a) Effective July 1, 2012 or as soon thereafter as approved by the federal
government, eligibility for medical assistance under an approved waiver program authorized under Section 5-2(17) of the Public Aid Code (Code) is available to individuals who meet all of the following eligibility requirements:
1) Cooperate in establishing eligibility as described in Section 120.308;
2) Have citizenship or immigration status as described in Section 120.310;
3) Reside within the boundaries of the unit of Illinois local government sponsoring the approved waiver program;
4) Assign rights to medical support and collection of payment as described in Section 120.319;
5) Furnish a Social Security Number as described in Section 120.327;
6) Be at least 19 years of age and no older than 64 years of age;
7) Not be an inmate of a correctional facility pursuant to 42 CFR 435.1008 unless eligibility for such individuals is expressly authorized by the approved waiver;
8) Not be enrolled in Medicare; and
9) Have countable monthly income at or below 133 percent of the federal poverty level.
b) An individual shall not be determined eligible under this Section if he or she is otherwise eligible for medical assistance without a spenddown under this Part
NOTICE OF PROPOSED AMENDMENT
except that, if authorized under the approved waiver, women enrolled in the Illinois Healthy Women Program, as established by Section 120.540, may be determined eligible under this Section.
c) An individual who is otherwise eligible for medical assistance with a spenddown and who meets the requirements of this Section shall have the option of enrolling in medical assistance with a spenddown or under this Section.
d) The earned and unearned income of the following persons shall be counted when determining eligibility:
1) The individual.
2) The spouse who lives with the individual.
e) Countable monthly income is determined by taking the total gross monthly income of the individual and the individual's spouse, if married and living with the spouse, and subtracting allowable deductions and exemptions according to the provisions of 89 Ill. Adm. Code 120.330 through 120.376, except that Sections, 120.338(a), 120.345(b), 120.350, 120.355(a), 120.360(d), 120.362, 120.370(a), 120.371(b) and (c), and 120.373(a) shall not apply.
f) All assets shall be exempt from consideration in determining eligibility under this Section.
g) Application Process
1) Individuals may apply by phone, at participating provider locations or in-person through designated application assistors or by additional means as established by the Department.
2) The application date shall be the date a signed application is received by the Department or its designee and can be no sooner than the effective date of the approved waiver.
3) Applications made for enrollment under this Section shall be considered only for eligibility under this Section.
4) Applications made for enrollment under this Section shall be exempt from the application requirements of 89 Ill. Adm. Code 110.
NOTICE OF PROPOSED AMENDMENT
h) Eligibility will be effective no earlier than the third month before the month of application if the applicant would have met the criteria of this Section had he or she applied. In no case shall eligibility be effective prior to the effective date of the waiver.
i) Individuals may be determined presumptively eligible as provided under an approved waiver program authorized under Section 5-2(17) of the Code.
j) Eligibility under this Section will be redetermined every 12 months.
k) An individual's eligibility shall be terminated if the individual no longer meets the requirements of this Section.
l) Persons applying or enrolled under this Section shall be entitled to appeal rights described in 89 Ill. Adm. Code 102.80 through 102.83.
m) Eligibility under this Section shall end upon termination of the approved waiver authorized under Section 5-2(17) of the Code.
n) Individuals enrolled under this Section shall not be exempt from estate recovery as established in 89 Ill. Adm. Code 102.210.
o) Benefits available for clients eligible under an approved waiver authorized by Section 5-2(17) of the Code shall be as defined in 89 Ill. Adm. Code 140.5.
(Source: Added at 36 Ill. Reg. ______, effective ____________)
NOTICE OF PROPOSED AMENDMENTS 1) Heading of the Part: Medical Payment
2) Code Citation: 89 Ill. Adm. Code 140
3) Section Numbers: Proposed Action:
140.5 Amendment
140.642 Amendment 140.643 Amendment
4) Statutory Authority: Section 12-13 of the Illinois Public Aid Code [305 ILCS 5/12-13]
5) Complete Description of the Subjects and Issues Involved: The administrative rule regarding the County Eligibility Expansion Waiver Program Services is authorized under Public Act 97-687. Public Act 97-687 expands medical assistance eligibility under Title XIX of the federal Social Security Act for individuals at or below 133% of the federal poverty level pursuant to a waiver authorized by the federal government. The program is financed entirely by units of local government and federal matching funds. Public Act 97-689, the Save Medicaid Access and Resources Together (SMART) Act, the law which addresses the significant spending and liability deficits in the Medicaid program, could not take effect until the bill underlying Public Act 97-687 became law.
The administrative rules impacting the “determination of need” (DON) is authorized by the SMART Act that mandates an increase in the DON from 29 to 37.
6) Published studies or reports, and sources of underlying data, used to compose this rulemaking: None
7) Will this rulemaking replace any emergency rulemaking currently in effect? No 8) Does this rulemaking contain an automatic repeal date? No
9) Does this rulemaking contain incorporations by reference? No 10) Are there any other proposed rulemakings pending on this Part? Yes
Section Numbers: Proposed Action: Illinois Register Citation:
140.445 Amendment 36 Ill. Reg. 7757; May 25, 2012 140.523 Amendment 36 Ill. Reg. 7757; May 25, 2012 140.539 Amendment 36 Ill. Reg. 7757; May 25, 2012
NOTICE OF PROPOSED AMENDMENTS
140.570 Amendment 36 Ill. Reg. 7757; May 25, 2012 140.1001 Amendment 36 Ill. Reg. 8081; June 1, 2012 140.400 Amendment 36 Ill. Reg. 8594; June 15, 2012 140.438 Amendment 36 Ill. Reg. 8594; June 15, 2012 11) Statement of Statewide Policy Objectives: This rulemaking does affect units of local
government.
12) Time, Place, and Manner in Which Interested Persons May Comment on this Proposed Rulemaking: Any interested parties may submit comments, data, views, or arguments concerning this proposed rulemaking. All comments must be in writing and should be addressed to:
Jeanette Badrov
General Counsel
Illinois Department of Healthcare and Family Services 201 South Grand Avenue E., 3rd Floor
Springfield IL 62763-0002 217/782-1233
The Department requests the submission of written comments within 45 days after the publication of this Notice. The Department will consider all written comments it receives during the first notice period as required by Section 5-40 of the Illinois Administrative Procedure Act [5 ILCS 100/5-40].
13) Initial Regulatory Flexibility Analysis:
A) Types of small businesses, small municipalities and not-for-profit corporations affected: Medicaid funded long term care facilities
B) Reporting, bookkeeping or other procedures required for compliance: None C) Types of professional skills necessary for compliance: None
14) Regulatory Agenda on which this Rulemaking was Summarized: This rulemaking was not anticipated by the Department when the most recent regulatory agendas were published.
NOTICE OF PROPOSED AMENDMENTS The full text of the Proposed Amendments begins on the next page
NOTICE OF PROPOSED AMENDMENTS
TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES