reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.90 - Co-Payments and Cost Sharing

Current through Register Vol. 48, No. 28, July 12, 2024
Unless a federal low-income subsidy results in lesser
				co-payments and cost sharing, a beneficiary enrolled in Illinois Cares Rx shall
				be responsible for payment of co-payments and cost sharing as follows:
a) Except for the cost-sharing described in
			 subsection (c) of this Section, Medicare-eligible beneficiaries shall pay a
			 co-payment equal to the greater of the co-payments required under Medicare Part
			 D for "other low-income subsidy eligible individuals" pursuant to
			 42 CFR 423.782(b)
			 (2005), or $5 for each prescription of a Tier
			 1 drug, $20 for each prescription of a Tier 3 drug, and $15 for each
			 prescription of a Tier 2 or 4 drug on the Medicare Part D plan's formulary.
			 Beneficiaries shall pay $5 for each prescription of a generic drug and $15 for
			 each prescription of a brand name drug when the drug is a Medicare Part
			 D-excluded drug covered by the Department. Beneficiaries not eligible for
			 Medicare shall pay a co-payment of $5 for each prescription of a generic drug
			 and $15 for each prescription of a brand name drug when the drug is covered by
			 the Department.
b) Except for cost
			 sharing described in subsection (c), 25 percent of the reimbursable amount of
			 the prescription plus the applicable co-payment for each prescription dispensed
			 after the Illinois Cares Rx benefit amount has reached $1,750 for the calendar
			 year or the beneficiary has reached the Medicare Part D Coverage Gap
			 phase.
c) Effective January 1,
			 2007, for individuals enrolled in Medicare Part D who have been identified to
			 the Department as having a diagnosis of HIV or AIDS, the applicable co-payment
			 for drugs that are listed on the ADAP formulary shall be equal to that required
			 by Medicare Part D for "other low income subsidy eligibles" pursuant to
			 42 CFR
			 423.782(b). The co-payments
			 described in this subsection are applicable throughout the Plan Year.
d) For those enrolled in Medicare Part D, the
			 Illinois Cares Rx benefit amount is the total payments made by the PDP to
			 pharmacies on behalf of the beneficiary, whether paid as a part of the Medicare
			 benefit or the Illinois Cares Rx benefit. For those not eligible for Medicare
			 Part D, the Illinois Cares Rx benefit amount is the total payments made by the
			 Department to pharmacies on behalf of the beneficiary.
e) A beneficiary also must pay to an
			 authorized pharmacy an ancillary charge for any covered prescription drug that
			 is a brand name product if the pharmacy is reimbursed at the generic price as
			 provided in Section
			 119.100(b)(2) and
			 (3).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.100 - Pharmacy Payment

Current through Register Vol. 48, No. 28, July 12, 2024
a) Direct
			 payment to pharmacies by the Department is made only for pharmaceutical
			 products for individuals not enrolled in Medicare Part D or for Medicare Part D
			 excluded pharmaceutical products covered by the Department when dispensed to
			 individuals enrolled in Medicare Part D.
b) Reimbursable Amount
1) Except as provided in subsections (b)(2),
			 (3) and (4) of this Section, the reimbursable amount for a pharmaceutical
			 product eligible for direct payment by the Department shall be:
A) For legend (prescription) drugs, the
			 Department shall pay the lower of:
i) the
			 pharmacy's prevailing charge to the general public; or
ii) the Department's maximum price plus a
			 dispensing fee of $2.25 for both generic and brand name drugs less applicable
			 co-payments and cost sharing as set forth in Section
			 119.90.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.110 - Inspection and Disclosure of Records

Current through Register Vol. 48, No. 28, July 12, 2024
a) In order to ensure compliance with the
			 requirements of the Act and to prevent fraud, the Department, or its designee,
			 shall have the right:
1) to inspect the books
			 and records of all authorized pharmacies (see
			 320 ILCS
			 25/6(d)(5) ); and
2) to require disclosure of information on
			 individuals who receive health coverage, pharmaceutical benefits, or related
			 services as policyholders, subscribers, or plan participants from entities
			 subject to the Illinois Insurance Code [215 ILCS 5 ], Comprehensive Health
			 Insurance Plan Act [215 ILCS 105 ], Dental Service Plan Act [225 ILCS 25 ],
			 Children's Health Insurance Program Act [215 ILCS 106 ], Health Care Purchasing
			 Group Act [215 ILCS 123 ], Health Maintenance Organization Act [215 ILCS 125 ]
			 Limited Health Service Organization Act [215 ILCS 130 ], Voluntary Health
			 Services Plans Act [215 ILCS 165 ], and Worker's Compensation Act [820 ILCS 305
			 ].
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.120 - Establishment of Liens

