a) Prior to
				the eligibility period ending, and in sufficient time for the individual to
				respond to the Department's request for information, the Department or its
				designee will send an annual renewal notice to the individual. Failure to
				respond to the renewal notice when required may result in
				termination.
b) Renewals shall be
				subject to all eligibility requirements and exclusions set forth in this
				Subpart, including Sections 118.710, 118.715, 118.725 and 118.730.
c) The Department may require renewal of
				eligibility more frequently than annually if necessary to keep spending within
				available funding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.745 - Covered Services

Current through Register Vol. 48, No. 28, July 12, 2024
Covered health care services shall be the same as covered
				  services for adults described in Article V of the Code, including kidney
				  transplants, except as provided in Section 118.750. The Department may also
				  cover certain services, including, but not limited to, select Department of
				  Human Services Home Services Program (HSP) services and select Department on
				  Aging Community Care Program (CCP) services, to the extent the individual is
				  otherwise determined eligible for those services.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.750 - Service Exclusions

Current through Register Vol. 48, No. 28, July 12, 2024
The following health care services shall not be covered under
				  this Subpart:
a) Nursing facility
				services;
b) Intermediate Care
				Facility for Persons with Developmental Disabilities (ICF/DD)
				services;
c) Specialized Mental
				Health Rehabilitation facility (SMHRF) services;
d) Medically Complex for the Developmentally
				Disabled facility (MC/DD) services; and
e) Funeral and burial expenses.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.755 - Provider Reimbursement

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Provider participation under this Subpart shall be subject to enrollment with,
				and approval by, the Department.
b)
				Providers shall be reimbursed in accordance with the established rates of the
				Department or other appropriate State agency.
c) Providers under this Subpart shall be
				prohibited from billing individuals covered under this Program for any
				difference between the charge amount and the amount paid by the
				Department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.760 - Program Limitations

Current through Register Vol. 48, No. 28, July 12, 2024
There is no entitlement to medical services under this
				  Subpart and those services are available only to the extent that payments made
				  for individuals eligible under this Subpart do not exceed the funding available
				  for this Program. The Department may take any action it deems necessary to
				  assure payments for this Program do not exceed available funding, including but
				  not limited to: ceasing or limiting enrollment, changing standards of
				  eligibility that are not statutorily required, changing enrollment practices,
				  changing eligibility time periods, and reducing available medical
				  services.
a) The Department shall
				publish notice of the opening or closing of enrollment, as referenced in 89
				Ill. Adm. Code 118.735(a)(4),
				via the Department's website at
https://hfs.illinois.gov/info/legal/publicnotices.html
no later than fourteen (14) calendar days prior to the action.
b) Co-payments or cost sharing may be charged
				for services provided to the population by a health care provider as described
				below, except for practitioner visits scheduled for family planning services.
1) Co-payment and cost sharing requirements
				are as follows, unless the services meet the requirement under 89 Ill. Adm.
				Code 120.310(b)(4)
				as an emergency medical condition or are otherwise covered under Department
				rule without a co-pay:
A) Inpatient
				hospitalizations, $250 per hospital stay; and
B) Hospital or Ambulatory Surgical Treatment
				Center outpatient services set forth at 89 Ill. Adm. Code
				148.140(b), 10
				percent of the Department rate as set forth in Section
				128.350(c).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart G - HEALTH BENEFITS FOR IMMIGRANT SENIORS › Section 118.760 - Program Limitations

Current through Register Vol. 48, No. 28, July 12, 2024
There is no entitlement to medical services under this
				  Subpart and those services are available only to the extent that payments made
				  for individuals eligible under this Subpart do not exceed the funding available
				  for this Program. The Department may take any action it deems necessary to
				  assure payments for this Program do not exceed available funding, including but
				  not limited to: ceasing or limiting enrollment, changing standards of
				  eligibility that are not statutorily required, changing enrollment practices,
				  changing eligibility time periods, and reducing available medical
				  services.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart H - KIDNEY TRANSPLANTATION AND RELATED SERVICES FOR NONCITIZENS › Section 118.780 - Kidney Transplantation for Noncitizens with End-Stage Renal Disease

