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Illinois General Assembly - Full Text of HB4824

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HB4824 - 104th General Assembly

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4824

Introduced , by Rep. Dagmara Avelar

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-2

from Ch. 23, par. 5-2

Amends the Medical Assistance Article of the Illinois Public Aid
Code. Expands medical assistance coverage to certain categories of
lawfully present noncitizens. Sets income guidelines for qualifying
persons age 19 through 64 and income guidelines for persons 65 years of age
or older. Removes a provision permitting medical assistance coverage for
up to 24 continuous months from the initial eligibility date, if otherwise
eligible.
LRB104 18145 KTG 31584 b

A BILL FOR

HB4824
LRB104 18145 KTG 31584 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 as follows:

6

(305 ILCS 5/5-2)

(from Ch. 23, par. 5-2)
7

Sec. 5-2.
Classes of persons eligible.
Medical assistance
8
under this Article shall be available to any of the following
9
classes of persons in respect to whom a plan for coverage has
10
been submitted to the Governor by the Illinois Department and
11
approved by him. If changes made in this Section 5-2 require
12
federal approval, they shall not take effect until such
13
approval has been received:
14

1. Recipients of basic maintenance grants under
15

Articles III and IV.
16

2. Beginning January 1, 2014, persons otherwise
17

eligible for basic maintenance under Article III,
18

excluding any eligibility requirements that are
19

inconsistent with any federal law or federal regulation,
20

as interpreted by the U.S. Department of Health and Human
21

Services, but who fail to qualify thereunder on the basis
22

of need, and who have insufficient income and resources to
23

meet the costs of necessary medical care, including, but

HB4824
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1

not limited to, the following:
2

(a) All persons otherwise eligible for basic
3

maintenance under Article III but who fail to qualify
4

under that Article on the basis of need and who meet
5

either of the following requirements:
6

(i) their income, as determined by the
7

Illinois Department in accordance with any federal
8

requirements, is equal to or less than 100% of the
9

federal poverty level; or
10

(ii) their income, after the deduction of
11

costs incurred for medical care and for other
12

types of remedial care, is equal to or less than
13

100% of the federal poverty level.
14

(b) (Blank).
15

3. (Blank).
16

4. Persons not eligible under any of the preceding
17

paragraphs who fall sick, are injured, or die, not having
18

sufficient money, property or other resources to meet the
19

costs of necessary medical care or funeral and burial
20

expenses.
21

5.(a) Beginning January 1, 2020, individuals during
22

pregnancy and during the 12-month period beginning on the
23

last day of the pregnancy, together with their infants,
24

whose income is at or below 200% of the federal poverty
25

level. Until September 30, 2019, or sooner if the
26

maintenance of effort requirements under the Patient

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LRB104 18145 KTG 31584 b
1

Protection and Affordable Care Act are eliminated or may
2

be waived before then, individuals during pregnancy and
3

during the 12-month period beginning on the last day of
4

the pregnancy, whose countable monthly income, after the
5

deduction of costs incurred for medical care and for other
6

types of remedial care as specified in administrative
7

rule, is equal to or less than the Medical Assistance-No
8

Grant(C) (MANG(C)) Income Standard in effect on April 1,
9

2013 as set forth in administrative rule.
10

(b) The plan for coverage shall provide ambulatory
11

prenatal care to pregnant individuals during a presumptive
12

eligibility period and establish an income eligibility
13

standard that is equal to 200% of the federal poverty
14

level, provided that costs incurred for medical care are
15

not taken into account in determining such income
16

eligibility.
17

(c) The Illinois Department may conduct a
18

demonstration in at least one county that will provide
19

medical assistance to pregnant individuals together with
20

their infants and children up to one year of age, where the
21

income eligibility standard is set up to 185% of the
22

nonfarm income official poverty line, as defined by the
23

federal Office of Management and Budget. The Illinois
24

Department shall seek and obtain necessary authorization
25

provided under federal law to implement such a
26

demonstration. Such demonstration may establish resource

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1

standards that are not more restrictive than those
2

established under Article IV of this Code.
3

6. (a) Subject to federal approval, children younger
4

than age 19 when countable income is at or below 313% of
5

the federal poverty level, as determined by the Department
6

and in accordance with all applicable federal
7

requirements. The Department is authorized to adopt
8

emergency rules to implement the changes made to this
