MEDICAID-BRAIN INJURY WAIVER

Illinois General Assembly - Full Text of HB4787

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4787

Introduced , by Rep. Sharon Chung

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-70 new

Amends the Medical Assistance Article of the Illinois Public Aid
Code. Provides that, on and after January 1, 2027, certain services shall
be eligible for reimbursement at approved programs through the Brain
Injury waiver for eligible individuals over the age of 21, including, but
not limited to: (1) case management; (2) nursing services; (3) medical
oversight by consulting medical director; (4) physical therapy; and (5)
occupational therapy. Requires the Department of Human Services to
reimburse approved programs at the rates in effect for the Home and
Community-Based Services Waiver program most recently approved. Effective
January 1, 2027.
LRB104 19788 KTG 33238 b

A BILL FOR

HB4787
LRB104 19788 KTG 33238 b
1

AN ACT concerning State government.

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
adding Section 5-70 as follows:

6

(305 ILCS 5/5-70 new)
7

Sec. 5-70.
Brain injury waiver services.
8

(a) Findings. The General Assembly finds that:
9

(1) Annually, over 141,000 new brain injuries are
10

sustained by children and adult Illinois residents.
11

(2) The State provides services and support for
12

individuals with brain injuries through the Persons with
13

Brain Injury waiver, which is part of the Home and
14

Community-Based Services Waiver and is operated by the
15

Department of Human Services' Division of Rehabilitation
16

Services. This program is administered by the Department
17

of Healthcare and Family Services. Day-to-day operations
18

are managed by the Department of Human Services' Division
19

of Rehabilitation Services. These services are offered for
20

individuals who are at risk of being placed in a nursing
21

facility for care due to functional limitations caused by
22

a brain injury.
23

(3) Individuals are eligible for Brain Injury waivers

HB4787
- 2 -
LRB104 19788 KTG 33238 b
1

if, among other requirements, they have an acquired brain
2

injury as documented by a physician or neurologist. This
3

includes traumatic brain injuries, infections, anoxia,
4

stroke, aneurysm, electrical injury, malignant or benign
5

tumors, neoplasm of the brain, and toxic encephalopathy.
6

(4) Twenty-two states currently offer care in the
7

community funding options for adults with brain injury who
8

require residential supports and services.
9

(5) Illinois does not currently offer reimbursement
10

for care to programs providing brain injury care services
11

for individuals over the age of 21. As a result, these
12

individuals must stop receiving care abruptly in their
13

current programs when they age out of eligibility for
14

reimbursement and must be transferred to a nursing home at
15

age 21, or transferred to another state that can seek
16

reimbursement from the State of Illinois for the provision
17

of services for this age group. This causes a disruption
18

in care and separation of families. Illinois Medicaid
19

funds are used to support these individuals in accessing
20

out-of-state care, resulting in funding going to
21

out-of-state providers and being paid at higher
22

out-of-state rates.
23

(b) As used in this Section, "approved programs" includes
24
programs authorized to provide care under the Medicaid Home
25
and Community-Based Services Waiver program.
26

(c) Notwithstanding any other provision of this Code to

HB4787
- 3 -
LRB104 19788 KTG 33238 b
1
the contrary, on and after January 1, 2027, the following
2
services shall be eligible for reimbursement at approved
3
programs through the Brain Injury waiver for eligible
4
individuals over the age of 21:
5

(1) Case management.
6

(2) Nursing services.
7

(3) Medical oversight by consulting medical director.
8

(4) Physical therapy.
9

(5) Occupational therapy.
10

(6) Speech language therapy.
11

(7) Behavioral intervention and therapy.
12

(8) Individual and family counseling.
13

(9) Life skills training, including community
14

re-access training.
15

(10) Residential habilitation.
16

(11) Day habilitation.
17

(d) The Department of Human Services shall reimburse
18
approved programs at the rates in effect for the Home and
19
Community-Based Services Waiver program most recently approved
20
under authority of Section 1915(c) of the Social Security Act.

21

Section 99.
Effective date.
This Act takes effect January
22
1, 2027.

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