Current through Register Vol. 48, No. 28, July 12, 2024
Pursuant to Public Act 98-0651, which amended Section 5-5 of
				  the Public Aid Code, effective for dates of outpatient services and inpatient
				  discharges on and after October 1, 2014, notwithstanding Section 1-11 of the
				  Code and any citizenship or immigration requirements under Title 89, any
				  noncitizen is eligible for kidney transplantation when each of the following
				  criteria are met:
a) The noncitizen:
1) has end-stage renal disease;
2) is enrolled with the Department with
				coverage limited to renal dialysis services;
3) is not eligible for comprehensive medical
				benefits under any government funded or private insurance plan;
4) otherwise meets the income, asset, and
				categorical requirements of the medical assistance program; and
5) meets the residency requirements of
				Section 5-3 of the Code.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart H - KIDNEY TRANSPLANTATION AND RELATED SERVICES FOR NONCITIZENS › Section 118.790 - Post Kidney Transplantation Services for Noncitizens

Current through Register Vol. 48, No. 28, July 12, 2024
Pursuant to Public Act 102-0043, which amended Section
				  5/12-4.35 of the Public Aid Code, any noncitizen is eligible for
				  post-transplant drugs and related services after 12 months from the date of
				  kidney transplant, when each of the following criteria are met:
a) The noncitizen:
1) provides proof that they received a kidney
				transplant, at least 12 months prior, at a certified transplant center in
				Illinois, and now require medically necessary post-transplant drugs and related
				services. Acceptable proof shall include medical records and operative report
				confirming the date of and location where the transplant occurred;
2) is not eligible for comprehensive medical
				benefits under any government funded or private insurance plan;
3) otherwise meets the income, asset, and
				categorical requirements of the medical assistance program; and,
4) meets the residency requirements of
				Section 5-3 of the Code.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.800 - General Description

Current through Register Vol. 48, No. 28, July 12, 2024
This Subpart implements Section 12-4.35(a-6) of the Code that
				  authorizes the Department to administer in Illinois the Health Benefits for
				  Immigrant Adults Program to certain non-citizens who are not eligible for
				  medical assistance receiving federal financial participation due to immigration
				  status.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.805 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For the purposes of this Subpart, the following terms have
				  the meanings ascribed in this Section:
"Code" means the Public Aid Code [305 ILCS 5 ].
"Department" means the Department of Healthcare and Family
				  Services and any successor agencies.
"FPL" means the federal poverty income guidelines established
				  by the federal Department of Health and Human Services and published in the
				  Federal Register.
"Health Benefits for Immigrant Adults" or "Program" means the
				  Program authorized by Section 12-4.35(a-6) of the Code and created by this
				  Subpart.
"Resident" means an individual who has an Illinois residence,
				  as established in Section 5-3 of the Code.
"Medical assistance receiving federal financial
				  participation" does not include emergency medical services for certain
				  non-citizens.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.810 - Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
An individual may be eligible for Health Benefits for
				  Immigrant Adults provided that all of the following eligibility criteria are
				  met:
a) The individual is not eligible
				for medical assistance receiving federal financial participation other than
				emergency medical for certain non-citizens;
b) The individual is not:
1) A U.S. citizen;
2) A person lawfully admitted for permanent
				residence under the Immigration and Nationality Act (INA) who lawfully resided
				in the United States for five years or more; or
3) Effective May 1, 2024, a person lawfully
				admitted for permanent residence under the INA, regardless of length of
				residency.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.810 - Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
An individual may be eligible for Health Benefits for
				  Immigrant Adults provided that all of the following eligibility criteria are
				  met:
a) The individual is not eligible
				for medical assistance receiving federal financial participation other than
				emergency medical for certain non-citizens;
b) The individual is not:
1) A U.S. citizen; or
2) A person:
A) Lawfully admitted for permanent residence
				under the Immigration and Nationality Act (INA); and
B) Who has lawfully resided in the United
				States for five years or more;
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.815 - Eligibility Exclusions and Terminations

Current through Register Vol. 48, No. 28, July 12, 2024
a) Coverage of medical services under this
				Subpart for inmates of public institutions shall be consistent with 89 Ill.
				Adm. Code
				120.318 and
				other applicable law.
b) An
				individual's coverage under the Program shall be terminated if the individual:
1) No longer qualifies as an Illinois
				resident;
2) Becomes eligible for
				medical assistance under the Public Aid Code that receives federal financial
				participation;
3) Fails to report
				to the Department changes that affect eligibility for the Program;
4) Asks the Department to terminate the
				coverage;
5) Is no longer eligible
				based on any other applicable State or federal law or regulation;
6) Failed to provide eligibility information
				that was truthful and accurate to the best of the individual's knowledge and
				belief and that affected the individual's eligibility;
7) Was incorrectly determined eligible;
				or
8) Fails to complete the
				redetermination of eligibility within the required timeframes or provide proof
				of on-going eligibility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.820 - Application Process

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Individuals apply for the Program by submitting an application through any
				available method (see 89 Ill. Adm. Code
				110.5)
				, including on-line at ABE.illinois.gov (Illinois Application for Benefits
				Eligibility), by mail, in person, by phone, or another method. The Department
				may designate entities that may assist individuals to submit
				applications.
b) The application
				shall meet all requirements of 89 Ill. Adm. Code
				110.10
				(Application for Medical Assistance), including provisions regarding who may
				apply on behalf of the individual.
c) Applicants are obligated to provide
				truthful and accurate information for determining eligibility and to promptly
				report any change in information provided on the application.
d) The Department may cease enrollment and
				deny applications that meet the eligibility requirements of this Subpart if the
				Department determines this action is necessary to maintain the cost of the
				Program within the available funding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.825 - Determination of Monthly Countable Income

Current through Register Vol. 48, No. 28, July 12, 2024
Income will be determined in the manner described in 89 Ill.
				  Adm.
				  120.64(i)
				  and other applicable provisions in 89 Ill. Adm. 120.64.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.830 - Eligibility Determination and Enrollment Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) The applicant's
				eligibility for medical assistance receiving federal financial participation
				will be considered as a part of the eligibility determination process for this
				Program.
b) If the monthly
				countable income is at or below 138% FPL in accordance with 89 Ill. Adm. Code
				120.64, the application will be
				approved if all other factors of eligibility under Section
				118.810 are met.
c) Applicants will be notified, in writing,
				regarding the outcome of their eligibility determination.
d) Eligibility will be redetermined at least
				annually.
e) Individuals may obtain
				backdated medical coverage for up to three months prior to the month of
				application, unless:
1) the individual does
				not meet all eligibility requirements for one or more backdated months;
				or
2) the Department determines
				that it is necessary to limit or eliminate the backdated medical coverage in
				order to assure payments for this Program do not exceed available annual
				funding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.830 - Eligibility Determination and Enrollment Process

Current through Register Vol. 48, No. 28, July 12, 2024
a) The applicant's
				eligibility for medical assistance receiving federal financial participation
				will be considered as a part of the eligibility determination process for this
				Program.
b) If the monthly
				countable income is at or below 138% FPL in accordance with 89 Ill. Adm. Code
				120.64,
				the application will be approved if all other factors of eligibility under
				Section 118.810 are met.
c)
				Applicants will be notified, in writing, regarding the outcome of their
				eligibility determination.
d)
				Eligibility will be redetermined at least annually.
e) Individuals may obtain backdated medical
				coverage for up to three months prior to the month of application unless the
				individual does not meet all eligibility requirements for one or more backdated
				months.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.835 - Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any person who
				applies for or receives benefits under the Program shall have the right to
				appeal any of the following actions:
1)
				Refusal to accept, or failure to act on, an application or
				reapplication;
2) Denial of an
				application or cancellation at the redetermination of eligibility, including
				denial based on failure to meet one or more of the eligibility requirements
				specified in this Subpart.
A) No eligibility
				exists during the appeal process.
B) If the appeal is decided in the
				individual's favor, the individual will have the opportunity to receive
				coverage back to the original application date, including possible backdated
				months or the cancellation month;
3) Termination of coverage based on failure
				to continue to meet one or more of the eligibility requirements specified in
				this Subpart.
A) If the termination is decided
				in the individual's favor on appeal, coverage under the Program shall be
				reinstated retroactive to the termination date.
B) If coverage is reinstated pursuant to
				subsection (a)(3)(A), the individual may choose coverage for all or some of the
				months during the appeal process as long as the retroactive months are
				consecutive to the new initial month of regular eligibility.
4) Individuals or their
				representatives do not have the right to appeal Department decisions necessary
				to keep the cost of the Program within the annual appropriations, such as a
				Department decision to:
A) Deny an application
				due to closing of enrollment for the Program;
B) Make a change to the Program pursuant to
				Section 118.860; and
C) Require
				more frequent redeterminations of eligibility.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.840 - Renewals of Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a) Prior to
				the eligibility period ending, and in sufficient time for the individual to
				respond to the Department's request for information, the Department or its
				designee will send an annual renewal notice to the individual. Failure to
				respond to the renewal notice when required will result in termination unless
				good cause is shown for the failure to respond.
b) Renewals shall be subject to all
				eligibility requirements and exclusions set forth in this Subpart, including
				Sections 118.810, 118.815, 118.825 and 118.830.
c) The Department may require renewal of
				eligibility more frequently than annually if necessary to keep spending within
				available funding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.845 - Covered Services