9

paragraph by Public Act 102-43. Until September 30, 2019,
10

or sooner if the maintenance of effort requirements under
11

the Patient Protection and Affordable Care Act are
12

eliminated or may be waived before then, children younger
13

than age 19 whose countable monthly income, after the
14

deduction of costs incurred for medical care and for other
15

types of remedial care as specified in administrative
16

rule, is equal to or less than the Medical Assistance-No
17

Grant(C) (MANG(C)) Income Standard in effect on April 1,
18

2013 as set forth in administrative rule.
19

(b) Children and youth who are under temporary custody
20

or guardianship of the Department of Children and Family
21

Services or who receive financial assistance in support of
22

an adoption or guardianship placement from the Department
23

of Children and Family Services.
24

7. (Blank).
25

8. As required under federal law, persons who are
26

eligible for Transitional Medical Assistance as a result

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LRB104 18145 KTG 31584 b
1

of an increase in earnings or child or spousal support
2

received. The plan for coverage for this class of persons
3

shall:
4

(a) extend the medical assistance coverage to the
5

extent required by federal law; and
6

(b) offer persons who have initially received 6
7

months of the coverage provided in paragraph (a)
8

above, the option of receiving an additional 6 months
9

of coverage, subject to the following:
10

(i) such coverage shall be pursuant to
11

provisions of the federal Social Security Act;
12

(ii) such coverage shall include all services
13

covered under Illinois' State Medicaid Plan;
14

(iii) no premium shall be charged for such
15

coverage; and
16

(iv) such coverage shall be suspended in the
17

event of a person's failure without good cause to
18

file in a timely fashion reports required for this
19

coverage under the Social Security Act and
20

coverage shall be reinstated upon the filing of
21

such reports if the person remains otherwise
22

eligible.
23

9. Persons with acquired immunodeficiency syndrome
24

(AIDS) or with AIDS-related conditions with respect to
25

whom there has been a determination that but for home or
26

community-based services such individuals would require

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LRB104 18145 KTG 31584 b
1

the level of care provided in an inpatient hospital,
2

skilled nursing facility or intermediate care facility the
3

cost of which is reimbursed under this Article. Assistance
4

shall be provided to such persons to the maximum extent
5

permitted under Title XIX of the Federal Social Security
6

Act.
7

10. Participants in the long-term care insurance
8

partnership program established under the Illinois
9

Long-Term Care Partnership Program Act who meet the
10

qualifications for protection of resources described in
11

Section 15 of that Act.
12

11. Persons with disabilities who are employed and
13

eligible for Medicaid, pursuant to Section
14

1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
15

subject to federal approval, persons with a medically
16

improved disability who are employed and eligible for
17

Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
18

the Social Security Act, as provided by the Illinois
19

Department by rule. In establishing eligibility standards
20

under this paragraph 11, the Department shall, subject to
21

federal approval:
22

(a) set the income eligibility standard at not
23

lower than 350% of the federal poverty level;
24

(b) exempt retirement accounts that the person
25

cannot access without penalty before the age of 59
26

1/2, and medical savings accounts established pursuant

HB4824
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LRB104 18145 KTG 31584 b
1

to 26 U.S.C. 220;
2

(c) allow non-exempt assets up to $25,000 as to
3

those assets accumulated during periods of eligibility
4

under this paragraph 11; and
5

(d) continue to apply subparagraphs (b) and (c) in
6

determining the eligibility of the person under this
7

Article even if the person loses eligibility under
8

this paragraph 11.
9

12. Subject to federal approval, persons who are
10

eligible for medical assistance coverage under applicable
11

provisions of the federal Social Security Act and the
12

federal Breast and Cervical Cancer Prevention and
13

Treatment Act of 2000. Those eligible persons are defined
14

to include, but not be limited to, the following persons:
15

(1) persons who have been screened for breast or
16

cervical cancer under the U.S. Centers for Disease
17

Control and Prevention Breast and Cervical Cancer
18

Program established under Title XV of the federal
19

Public Health Service Act in accordance with the
20

requirements of Section 1504 of that Act as
21

administered by the Illinois Department of Public
22

Health; and
23

(2) persons whose screenings under the above
24

program were funded in whole or in part by funds
25

appropriated to the Illinois Department of Public
26

Health for breast or cervical cancer screening.

HB4824
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LRB104 18145 KTG 31584 b
1