Current through Register Vol. 48, No. 28, July 12, 2024
The Director is entitled to establish a lien on any and all
				causes of action that accrue to a beneficiary as a result of injuries for which
				covered prescription drugs are directly or indirectly prescribed and for which
				payment was made under this program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 119 - ILLINOIS CARES RX PROGRAM (REPEALED) › Section 119.130 - Penalties

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any person who
			 takes any of the following actions is guilty of a Class 4 felony for the first
			 offense and a Class 3 felony for each subsequent offense:
1) on behalf of an authorized pharmacy, files
			 a fraudulent claim for payment; or
2) for compensation, prepares a claim for
			 this program and knowingly enters false information on the claim for an
			 applicant or a beneficiary; or
3)
			 fraudulently files multiple claims; or
4) fraudulently states that a nondisabled
			 person is disabled; or
5)
			 fraudulently procures a card; or
6)
			 fraudulently uses a card to obtain covered prescription drugs. (See
			 320 ILCS
			 25/9.)
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart A - GENERAL PROVISIONS › Section 120.1 - 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 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart B - ASSISTANCE STANDARDS › Section 120.11 - Eligibility for Pregnant Women and Children

Current through Register Vol. 48, No. 28, July 12, 2024
a) Pregnant Women Eligible
1) Eligibility for medical assistance exists
				for a pregnant woman of any age who meets the following eligibility
				requirements:
A) cooperation in establishing
				eligibility as described in Section
				120.308;
B) residency as described in Section
				120.311; and
C) whose countable monthly income is at or
				below 200% of FPL as determined pursuant to Section
				120.64.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart B - ASSISTANCE STANDARDS › Section 120.20 - MANG(AABD) Income Standard

Current through Register Vol. 48, No. 28, July 12, 2024
The monthly countable income standard is 100 percent of the
				  Federal Poverty Level Income Guidelines, as published annually in the Federal
				  Register, for the appropriate family size.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart B - ASSISTANCE STANDARDS › Section 120.30 - MANG(C) Income Standard

Current through Register Vol. 48, No. 28, July 12, 2024
Number In Family
Monthly Net Income
1
283
2
375
3
508
4
558
5
650
6
733
7
767
8
808
9
850
10
900
11
942
12
992
13
1042
14
1100
15
1158
16
1217
17
1283
18
1350
a) If the
				number in the household unit exceeds the number provided above, add $67 for
				each additional person.
b) MANG(C)
				is available for a pregnant woman, of any age, who would be eligible for TANF
				or MANG(C) if the child had already been born. The pregnant woman and her
				spouse's income are combined and compared to the MANG standard for three
				persons.
c) If the case includes
				adults only, the MANG standard for one adult is $283. The standard for two
				adults is $375. An unborn child is counted as a family member.
d) When a child has earmarked income, other
				than State Supplemental Income (SSI), and the parent does not want this income
				applied to total family needs, the child is not to be included in the
				assistance unit. The family size used in the application of the MANG(C) Income
				Standards shall be reduced by one for each such child determined ineligible on
				this basis.
e) When financial
				eligibility for MANG(C) is being determined for one child only, the income of
				the child in excess of $283 a month is considered available to pay toward the
				child's medical expenses.
f) If
				eligibility is being determined for more than one child, the MANG(C) Standard
				for number of people shall be used.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart B - ASSISTANCE STANDARDS › Section 120.31 - MANG(P) Income Standard

Current through Register Vol. 48, No. 28, July 12, 2024
a) MANG(P)
				is available to pregnant women and to children under age 19 who do not qualify
				as mandatory categorically needy (42 U.S.C.
				1396a(a)(10)(A)(i)) whose
				non-exempt countable income does not exceed the MANG(P) income standard. If the
				household's countable monthly income exceeds the appropriate MANG(P) standards,
				eligibility for MANG(P) does not exist. The MANG(P) income standards are as
				follows:
1) The MANG(P) income standard shall
				be 200 percent of the current Federal Poverty Level Income Guidelines, as
				published annually in the Federal Register, for pregnant women and for infants
				born to women eligible for and receiving medical assistance on the date of the
				child's birth, including women determined eligible for the date of birth
				pursuant to subsection (e)(4).
2)
				The MANG(P) income standard shall be 313 percent of the current Federal Poverty
				Level Income Guidelines, as published annually in the Federal Register, for all
				other children under age 19.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart B - ASSISTANCE STANDARDS › Section 120.32 - FamilyCare Assist

Current through Register Vol. 48, No. 28, July 12, 2024
a) A caretaker
				relative (see Section
				120.390
				) who is 19 years of age or older qualifies for medical assistance when
				countable income is at or below the appropriate income standard.
b) The appropriate income standard is 133
				percent of the Federal Poverty Level (FPL) for the appropriate family
				size.
c) For applications received
				on or after October 1, 2013, eligibility under this Section shall be determined
				as set forth in Section
				120.64.
d) Notwithstanding any other provision of
				this Title 89, effective January 1, 2014, a person may not spend down to become
				eligible under this Section.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart C - FINANCIAL ELIGIBILITY DETERMINATION › Section 120.60 - Community Cases

Current through Register Vol. 48, No. 28, July 12, 2024
The following subsections apply to persons or family units
				  who reside in the community or community-based residential facilities or
				  settings (such as a Community Living Facility, Special Home Placement, Home
				  Individual Program or Community and Residential Alternatives (59 Ill. Adm. Code
				  120.10) .
a) The eligibility period shall begin with:
1) the first day of the month of
				application;
2) the first day of
				any month, prior to the month of application, in which the person meets
				financial and non-financial eligibility requirements up to three months prior
				to the month of application, if the person so desires; or
3) the first day of a month, after the month
				of application, in which the person meets non-financial eligibility
				requirements.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart C - FINANCIAL ELIGIBILITY DETERMINATION › Section 120.61 - Long Term Care

Current through Register Vol. 48, No. 28, July 12, 2024
This Section applies to persons residing in long term care
				  facilities or State-certified, State-licensed, or State-contracted residential
				  care programs who, as a condition of eligibility for medical assistance, are
				  required to pay all of their income, less certain protected amounts, for the
				  cost of their own care.
a) The term
				"long term care facility" refers to:
1) an
				institution (or a distinct part of an institution) that meets the definition of
				a "nursing facility" as that term is defined in
				42 USC
				1396r;
2) licensed Intermediate Care Facilities (ICF
				and ICF/DD), licensed Skilled Nursing Facilities (SNF and SNF/Ped) and licensed
				hospital-based long term care facilities (see 89 Ill. Adm. Code
				148.50(c))
				; and
3) Supportive Living
				Facilities (SLF) and Community Integrated Living Facilities
				(CILA).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart C - FINANCIAL ELIGIBILITY DETERMINATION › Section 120.62 - Department of Mental Health and Developmental Disabilities (DMHDD) Approved Home and Community Based Residential Settings Under 89 Ill. Adm. Code 140.643 (Repealed)

Current through Register Vol. 48, No. 28, July 12, 2024
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart C - FINANCIAL ELIGIBILITY DETERMINATION › Section 120.64 - Determination of Eligibility for Cases Subject to Modified Adjusted Gross Income (MAGI) Methodology

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				eligibility period for a client shall begin with:
1) the first day of the month of application;
				or
2) the first day of any month
				prior to the month of application, if the client so desires, up to three months
				prior to the month of application; or
3) the first day of the month after the month
				of application; or
4) the first day
				of a month a pregnant woman and/or child under age 19 meets the requirements of
				Sections
				120.11
				and
				120.31.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart C - FINANCIAL ELIGIBILITY DETERMINATION › Section 120.66 - Medicaid Presumptive Eligibility for Pregnant Women

Current through Register Vol. 48, No. 28, July 12, 2024
a) The purpose of Medicaid Presumptive
				Eligibility (MPE) for pregnant women is to encourage early and continuous
				prenatal care of low income pregnant women who otherwise may postpone or do
				without that care. Qualified MPE Providers may make presumptive determinations
				for MPE.
b) A pregnant woman, as
				defined in Section 5-2(5)(a) and (b) of the Public Aid Code [ 305 ILCS 5 ] may
				be found presumptively eligible by a qualified MPE Provider as long as she has
				not been previously determined presumptively eligible under this Section or
				Section
				120.68
				during the current pregnancy.
c)
				The presumptive eligibility period shall be the period that:
1) begins with the date on which a qualified
				provider determines that the family income does not exceed 200 percent of the
				Federal Poverty Level (FPL) as determined pursuant to Section
				120.64;
				and
2) ends with and includes the
				earlier of:
A) in the case of a woman who
				files an application pursuant to 89 Ill. Adm. Code
				110.10 by the
				last day of the month following the month during which the qualified MPE
				Provider makes the determination that she is presumptively eligible, the day on
				which a determination is made by the State with respect to the eligibility of
				the woman for medical assistance under the Illinois State Medicaid Plan;
				or
B) in the case of a woman who
				does not file an application as described in subsection (2)(A), the last day of
				the month following the month during which the qualified MPE Provider makes the
				determination that she is presumptively eligible.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart C - FINANCIAL ELIGIBILITY DETERMINATION › Section 120.67 - Presumptive Eligibility for Children

