MEDICAID-CONTINUED COVERAGE

Illinois General Assembly - Full Text of HB4784

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HB4784 - 104th General Assembly

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4784

Introduced , by Rep. Lindsey LaPointe

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-2.03
305 ILCS 5/5-2.03a new

Amends the Medical Assistance Article of the Illinois Public Aid
Code. Provides that any person who was initially determined to be eligible
for medical assistance and is receiving institutional services or home and
community-based services as authorized under the Article shall be presumed
eligible for a continuation of coverage for such services during any
redetermination process, unless the person experiences a material change
in financial circumstances that results in the loss of eligibility.
Requires any person who experiences a material change in financial
circumstances that results in the loss of eligibility to notify the
Department of Healthcare and Family Services. Permits the Department to
conduct a redetermination of eligibility. Requires the Department to
notify the person before the commencement of any redetermination and after
the redetermination is concluded along with the results of the
redetermination and the effective date of any eligibility change. Requires
the Department to seek federal authorization, no later than January 1,
2028, to exempt persons with disabilities who are otherwise eligible for
medical assistance from annual eligibility redeterminations, except that a
full redetermination shall be conducted at least once every 5 years,
regardless of whether a material change in financial circumstances has
occurred.
LRB104 18736 KTG 32179 b

A BILL FOR

HB4784
LRB104 18736 KTG 32179 b
1

AN ACT concerning public aid.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Public Aid Code is amended by
5
changing Section 5-2.03 and by adding Section 5-2.03a as
6
follows:

7

(305 ILCS 5/5-2.03)
8

Sec. 5-2.03.
Presumptive eligibility.
Except as provided
9
in Section 5-2.03a

Beginning on the effective date of this
10
amendatory Act of the 96th General Assembly
and except where
11
federal law requires presumptive eligibility, no adult may be
12
presumed eligible for medical assistance under this Code and
13
the Department may not cover any service rendered to an adult
14
unless the adult has completed an application for benefits,
15
all required verifications have been received, and the
16
Department or its designee has found the adult eligible for
17
the date on which that service was provided. Nothing in this
18
Section shall apply to pregnant women or to persons enrolled
19
under the medical assistance program due to expansions
20
approved by the federal government that are financed entirely
21
by units of local government and federal matching funds.
22
(Source: P.A. 96-1501, eff. 1-25-11; 97-687, eff. 6-14-12.)

HB4784
- 2 -
LRB104 18736 KTG 32179 b
1

(305 ILCS 5/5-2.03a new)
2

Sec. 5-2.03a.
Redeterminations of eligibility for certain
3
persons.
4

(a) Any person who was initially determined to be eligible
5
for medical assistance and is receiving institutional services
6
or home and community-based services as authorized under this
7
Article shall be presumed eligible for a continuation of
8
coverage for such services during any redetermination process,
9
unless the person experiences a material change in financial
10
circumstances that results in the loss of eligibility.
11

(b) If the person experiences a material change in
12
financial circumstances that results in the loss of
13
eligibility, the person, or the person's designated caregiver
14
or responsible party, shall notify the Department. The
15
Department may conduct a redetermination of eligibility. If a
16
redetermination is conducted, the Department must send written
17
notice to the person or to the person's designated caregiver
18
or responsible party:
19

(1) before the commencement of any redetermination;
20

and
21

(2) upon conclusion of the redetermination, including
22

the results and the effective date of any eligibility
23

change.
24

(c) No later than January 1, 2028, the Department shall
25
seek federal authorization to exempt persons with disabilities
26
who are eligible for medical assistance from annual

HB4784
- 3 -
LRB104 18736 KTG 32179 b
1
redeterminations of eligibility, except that a full
2
redetermination shall be conducted at least once every 5
3
years, regardless of whether a material change in financial
4
circumstances has occurred.
5

(d) The Department shall adopt any rules necessary to
6
implement the provisions of this Section.

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