Bill Text: IL SB2021 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Creates the Medicaid Eligibility Determination and Renewal Reform Act. Requires the Department of Healthcare and Family Services (Department) to work with the Department of Human Services to achieve the following goals related to eligibility determinations and renewals under the Medical Assistance Program: (i) reduce procedural terminations so that no more than 10% of medical assistance beneficiaries who remain eligible for medical assistance experience any lapse in contemporaneous medical coverage; and (ii) use technology to lower administrative burdens and increase beneficiary continuity of coverage by providing real-time eligibility determination decisions for at least 75% of all medical assistance applicants, increasing automatic renewals for medical assistance beneficiaries, and offering an electronic means by which medical assistance beneficiaries can track and maintain their benefits. Provides that the goals must be meet by December 31, 2020. Requires the Department to submit Medicaid and CHIP State Plan amendments to implement express lane eligibility for all beneficiaries of medical assistance and benefits under the Children's Health Insurance Program Act. Contains provisions concerning community-based enrollment and redetermination assistance; the creation of enhanced user permission; and other matters. Amends the Illinois Public Aid Code. Requires the Department to reduce administrative burdens and minimize delay utilizing its income, residency, and identity verification system; and to utilize federal or State electronic data sources to obtain certain financial, employment, and residency information. Contains provisions concerning data matching; the waiver of residency verification requirements; rulemaking authority; and other matters. Effective immediately.

Spectrum: Strong Partisan Bill (Democrat 12-1)

Status: (Failed) 2021-01-13 - Session Sine Die [SB2021 Detail]

Download: Illinois-2019-SB2021-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB2021 Introduced 2/15/2019, by Sen. Heather A. Steans SYNOPSIS AS INTRODUCED:
See Index
Creates the Medicaid Eligibility Determination and Renewal Reform Act. Requires the Department of Healthcare and Family Services (Department) to work with the Department of Human Services to achieve the following goals related to eligibility determinations and renewals under the Medical Assistance Program: (i) reduce procedural terminations so that no more than 10% of medical assistance beneficiaries who remain eligible for medical assistance experience any lapse in contemporaneous medical coverage; and (ii) use technology to lower administrative burdens and increase beneficiary continuity of coverage by providing real-time eligibility determination decisions for at least 75% of all medical assistance applicants, increasing automatic renewals for medical assistance beneficiaries, and offering an electronic means by which medical assistance beneficiaries can track and maintain their benefits. Provides that the goals must be meet by December 31, 2020. Requires the Department to submit Medicaid and CHIP State Plan amendments to implement express lane eligibility for all beneficiaries of medical assistance and benefits under the Children's Health Insurance Program Act. Contains provisions concerning community-based enrollment and redetermination assistance; the creation of enhanced user permission; and other matters. Amends the Illinois Public Aid Code. Requires the Department to reduce administrative burdens and minimize delay utilizing its income, residency, and identity verification system; and to utilize federal or State electronic data sources to obtain certain financial, employment, and residency information. Contains provisions concerning data matching; the waiver of residency verification requirements; rulemaking authority; and other matters. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be referred to as the
Medicaid Eligibility Determination and Renewal Reform Act.
Section 5. Purpose. The processes currently in place for
eligibility determination and renewal (also known as
redetermination) under the State's medical assistance programs
lead to delayed access to benefits, disruptions in care
delivery, decreased quality of care, waste in spending on
unnecessary administrative costs, and worse overall health and
well-being for enrollees. To improve continuity of care for
beneficiaries and remedy significant administrative
challenges, to the benefit of both the State and beneficiaries,
this Act implements improvements and efficiencies to increase
accountability and transparency, minimize delay and procedural
terminations, and improve the overall integrity of the State's
medical assistance programs.
Section 10. Medicaid eligibility determination and renewal
goals.
(a) The Department of Healthcare and Family Services shall
work with the Department of Human Services, as well as other