Current through Register Vol. 48, No. 28, July 12, 2024
a) The purpose of Presumptive Eligibility for
				Children (CPE) is to enable timely provision of preventive and treatment
				services to children.
b) Children
				younger than 19 years of age, as defined in Section 5-2(6)(a) of the Public Aid
				Code may be presumed eligible for medical assistance under this Section if all
				of the following apply:
1) an application has
				been made on behalf of the child and received by the State;
2) unless the federal Centers for Medicare
				and Medicaid Services directs the Department otherwise, the child is not living
				in a jail, prison, half-way house, or juvenile detention facility, including
				being on work release, furlough or admitted for inpatient hospital treatment
				from such facilities;
3) the State
				employee who registers the application has no information that the child is not
				a U.S. citizen or a qualified non-citizen as described in Section
				120.310
				or 89 Ill. Adm. Code
				118.500;
				and
4) the child has not been
				determined presumptively eligible within the past 12 months under this Section,
				Section 120.68 or 89 Ill. Adm. Code 118 or 125 within the past 12
				months.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart C - FINANCIAL ELIGIBILITY DETERMINATION › Section 120.68 - Hospital Presumptive Eligibility (HPE) under the Affordable Care Act

Current through Register Vol. 48, No. 28, July 12, 2024
a) The purpose of
				Hospital Presumptive Eligibility (HPE) is to fulfill the mandate of the
				Affordable Care Act (ACA) that requires states to permit qualified hospitals to
				make presumptive determinations of eligibility for certain Medicaid eligibility
				groups pursuant to
				42 USC
				1396 a(a)(47)(B) and
				42 CFR
				435.1110.
b) The following classes of persons may be
				found presumptively eligible by qualified hospitals:
1) Pregnant women (see Section 5-2(5)(a) and
				(b) of the Public Aid Code (Code));
2) Children (see Section 5-2(6)(a) of the
				Code);
3) Persons who need
				treatment for breast or cervical cancer (see Section 5-2(12)(a) and (b) of the
				Code);
4) Parents or other
				caretaker relatives (see Section 5-2(15) of the Code (FamilyCare));
5) Persons age 19 or older, but younger than
				age 65 (see Section 5-2(18) of the Code);
6) Persons age 19 or older, but younger than
				age 26, who were formerly in foster care in Illinois (see Section 5-2(19) of
				the Code).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart D - MEDICARE PREMIUMS › Section 120.70 - Supplementary Medical Insurance Benefits (SMIB) Buy-In Program

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department
				shall pay the premium for Supplementary Medical Insurance benefits (SMIB) (Part
				B of Medicare) for specified clients in accordance with the buy-in agreement
				with the Social Security Administration (SSA) and the Medicare Catastrophic
				Coverage Act of 1988 ( P.L. 100-360 ). Individuals may previously have enrolled
				in SMIB themselves or they will be enrolled by the Department.
b) Eligible Individuals
1) The Department shall pay the SMIB premium
				for the following individuals:
A) individuals
				who receive financial assistance (including zero grant) under the AABD or TANF
				program;
B) individuals who, except
				for the Social Security benefit increase of 1972 (
				42
				CFR 435.134 ), would still be eligible to
				receive cash assistance as an aged, blind or disabled person (89 Ill. Adm. Code
				113) and who are eligible for both SMIB and medical assistance;
C) individuals with Supplemental Security
				Income (SSI) income who receive full Medicaid benefits under the AABD
				program;
D) Qualified Medicare
				Beneficiaries (QMBs) (see Section
				120.72
				);
E) Specified Low-Income Medicare
				Beneficiaries (SLIBs) (see Section
				120.73(b)
				); and
F) to the extent federal
				matching funds are available, Qualified Individuals-1 (QI-1) (see Section
				120.73(c)
				 ).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart D - MEDICARE PREMIUMS › Section 120.72 - Eligibility for Medicare Cost Sharing as a Qualified Medicare Beneficiary (QMB)

Current through Register Vol. 48, No. 28, July 12, 2024
a) Eligibility for
				Medicare cost sharing exists for Qualified Medicare Beneficiaries (QMB)s. A QMB
				is an individual who:
1) is a beneficiary of
				Medicare Part A (i.e. Hospital Insurance);
2) meets the general non-financial factors of
				eligibility for the Medicaid Program (see Sections
				120.310,
				120.311,
				120.319
				and
				120.325
				);
3) has countable monthly income
				which does not exceed the QMB income standard (see Section
				120.74
				); and
4) has countable assets
				which do not exceed the QMB asset disregard (see Section
				120.382(d)
				 ).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart D - MEDICARE PREMIUMS › Section 120.73 - Eligibility for Payment of Medicare Part B Premiums for Specified Low-Income Medicare Beneficiaries (SLIBs) and Qualified Individiduals-1 (QI-1)