Current through Register Vol. 48, No. 28, July 12, 2024
Services available to the population covered in this Subpart
				  shall be consistent with the services covered under section
				  118.745 of
				  Subpart G.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.850 - Service Exclusions

Current through Register Vol. 48, No. 28, July 12, 2024
The following services shall not be covered under this
				  Subpart:
a) Funeral and burial
				expenses.
b) Pursuant to Section
				12-4.35(b) of the Code, health care services excluded under section
				118.750 of
				Subpart G shall be excluded from this Subpart, unless it is determined by the
				Department that Section 12-4.35(b) is not applicable.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.855 - Provider Reimbursement

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Provider participation under this Subpart shall be subject to enrollment with,
				and approval by, the Department.
b)
				Providers shall be reimbursed in accordance with the established rates of the
				Department or other appropriate State agency.
c) Providers under this Subpart shall be
				prohibited from billing individuals covered under this Program for any
				difference between the charge amount and the amount paid by the
				Department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.860 - Program Limitations

Current through Register Vol. 48, No. 28, July 12, 2024
There is no entitlement to medical services under this
				  Subpart and those services are available only to the extent that payments made
				  for individuals eligible under this Subpart do not exceed the funding available
				  for this Program. The Department may take any action it deems necessary to
				  assure payments for this Program do not exceed available funding, including but
				  not limited to: ceasing or limiting enrollment, changing standards of
				  eligibility that are not statutorily required, changing enrollment practices,
				  changing eligibility time periods, and reducing available medical
				  services.
a) The Department shall
				publish notice of the opening or closing of enrollment, as referenced in 89
				Ill. Adm. Code 118.835(a)(4),
				via the Department's website at
https://hfs.illinois.gov/info/legal/publicnotices.html
no later than fourteen (14) calendar days prior to the action.
b) Co-payments or cost sharing may be charged
				for services provided to the population by a health care provider as described
				below, except for practitioner visits scheduled for family planning services.
1) Co-payment and cost sharing requirements
				are as follows, unless the services meet the requirement under 89 Ill. Adm.
				Code 120.310(b)(4)
				as an emergency medical condition or are otherwise covered under Department
				rule without a co-pay:
A) Inpatient
				hospitalizations, $250 per hospital stay; and
B) Hospital or Ambulatory Surgical Treatment
				Center outpatient services set forth at 89 Ill. Adm. Code
				148.140(b), 10
				percent of the Department rate as set forth in Section
				128.350(c).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 118 - SPECIAL ELIGIBILITY GROUPS › Subpart I - HEALTH BENEFITS FOR IMMIGRANT ADULTS › Section 118.860 - Program Limitations

Current through Register Vol. 48, No. 28, July 12, 2024
There is no entitlement to medical services under this
				  Subpart and those services are available only to the extent that payments made
				  for individuals eligible under this Subpart do not exceed the funding available
				  for this Program. The Department may take any action it deems necessary to
				  assure payments for this Program do not exceed available funding, including but
				  not limited to: ceasing or limiting enrollment, changing standards of
				  eligibility that are not statutorily required, changing enrollment practices,
				  changing eligibility time periods, and reducing available medical
				  services.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.20 - Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a) Illinois Cares
			 Rx Eligibility Qualifications
To be eligible for Illinois Cares Rx pharmaceutical benefits,
				an individual must meet all of the following requirements:
1) Be:
A)
			 65 years of age or older; or
B) a
			 disabled person.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.30 - Low Income Subsidy