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stakeholders, to achieve the following goals related to
eligibility determinations and renewals under the Medical
Assistance Program established under Article V of the Illinois
Public Aid Code:
(1) Reduce procedural terminations under the Medical
Assistance Program so that no more than 10% of medical
assistance beneficiaries who remain eligible for medical
assistance experience any lapse in contemporaneous medical
coverage.
(2) Use technology to lower administrative burdens and
increase beneficiary continuity of coverage by providing
real-time eligibility determination decisions under the
Medical Assistance Program for at least 75% of all medical
assistance applicants, increasing automatic renewals for
medical assistance beneficiaries, and offering an
electronic means by which a broad array of medical
assistance beneficiaries can track and maintain their
benefits.
(b) The Department of Healthcare and Family Services and
the Department of Human Services shall work together with
stakeholders, including, but not limited to, beneficiaries of
medical assistance, consumer advocates, governmental staff,
provider, and managed care organizations, to achieve the goals
described in subsection (a) by December 31, 2020. The
Department of Healthcare and Family Services shall provide a
report to the General Assembly on the Department's progress

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toward achieving those goals by December 31, 2019. The report
shall be posted on the Department of Healthcare and Family
Services' website and shall describe the policy changes the
Department has made, any challenges the Department has faced,
the Department's plan to achieve the goals by the deadline, and
the current rate of procedural termination, data-driven
renewals, and electronic portal use.
Section 15. Express lane eligibility State Plan amendment;
implementation timeline.
(a) As used in this Section:
"CHIP" means the Children's Health Insurance Program
established under the Children's Health Insurance Program
Act.
"Medicaid" means medical assistance authorized under
Section 1902 of the Social Security Act.
(b) Federal approval for express lane eligibility. The
Department of Healthcare and Family Services shall submit
Medicaid and CHIP State Plan amendments to the federal Centers
for Medicare and Medicaid Services to implement express lane
eligibility for all Medicaid and CHIP beneficiaries as
permitted by Section 203 of the Children's Health Insurance
Program Reauthorization Act of 2009 (Public Law 111-3), no
later than 90 days after the effective date of this Act. The
Department of Healthcare and Family Services shall cooperate
with the federal Centers for Medicare and Medicaid Services to

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obtain approval, if necessary, to implement an express lane
eligibility option to ensure that children eligible for
Medicaid or CHIP have a fast and simplified process for having
their eligibility determined or renewed to facilitate
enrollment in Medicaid and CHIP.
(c) Content of State Plan amendment. At a minimum, the
State Plan amendment shall specify that express lane
eligibility shall apply to all Medicaid and CHIP beneficiaries.
If federal approval is granted, the Department of Healthcare
and Family Services shall seek an 1115 waiver to apply the
express lane eligibility option to beneficiaries age 21 or
older no later than 90 days after approval. The State Plan
amendment shall identify, at a minimum, the Supplemental
Nutrition Assistance Program as its express lane agency. The
State Plan amendment shall also specify that the express lane
eligibility option will be used for both applications and
renewals. The Department of Healthcare and Family Services may
select more than one express lane agency, consistent with the
Centers for Medicare and Medicaid Services' rules governing
express lane eligibility. The Department of Healthcare and
Family Services may also elect to obtain and use information
directly from State income tax records or returns, consistent
with the Centers for Medicare and Medicaid Services' rules
governing express lane eligibility.
(d) Implementation. After the Department of Healthcare and
Family Services secures federal approval (if required) from the

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Centers for Medicare and Medicaid Services, the Department
shall implement express lane eligibility within 90 days after
the date of federal approval.
Section 20. Reinstatement upon renewal.
(a) If an individual who failed to cooperate during the
renewal process cooperates and submits all required
verifications prior to the end of the third month (or 90 days
if longer) following the last day of coverage, and the case
remains eligible, the Department of Healthcare and Family
Services shall restore assistance immediately, with no loss of
coverage and back to the date of cancellation, without
requiring a new application from the individual. In restoring
assistance, the Department shall act to ensure that an eligible
individual has the shortest time possible, if any, when his or
her case shows as inactive to providers. Retroactive coverage
alone does not satisfy the objective of this Section if
eligible individuals still experience real-time periods of an
inactive case.
(b) Individuals who are reinstated and who are enrolled in
a managed care organization prior to initial cancellation of
coverage shall be reinstated to the same managed care
organization, regardless of when the individual's coverage is
reinstated, and the annual HealthChoice Illinois open
enrollment period for the individual shall remain the same.
Managed care organizations shall be paid the appropriate per