Current through Register Vol. 48, No. 28, July 12, 2024
a) To the extent
				permitted under federal law (
				42 USC
				1396 a(a)(10) ), eligibility for payment of
				Medicare Part B premiums exists for Specified Low-Income Medicare Beneficiaries
				(SLIBs) and Qualified Individuals-1 (QI-1).
b) A SLIB is an individual who:
1) is a beneficiary of Medicare Part A (i.e.,
				Hospital Insurance);
2) meets the
				general non-financial factors of eligibility for the Medicaid Program (see
				Sections
				120.310,
				120.311,
				120.319
				and
				120.325
				);
3) has countable monthly income
				greater than 100 percent of the Federal Poverty Level (FPL), but less than 120
				percent of the FPL; and
4) has
				countable assets that do not exceed the QMB asset disregard (see Section
				120.382(f)(1)
				 ).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart D - MEDICARE PREMIUMS › Section 120.74 - Qualified Medicare Beneficiary (QMB) Income Standard

Current through Register Vol. 48, No. 28, July 12, 2024
The QMB income standard is equal to a percentage of the then
				  current Federal Poverty Level Income Guidelines as published annually in the
				  Federal Register) for the size of the household. If the household's countable
				  monthly income (see 89 Ill. Adm. Code 112, 113, 120) exceeds the QMB income
				  standard, eligibility for QMB status does not exist. The timetable for the
				  applicable percentage is as follows:
January-December 1989 - 80%
January-December 1990 - 85%
January-December 1991 - 95%
January-December 1992 - 100%
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart D - MEDICARE PREMIUMS › Section 120.75 - Specified Low-Income Medicare Beneficiaries (SLIBs) and Qualified Individuals-1 (QI-1) Income Standards

Current through Register Vol. 48, No. 28, July 12, 2024
The SLIB and QI-1 income standards are equal to a percentage
				  of the Federal Poverty Level (FPL) Income Guidelines as published annually in
				  the Federal Register for the size of the household. If the household's
				  countable monthly income (see 89 Ill. Adm. Code 112, 113, 120) exceeds the
				  appropriate SLIB or QI-1 income standard, eligibility for SLIB or QI-1 status
				  does not exist. The applicable percentages are as follows:
a) Effective January 5, 1998, the SLIB income
				standard is greater than 100 percent of the FPL, but less than 120 percent of
				the FPL.
b) Effective January 5,
				1998, the QI-1 income standard is at least 120 percent of the FPL, but less
				than 135 percent of the FPL.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart D - MEDICARE PREMIUMS › Section 120.76 - Hospital Insurance Benefits (HIB)

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department shall pay the Hospital
				Insurance Benefit (HIB) (Part A of Medicare) premium for Qualified Medicare
				Beneficiaries (QMBs) (see Section
				120.72
				). Payments will be made in behalf of QMBs who have individually enrolled for
				HIB with the Social Security Administration and who are charged a HIB
				premium.
b) The Department will pay
				the HIB premium beginning the month following the month of the QMB eligibility
				determination. Payment will continue as long as the individual retains QMB
				status.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart G - AID TO THE MEDICALLY INDIGENT › Section 120.200 - Elimination Of Aid To The Medically Indigent

Current through Register Vol. 48, No. 28, July 12, 2024
Effective August 1, 1991, the Aid to the Medically Indigent
				  Program (AMI) was eliminated pursuant to Public Act 87-14. Any references to
				  the AMI program contained in the Department's rules are obsolete and of no
				  effect as of August 1, 1991.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.308 - Client Cooperation

Current through Register Vol. 48, No. 28, July 12, 2024
a) As a
				condition of eligibility, clients must cooperate:
1) in the determination of
				eligibility;
2) with Department
				programs conducted for the purposes of acquisition or verification of
				information upon which eligibility may depend; and
3) in applying for all financial benefits for
				which they may qualify and to avail themselves of those benefits at the
				earliest possible date.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.309 - Caretaker Relative

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				caretaker relative is the specified relative with whom the child is living.
				When a dependent child lives with a parent that parent shall be designated as
				the caretaker relative.
b) Every
				MANG(C) case shall have one person designated as the caretaker relative. The
				caretaker relative does not have to meet a minimum or a maximum age requirement
				and if the caretaker relative is included in the assistance unit, this person
				shall no longer be considered a dependent child. No person shall serve as
				caretaker relative for more than one AFDC grant case at the same time, except
				for an AFDC-U parent whose child's eligibility is based on the lack of parental
				support or care of that child's other parent.
c) An exception to the above shall occur when
				no specified relative is immediately available to act as a caretaker relative.
				(In this situation, another person may serve as a Temporary Caretaker for a
				period not to exceed 90 days.) "Living with" requirements of the child(ren) are
				the same as with a caretaker relative. The Temporary Caretaker will not be
				included in the assistance unit.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.310 - Citizenship