Current through Register Vol. 48, No. 28, July 12, 2024
a) To
			 be eligible for Illinois Cares Rx, Medicare-eligible enrollees must apply for
			 all available subsidies under Medicare Part D. The Department may deem
			 individuals to be compliant with this requirement in cases where the
			 Department's data clearly indicate the individual would not be eligible for any
			 low-income subsidy (LIS) as described in 89 Ill. Adm. Code 127.
b) Eligibility of individuals who do not
			 apply for LIS, except in cases where Department data clearly indicate the
			 individual would not be eligible for any LIS, may be terminated at the end of
			 the month following the month in which written notice of termination was given
			 to the individual.
c) If the
			 beneficiary provides proof of application for LIS prior to the scheduled
			 termination date, eligibility will not be terminated.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.40 - Automatic Enrollment of Program Beneficiaries

Current through Register Vol. 48, No. 28, July 12, 2024
The Department may auto-enroll beneficiaries with a
				Coordinating Medicare Part D Prescription Drug Plan authorized under Section
				1860D-1 of the Social Security Act. The Department shall enroll the eligible
				beneficiaries into a Coordinating Medicare Part D PDP in order to coordinate
				the members' Medicare prescription drug benefit coverage with coverage under
				the program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.50 - Assignment and Coordination of Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
a) Acceptance of benefits under Illinois
			 Cares Rx constitutes assignment of benefits from any private plan of
			 assistance, including any insurance plan, public assistance program, or third
			 party for covered prescription drugs under this program.
b) The Department shall charge or collect
			 payments from any private plan of assistance, including any insurance plan,
			 public assistance program, or third party for any claims assigned by a
			 beneficiary.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.60 - Covered Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Illinois
			 Cares Rx Plus
1) For an individual enrolled
			 in a Coordinating Medicare Part D Plan coverage under the Illinois Cares Rx
			 Plus Program shall consist of:
A) Payment to
			 the individual's Coordinating Medicare Part D PDP for premium and deductible
			 and cost sharing expenses, except for applicable cost sharing and co-payments
			 set forth in Section
			 119.90
			 for pharmaceutical products covered by the individual's Medicare Part D
			 PDP.
B) Payment to a pharmacy for
			 pharmaceutical products excluded by Medicare Part D but covered by the Medical
			 Assistance Program operated pursuant to Article V of the Public Aid Code,
			 subject to applicable cost sharing and co-payments set forth in Section
			 119.90.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.70 - Prior Authorization and Preferred Drug List (PDL)

Current through Register Vol. 48, No. 28, July 12, 2024
a) For Medicare-eligible individuals enrolled
			 in a coordinating Medicare Part D PDP, the Department may enforce the PDP's
			 Preferred Drug List by requiring tiered copays of $15 for each dispensing of a
			 non-preferred drug.
b) For
			 individuals not enrolled in Medicare, the Department may utilize a Preferred
			 Drug List (PDL) enforced through the prior approval process and other
			 utilization controls including, but not limited to, maximum quantity, daily
			 dose and refill-too-soon.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.80 - Illinois Cares Rx Basic Covered Prescription Drugs

Current through Register Vol. 48, No. 28, July 12, 2024
The Illinois Cares Rx Basic Program shall cover pharmaceutical
				products as described in this Section for the treatment of heart disease and
				its related conditions, diabetes, arthritis, cancer, Alzheimer's disease,
				Parkinson's disease, glaucoma, lung disease and smoking related illnesses,
				osteoporosis and multiple sclerosis.
a) Drugs prescribed for treatment of heart
			 disease and its related conditions that fall within the following categories
			 qualify for inclusion in the Illinois Cares Rx Basic Pharmaceutical Assistance
			 Program as covered prescription drugs:
1)
			 Antihypertensives
2)
			 Antiarrhythmics
3)
			 Antihyperlipidemics
4) Cardiac
			 Glycosides
5) Calcium Channel
			 Blockers
6) Vasodilators
7) Anti-Adrenergic/Sympatholytics
8) Renin Angiotensin System
			 Antagonists
9) Diuretics
10) Potassium Supplements
11) Anticoagulants
12) Vasopressor Used in Shock
13) Potassium Removing Agents
14) System Alkalinizers