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member per month payment retroactively for reinstated members.
(c) Providers serving individuals in the State's
fee-for-service system may submit prior approval requests to
the Department of Healthcare and Family Services for review and
retroactive processing for medical assistance provided during
the reinstatement period. Providers serving individuals
enrolled in managed care may have their prior approval requests
submitted and processed retroactively for medical assistance
provided during the reinstatement period, provided that
appropriate member attribution and associated payment are also
made to the managed care organization for the reinstated
coverage period.
Section 25. Community-based enrollment and redetermination
assistance.
(a) The Department of Healthcare and Family Services shall
create and support agency-associated permission and enhanced
user permission within the Department's integrated eligibility
system to provide authorized access to client cases to better
enable providers and community-based organizations to support
applicants and clients enrolling in, renewing, or otherwise
maintaining their benefits.
(b) Creation of agency-associated permission.
(1) The Department of Healthcare and Family Services
shall authorize, create, support, and administer a process
by which a provider or community-based organization can

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access each client case that is associated with that
provider or community-based organization in the
Department's integrated eligibility system for each
client, provider, and community-based organization that
seeks such access, and cooperates with the Department's
screening, training, and security protocols. Such access
shall enable the provider or community-based organization
to assist its clients with their benefits cases.
(2) A client must authorize the Department of
Healthcare and Family Services to associate his or her case
with one or more particular providers or community-based
organizations before the provider or organization may
access the client's case. Such authorization must be given
in writing and may be revoked in writing by the client,
provider, or community-based organization at any time. The
permission to access the case shall be granted to the
provider or community-based organization as a whole and not
specific to any particular employee or staff member. The
Department of Healthcare and Family Services shall process
all requests to associate a case or revoke an association
with particular providers or community-based organizations
promptly.
(3) For each provider and community-based organization
that seeks such access, the Department of Healthcare and
Family Services shall authorize and create
agency-associated permission within the Department's

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integrated eligibility system to view the specific case for
each client associated with the provider or
community-based organization. This agency-associated
permission shall permit staff authorized by the provider or
community-based organization to access and interact with
all client cases associated with the provider or
community-based organization in ways that are otherwise
accessible to the client. The provider or community-based
organization shall identify and supervise authorized
staff. Such agency-associated permission shall enable the
provider or community-based organization to access all
client-facing aspects of the case for each client
associated with the provider or community-based
organization who has authorized such access.
(4) The Department of Healthcare and Family Services
shall ensure that the provider or community-based
organization has been granted permission within the
Department's integrated eligibility system (or other
electronic systems) to receive and view notifications and
alerts for all associated client cases, and to perform
certain actions in associated client cases. Permitted
actions shall include, but are not limited to: (i) viewing
notifications, (ii) uploading documentation such as
spend-down verifications and renewal forms, and (iii)
initiating contact with and continuing communication with
Department staff.

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(c) Administration of agency-associated permission.
(1) The Department of Healthcare and Family Services
shall develop criteria and policies for granting
permission to providers and community-based organizations
that seek agency-associated permission.
(2) The Department of Healthcare and Family Services
shall create criteria and policies to ensure that
agency-associated permission is granted only for accounts
where the authorized user has agreed to (i) obtain the
written consent of the individual, (ii) act in the best
interest of the individual, (iii) maintain the integrity of
the Department's programs, and (iv) act in compliance with
applicable State and federal law.
(3) Agency-associated permission shall be authorized
by the Department of Healthcare and Family Services in
accordance with the criteria and policies to be developed
by the Department under this Act.
(4) The Department of Healthcare and Family Services
shall not unreasonably restrict or limit agency-associated
permission.
(d) Creation of enhanced user permission.
(1) The Department of Healthcare and Family Services
shall authorize, create, support, and administer an
enhanced user permission under which particular
individuals have authority to manually verify information
and work around error messages in the Department's

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integrated eligibility system. Individuals who are
associated with navigators, providers, or community-based
organizations may apply for such access, and the Department
shall grant enhanced user permission in compliance with
this Section to those who cooperate with the Department's
screening, training, and security protocols.
(2) Enhanced user permissions shall permit individuals
to work in the integrated eligibility system with enhanced
permissions beyond the consumer-facing portal. Such
enhanced permissions shall include, but not be limited to,
addressing common challenges, including (i) resolving
common error codes, (ii) manually verifying data in the
integrated eligibility system, and (iii) performing
identity verification for the purposes of eligibility
determination in accordance with requirements set forth by
State and federal law. Nothing in this Act shall be
interpreted as changing program eligibility or renewal
criteria.
(e) Administration of enhanced user permission.
(1) Providers and community-based organizations shall
nominate and supervise individual staff that serve as
assisters, navigators, or who are otherwise proficient
with Manage My Case to be granted enhanced user permissions
by the Department of Healthcare and Family Services.
(2) The Department of Healthcare and Family Services
shall develop criteria and policies for granting enhanced