Current through Register Vol. 48, No. 28, July 12, 2024
To be eligible for assistance, an individual shall be either
				  a United States (U.S.) citizen or a non-citizen within specific categories and
				  subject to specific restrictions set forth in subsection (a) and (b).
a) Citizenship status - Persons born in the
				U.S., or in its possessions, are U.S. citizens. Citizenship can also be
				acquired by naturalization through court proceedings, or by certain persons
				born in a foreign country of U.S. citizen parents.
b) Non-citizens
1) The following categories of non-citizens
				may receive assistance, if otherwise eligible:
A) A U.S. veteran honorably discharged and a
				person on active military duty, and the spouse and unmarried dependent children
				of that person;
B) Refugees under
				section 207 of the Immigration and Nationality Act (INA);
C) Asylees under section 208 of
				INA;
D) Persons for whom
				deportation has been withheld under section 243(h) of INA;
E) Persons granted conditional entry under
				section 203(a)(7) of INA as in effect prior to April 1, 1980;
F) Persons lawfully admitted for permanent
				residence under INA;
G) Parolees,
				for at least one year, under section 212(d)(5) of INA;
H) Nationals of Cuba or Haiti;
I) Persons identified by the Federal Office
				of Refugee Resettlement (ORR) as victims of trafficking;
J) Amerasians from Vietnam;
K) Members of the Hmong or Highland Laotian
				tribe when the tribe helped U.S. personnel by taking part in a military or
				rescue operation during the Vietnam era;
L) American Indians born in Canada;
				and
M) Persons who are a spouse,
				widow or child of a U.S. citizen or a spouse or child of a legal permanent
				resident (LPR) who have been battered or subjected to extreme cruelty by the
				U.S. citizen or LPR or a member of that relative's family who lived with them,
				who no longer live with the abuser or plan to live separately within one month
				of assistance and whose need for assistance is due, at least in part, to the
				abuse.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.311 - Residence

Current through Register Vol. 48, No. 28, July 12, 2024
a) Only those
				persons who are legally admitted to the United States can be found to be
				residents of the State of Illinois.
b) In order to be eligible an individual must
				be a resident of Illinois, but does not require actual physical presence within
				the State.
c) An individual is a
				resident of Illinois if living in Illinois (as defined by Section 2-10 of the
				Illinois Public Aid Code, Ill. Rev. Stat. 1983, ch. 23, par. 2-10) or if living
				in an out-of-state institution (as defined at
				42 CFR
				435.403(b)(1984) ) and was
				placed there by an Illinois Agency unless:
1)
				the individual maintains a house, apartment or other home in another State;
				or
2) the individual voluntarily
				leaves the out-of-state institution in which the individual was placed by an
				Illinois agency and does not return to Illinois; or
3) the individual is receiving a State
				Supplementary Payments (as defined at
				42 CFR
				435.4(1984), Mandatory State
				Supplement or Optional State Supplement) from another State as a resident of
				that State; or
4) the individual
				was placed in an institution located in Illinois by another State.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.312 - Age

Current through Register Vol. 48, No. 28, July 12, 2024
a) There is no age
				requirement for the Aid to the Aged, Blind or Disabled (Blind) (AABD(B)) and
				Aid to the Aged, Blind or Disabled (Disabled) (AABD(D)) Medical Assistance - No
				Grant (MANG) programs.
b) An
				individual must be 65 years of age or older to qualify for Aged, Blind or
				Disabled (Aged) (AABD(A)) Medical Assistance - No Grant (MANG).
c) To be designated as or to receive medical
				assistance as a caretaker relative in an AFDC-MANG case there is no minimum or
				maximum age requirement.
d) To be
				included in an AFDC-MANG case as a dependent child, a child must be under age
				18 or age 18 and a full time high school senior (or equivalent level) and will
				finish school before reaching age 19.
e) If an individual receives medical
				assistance as a caretaker relative in an AFDC-MANG case that individual shall
				not be considered as a child in the determination of the medical assistance
				standard.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.313 - Blind

Current through Register Vol. 48, No. 28, July 12, 2024
MANG(B)
a) To be
				eligible for medical assistance as a blind person an individual must be
				determined blind as currently defined by the Social Security Administration
				(SSA). (See 20 CFR 416, Subpart I, April 1, 1984).
b) If an individual is receiving Supplemental
				Security Income (SSI) or primary Social Security (OASDI) benefits, the
				Department shall accept the Social Security Administration determination of
				blindness. The Department will make the determination when the client has been
				denied SSI on the basis of too much income or when the client is applying for
				medical assistance only and not receiving SSI or OASDI. The Department uses the
				same criteria for blindness as is used under SSI. (See 20 CFR 416, Subpart I,
				April 1, 1984).
c)
1) If an individual applying for or receiving
				medical assistance is determined currently "not blind" by SSA under the SSI or
				primary OASDI programs, the Department shall accept SSA's determination of
				blindness and deny or cancel the case, no matter which agency made the original
				determination of eligibility.
2) If
				the individual appeals the SSA determination of blindness to SSA, medical
				assistance shall be continued for recipients through the level of a
				determination by an Administrative Law Judge (ALJ) subject to the time limits
				of c)3) below. If medical assistance has been cancelled but the client later
				appeals to SSA, the case shall be reinstated through the ALJ level subject to
				the time limits of c)3) below.
3)
				If the client notifies the Department of his appeal to SSA within 10 days of
				the date of the Department notice, medical assistance will be continued with no
				break. If the client notifies the Department of his appeal to SSA within 11
				through 65 days of the date of the Department notice, medical assistance will
				be reinstated back to the original date of cancellation. If the client notifies
				the Department of his appeal to SSA more than 65 days after the date of the
				Department notice, medical assistance will be provided prospectively only,
				unless the client actually appealed to SSA within 65 days of the date of the
				Department notice, in which case medical assistance will be reinstated back to
				the original date of cancellation.
4) Medical assistance shall not be provided
				to applicants for medical assistance through the SSA appeals process.
5) If an Administrative Law Judge finds the
				individual "not blind", the Department shall accept that finding as final. The
				individual shall not have the right to appeal the determination of blindness to
				the Department at any time during this process.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.314 - Disabled