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user permission.
(3) The Department of Healthcare and Family Services
shall provide support and training to individuals granted
enhanced user permission.
(4) The Department of Healthcare and Family Services
shall maintain and publish online a list of providers and
community-based organizations that employ staff who have
been granted enhanced user permission, to help individuals
and families looking for assistance enrolling in and
maintaining benefits.
(5) The Department of Healthcare and Family Services
shall create criteria and policies to ensure that
individuals with enhanced user permission agree to (i)
obtain the written consent of the individual, (ii) act in
the best interest of the individual, (iii) maintain the
integrity of the Department's programs, and (iv) act in
compliance with applicable State and federal law.
(6) Enhanced user permission shall be authorized by the
Department of Healthcare and Family Services in accordance
with the criteria and policies to be developed by the
Department under this Act.
(7) The Department of Healthcare and Family Services
shall not unreasonably restrict or limit enhanced user
permission.
Section 30. The Department shall adopt any rules or

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policies necessary to implement this Act.
Section 35. The Illinois Public Aid Code is amended by
changing Section 11-5.2 as follows:
(305 ILCS 5/11-5.2)
Sec. 11-5.2. Income, Residency, and Identity Verification
System.
(a) The Department shall ensure that its proposed
integrated eligibility system shall include the computerized
functions of income, residency, and identity eligibility
verification to verify eligibility, eliminate duplication of
medical assistance, and deter fraud, reduce administrative
burdens on the Department and the applicant or recipient, and
minimize delay. Until the integrated eligibility system is
operational, the Department may enter into a contract with the
vendor selected pursuant to Section 11-5.3 as necessary to
obtain the electronic data matching described in this Section.
This contract shall be exempt from the Illinois Procurement
Code pursuant to subsection (h) of Section 1-10 of that Code.
(b) Prior to awarding medical assistance at application
under Article V of this Code, the Department shall, to the
extent such databases are available to the Department, conduct
data matches using the name, date of birth, address, and Social
Security Number of each applicant or recipient or responsible
relative of an applicant or recipient through one or more

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federal or State electronic data sources including against the
following:
(1) Income tax information.
(2) Employer reports of income and unemployment
insurance payment information maintained by the Department
of Employment Security.
(3) Earned and unearned income, citizenship and death,
and other relevant information maintained by the Social
Security Administration.
(4) Immigration status information maintained by the
United States Citizenship and Immigration Services.
(5) Wage reporting and similar information maintained
by states contiguous to this State.
(6) Employment information maintained by the
Department of Employment Security in its New Hire Directory
database.
(7) Employment information maintained by the United
States Department of Health and Human Services in its
National Directory of New Hires database.
(8) Veterans' benefits information maintained by the
United States Department of Health and Human Services, in
coordination with the Department of Health and Human
Services and the Department of Veterans' Affairs, in the
federal Public Assistance Reporting Information System
(PARIS) database.
(9) Residency information maintained by the Illinois

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Secretary of State.
(10) A database which is substantially similar to or a
successor of a database described in this Section that
contains information relevant for verifying eligibility
for medical assistance.
(c) (Blank).
(c-5) Financial information shall be data matched by first
using the electronic data source with the most recent data. The
most recent data source shall be accepted as a reliable
electronic data source for determining reasonable
compatibility with the applicant's or recipient's attestation
or records. The Department may use a less recent data source
only if it will maximize accuracy, minimize delay, and meet
other applicable requirements.
(d) If information provided by or on behalf of an
individual (on the application or renewal form or otherwise) is
reasonably compatible with the information obtained by the
Department in accordance with subsection (b), the Department
must determine or renew eligibility based on such information
without making additional requests for verification,
information, or documentation to the individual. "Reasonable
compatibility" means an allowable difference or discrepancy
between the income reported by an applicant or recipient and
the income reported by an electronic data source. a discrepancy
results between information provided by an applicant,
recipient, or responsible relative and information contained