Current through Register Vol. 48, No. 28, July 12, 2024
MANG(D)
a) To be
				eligible for medical assistance as a disabled person an individual must be
				determined disabled as currently defined by the Social Security Administration.
				(See 20 CFR 416, Subpart I, April 1, 1984.)
b) If an individual is receiving Supplemental
				Security Income (SSI) or primary Social Security (OASDI) benefits, the
				Department shall accept the Social Security Administration determination of
				disability. The Department will make the determination when the client has been
				denied SSI on the basis of too much income or when the client is applying for
				medical assistance only and not receiving SSI or OASDI. The Department uses the
				same criteria for disability as is used under SSI. (See 20 CFR 416, Subpart I,
				April 1, 1984).
c) If a child was
				terminated from SSI due to the August 22, 1996, change in disability standards
				( Public Law
				104-193 ), and the child was eligible for both
				Medicaid and SSI on August 22, 1996, the child is considered disabled unless:
1) the child becomes 18, or
2) the child has not received Medicaid for 12
				months, or
3) the child no longer
				meets the pre-August 22, 1996, definition of disability.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.315 - Relationship

Current through Register Vol. 48, No. 28, July 12, 2024
MANG(C)
a) The
				child(ren) must be living with a blood relative, step-relative or adoptive
				relative in the relative's home.
b)
				The required relationship does not exist between a child born-out-of-wedlock
				and the child's father or the father's relatives unless:
1) paternity has been adjudicated;
2) the father has acknowledged paternity in
				open court or by notarized written statement within the last two years;
				or
3) the father has contributed to
				the child's support within the last two years and had previously acknowledged
				paternity in open court or by notarized written statement.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.316 - Living Arrangement

Current through Register Vol. 48, No. 28, July 12, 2024
All persons included in the assistance unit must be residing
				  in the same household. To be included in the assistance unit as a child, the
				  child must live with a specified relative in that relative's home. The relative
				  must exercise primary responsibility for care and supervision of the child,
				  even though either the child or the relative is temporarily absent from the
				  customary family setting.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.317 - Supplemental Payments

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				MANG(AABD)
State Supplemental Payments (SSP) shall be available to
				  supplement the income of those individuals whose age, disability, or blindness
				  would (apart from consideration of income) satisfy the eligibility factors of
				  the Federal SSI program. Eligibility shall not exist if SSI payments would be
				  higher in the absence of the SSP payments, or if the individual refuses or
				  neglects to make application for assistance from SSI when so directed by the
				  Department. Receipt of SSI is not a requirement of eligibility for SSP. Having
				  made application for SSI benefits is an eligibility requirement for receipt of
				  SSP; however denial of the SSI application does not preclude ineligibility for
				  SSP unless SSI was denied due to a finding of "not aged", "not blind" or "not
				  disabled". An individual determined by SSA as not aged, blind or disabled, is
				  not eligible for SSP.
b)
				MANG(C)
An individual who is eligible for either MANG(C) or SSP shall
				  have a choice between the two programs. In no instance may that individual
				  receive both MANG(C) and SSP.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.318 - Institutional Status

Current through Register Vol. 48, No. 28, July 12, 2024
a) Individuals
				residing in public institutions (see
				42 CFR
				435.1009 ) are ineligible for medical
				assistance, except as provided in subsections (b) and (c) of this
				Section.
b) For individuals
				confined or detained in any local or State penal or correctional institution
				who are otherwise eligible for, and enrolled in, medical assistance authorized
				under Article V of the Illinois Public Aid Code [305 ILCS 5 ], benefits shall
				be limited to those services reimbursed by the Department as described in 89
				Ill. Adm. Code
				140.10. The limitation
				shall be lifted upon timely notice to the Department that the individual has
				been released. The notice must confirm that the individual is residing in
				Illinois and shall include an address through which the individual may be
				contacted. This change shall take effect upon adoption of this amended rule for
				persons who are eligible for medical assistance because they have attained the
				age of 65, are blind or have a disability. For all other individuals, this
				change shall take effect no later than January 1, 2012.
c) Nothing in subsection (b) shall affect the
				eligibility of pregnant women whose medical care during pregnancy is eligible
				for federal reimbursement of the cost of care provided to an unborn
				child.
d) Individuals who are
				confined or detained by a federal law enforcement agency are ineligible for
				medical assistance.
e) A resident
				of a private institution who has a contract with the institution providing
				total needs throughout life is ineligible, as no needs remain to be
				met.
f) Residents of private
				institutions (other than those who have purchased life care contracts) are
				ineligible for public assistance when they have purchased care and maintenance
				to provide for all their needs in the institution and the amount paid has not
				been wholly consumed for care.
g)
				Individuals, living in a public or a private facility that has official
				policies and administrative procedures that are not in conformance or are in
				conflict with the Illinois Public Aid Code provision or Department rules
				governing eligibility for medical assistance, are ineligible for medical
				assistance.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.319 - Assignment of Rights to Medical Support and Collection of Payment

Current through Register Vol. 48, No. 28, July 12, 2024
a) Assignment of
				Rights to Medical Support
1) By accepting
				medical assistance under the Public Aid Code (Ill. Rev. Stat. 1989, ch. 23,
				par. 5-2), a custodial relative, spouse, or a parent shall be deemed to have
				made assignment to the Department of any and all rights, title, and interest in
				any medical support obligations up to the amount of medical assistance provided
				(Ill. Rev. Stat. 1989, ch. 23, par. 10-1). The rights to medical support
				assigned to the Department shall constitute an obligation owed to the State by
				the person who is responsible for providing the support and is collectable
				under all available processes.
2)
				This right includes the rights of any individual or any other person who is
				eligible for medical assistance and on whose behalf the individual has the
				legal authority to execute an assignment of such rights, to support (specified
				as support for the purposes of medical care by a court or administrative order)
				and to a payment for medical care from any third party.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.320 - Cooperation in Establishing Paternity and Obtaining Medical Support

Current through Register Vol. 48, No. 28, July 12, 2024
a) In accordance
				with 89 Ill. Adm. Code
				160.30,
				as a condition of eligibility for medical assistance a caretaker relative or
				spouse included in the assistance unit, who assigned to the Department his/her
				rights to medical support, shall cooperate with the Department in:
1) establishing the paternity of a child born
				out of wedlock, for whom the individual can legally assign rights;
				and
2) obtaining medical support
				and payments on his or her own behalf and on behalf of those persons for whom
				the client has assigned rights.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.321 - Good Cause for Failure to Cooperate in Establishing Paternity and Obtaining Medical Support

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department shall inform the caretaker relative of his/her right to claim an
				exemption from cooperation, based on a claim of good cause.
b) With respect to claiming good cause for
				exemption as not in the best interests of a child for whom an assignment was
				executed, the Department's Good Cause policy at 89 Ill. Adm. Code
				160.35,
				shall apply.
c) With respect to
				claiming good cause for exemption as not in the best interests of the caretaker
				relative or any individual other than the child for whom an assignment was
				executed, the Department's Good Cause policy at 89 Ill. Adm. Code 160.35, shall
				apply excluding those parts applicable only to children.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.322 - Proof of Good Cause for Failure to Cooperate in Establishing Paternity and Obtaining Medical Support

Current through Register Vol. 48, No. 28, July 12, 2024
a) With respect
				to the caretaker relative proving/documenting a claim of good cause as not in
				the best interest of the child, the Department's Proof of Good Cause policy at
				89 Ill. Adm. Code
				160.40,
				shall apply.
b) With respect to the
				caretaker relative proving/documenting a claim of good cause as not in the best
				interest of a person other than a child, the Department's Proof of Good Cause
				policy at 89 Ill. Adm. Code 160.40, shall apply, excluding those parts
				applicable only to children.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 120 - MEDICAL ASSISTANCE PROGRAMS › Subpart H - MEDICAL ASSISTANCE - NO GRANT (MANG) ELIGIBILITY FACTORS › Section 120.323 - Suspension of Paternity Establishment and Obtaining Medical Support Upon Finding of Good Cause

Current through Register Vol. 48, No. 28, July 12, 2024
a) Upon a
				caretaker relative's claim of good cause, the Department will suspend all
				activities to establish paternity or secure medical support payments until a
				final determination is made on the good cause claim.
b) The Department shall not undertake to
				establish paternity or secure medical support payments when the Department
				determines that good cause for exemption exists.
c) This suspension shall be in accordance
				with 89 Ill. Adm. Code
				160.45,
				Suspension of Child Support Enforcement Upon Finding of Good Cause.