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in one or more of the databases or information tools listed
under subsection (b) of this Section or subsection (c) of
Section 11-5.3 and that discrepancy calls into question the
accuracy of information relevant to a condition of eligibility
provided by the applicant, recipient, or responsible relative,
the Department or its contractor shall review the applicant's
or recipient's case using the following procedures:
(1) Income information obtained through an electronic
data source shall be considered reasonably compatible with
income information provided by or on behalf of the
individual if both are either above or at or below the
applicable income threshold. If the information discovered
under subsection (b) of this Section or subsection (c) of
Section 11-5.3 does not result in the Department finding
the applicant or recipient ineligible for assistance under
Article V of this Code, the Department shall finalize the
determination or redetermination of eligibility.
(1.5) Income information is reasonably compatible if
the discrepancy between the information provided by or on
behalf of the individual is within 10% of the federal
poverty level (above or below) of the information from the
electronic data source. "Federal poverty level" means the
poverty guidelines updated periodically in the Federal
Register by the U.S. Department of Health and Human
Services. These guidelines set poverty levels by family
size.

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(1.6) The reasonable compatibility standard for
financial information shall also be met when the
information provided by or on behalf of the individual is
zero income or income that is below the program's
applicable income standard, or when no income data is
available from electronic data sources.
(1.7) If information provided by or on behalf of the
individual is not reasonably compatible with information
obtained through an electronic data match, the Department
shall provide written notice to the applicant or recipient
which shall describe in sufficient detail the
circumstances and sources of the discrepancy, the
information or documentation required, the manner in which
the applicant or recipient may respond, and the
consequences of failing to take action. The applicant or
recipient shall have 10 business days to respond.
(2) If the information from both the electronic data
source and the applicant or recipient discovered results in
the Department finding the applicant or recipient
ineligible for assistance, the Department shall provide
notice as set forth in Section 11-7 of this Article.
(3) (Blank). If the information discovered is
insufficient to determine that the applicant or recipient
is eligible or ineligible, the Department shall provide
written notice to the applicant or recipient which shall
describe in sufficient detail the circumstances of the

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discrepancy, the information or documentation required,
the manner in which the applicant or recipient may respond,
and the consequences of failing to take action. The
applicant or recipient shall have 10 business days to
respond.
(4) If the applicant or recipient does not respond to
the notice, the Department shall deny assistance for
failure to cooperate, in which case the Department shall
provide notice as set forth in Section 11-7. Eligibility
for assistance shall not be established until the
discrepancy has been resolved.
(5) If an applicant or recipient responds to the
notice, the Department shall determine the effect of the
information or documentation provided on the applicant's
or recipient's case and shall take appropriate action.
Written notice of the Department's action shall be provided
as set forth in Section 11-7 of this Article.
(6) Suspected cases of fraud shall be referred to the
Department's Inspector General.
(e) Excepting citizenship and satisfactory immigration
status, the Department may waive its verification requirements
for exceptional circumstances, including: The Department shall
adopt any rules necessary to implement this Section.
(1) homelessness;
(2) domestic violence;
(3) instances where a noncustodial parent refuses to

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release documentation germane to verification of one or
more eligibility factors;
(4) natural disaster; and
(5) other circumstances as identified on a
case-by-case basis and approved by the Department,
including, but not limited to, when documentation does not
exist at the time of application or renewal or is not
reasonably available.
(f) The Department shall ensure the integrated eligibility
system shall include an applicant portal that allows electronic
submission of eligibility documentation, updating of family
and demographic information, tracking application status, and
receiving electronic notifications from the Department. The
Department shall actively promote the use of this portal
through materials provided at Family and Community Resource
Centers, staff communications with applicants, and electronic
and print media. The portal and materials used to promote the
portal must be available, at a minimum, in English, Spanish,
and the next 4 most commonly used languages. The portal shall
be available to all applicants and recipients of medical
assistance provided they satisfy electronic identity
verification requirements through one of the following
processes:
(1) Providing personally identifying credit history
information.
(2) Providing requested personally identifying

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documentation to the Department.
(3) Completing an email, text, or mobile phone
verification where a message is sent to the email or phone
associated with the account and the applicant or recipient
must respond to that message.
(4) Completing any alternative process developed by
the Department for ensuring the electronic security of
applicants and recipients.
(g) The Department shall adopt any rules necessary to
implement this Section.
(Source: P.A. 97-689, eff. 6-14-12; 98-756, eff. 7-16-14.)
Section 99. Effective date. This Act takes effect upon
becoming law.
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INDEX
Statutes amended in order of appearance