"Medical assistance" under this paragraph 12 shall be
2

identical to the benefits provided under the State's
3

approved plan under Title XIX of the Social Security Act.
4

The Department must request federal approval of the
5

coverage under this paragraph 12 within 30 days after July
6

3, 2001 (the effective date of Public Act 92-47).
7

In addition to the persons who are eligible for
8

medical assistance pursuant to subparagraphs (1) and (2)
9

of this paragraph 12, and to be paid from funds
10

appropriated to the Department for its medical programs,
11

any uninsured person as defined by the Department in rules
12

residing in Illinois who is younger than 65 years of age,
13

who has been screened for breast and cervical cancer in
14

accordance with standards and procedures adopted by the
15

Department of Public Health for screening, and who is
16

referred to the Department by the Department of Public
17

Health as being in need of treatment for breast or
18

cervical cancer is eligible for medical assistance
19

benefits that are consistent with the benefits provided to
20

those persons described in subparagraphs (1) and (2).
21

Medical assistance coverage for the persons who are
22

eligible under the preceding sentence is not dependent on
23

federal approval, but federal moneys may be used to pay
24

for services provided under that coverage upon federal
25

approval.
26

13. Subject to appropriation and to federal approval,

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LRB104 18145 KTG 31584 b
1

persons living with HIV/AIDS who are not otherwise
2

eligible under this Article and who qualify for services
3

covered under Section 5-5.04 as provided by the Illinois
4

Department by rule.
5

14. Subject to the availability of funds for this
6

purpose, the Department may provide coverage under this
7

Article to persons who
8

(a) reside in Illinois;
9

(b) are not eligible under any of the preceding
10

paragraphs of this Section;
and

11

(c)
(blank);

meet the income guidelines of
12

paragraph 2(a) of this Section; and
13

(d) meet one of the following conditions:
14

(i) have filed an application for asylum
15

status under 8 U.S.C. 1158 that is pending with
16

the appropriate federal agency or have a pending
17

appeal of such an application before a court of
18

competent jurisdiction and are represented either
19

by counsel or by an advocate accredited by the
20

appropriate federal agency and employed by a
21

not-for-profit organization in regard to that
22

application or appeal;
23

(ii) are receiving services through a
24

federally funded torture treatment center;
25

(iii) have filed a pending application for T
26

nonimmigrant status pursuant to 8 U.S.C.

HB4824
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LRB104 18145 KTG 31584 b
1

1101(a)(15)(T);
2

(iv) have filed a pending application for U
3

nonimmigrant status pursuant to 8 U.S.C.
4

1101(a)(15)(U);
or

5

(v) have filed as a derivative family member
6

or are included in the application for item (i),
7

(iii), or (iv) as provided by Department rule
; or

8

.
9

(vi) are not eligible, due to immigration
10

status, per 42 U.S.C. 1396a(a)(10)(A)(i)(VIII) and
11

are:
12

(1) a qualified immigrant as defined in 8
13

U.S.C. 1641; or
14

(2) a spouse, widow, or child of a U.S.
15

citizen or a spouse or child of a lawful
16

permanent resident who has been battered or
17

subjected to extreme cruelty by the U.S.
18

citizen or lawful permanent resident or a
19

member of that relative's family who lived
20

with them, and the individual no longer lives
21

with the abuser or plans to live separately
22

within one month of receipt of assistance and
23

whose need for assistance is due, at least in
24

part, to the abuse; or
25

(3) an individual described in 22 U.S.C.
26

7105(b)(1)(C); or

HB4824
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LRB104 18145 KTG 31584 b
1

(4) an American Indian born in Canada who
2

possesses at least 50% of blood of the
3

American Indian race to whom the provisions of
4

Section 1359 of Title 8 of the United States
5

code apply; or
6

(5) a member of an Indian tribe as defined
7

in Section 5304(e) of Title 25 of the United
8

States Code which is recognized as eligible
9

for the special programs and services provided
10

by the U.S. to Indians because of their status
11

as Indians; or
12

(6) an Iraqi or Afghan special immigrant
13

under 8 U.S.C. 1101(a)(27); or
14

(7) an individual who is granted deferred
15

action and any individual who is lawfully
16

present in the U.S. as defined in 45 CFR
17

155.20 (as in effect on January 1, 2026).
18

Persons covered under this paragraph who are age 65 or
19

older must meet the income guidelines of subparagraph (a)
20

of paragraph 2. Persons covered under this paragraph who
21

are age 19 or older, but younger than 65, must meet the
22

income guidelines under paragraph 18.
23

Medical coverage under this paragraph 14 may be
24

provided for up to 24 continuous months from the initial
25

eligibility date so long as an individual continues to
26

satisfy the criteria of this paragraph 14. If an

HB4824
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LRB104 18145 KTG 31584 b
1

individual has an application or appeal pending regarding
2

an application for asylum, T nonimmigrant status, or U
3

nonimmigrant status before the appropriate federal agency
4

for such applications or appeals, eligibility under this
5

paragraph 14 may be extended until a final decision is
6

rendered with respect to the application or appeal, except
7

that an individual who is approved for a U visa continues
8

to qualify for medical coverage under this paragraph 14 as
9

long as the individual meets all other eligibility
10

criteria.
The Department shall adopt rules governing the
11

implementation of this paragraph 14.
12

15. Family Care Eligibility.
13

(a) On and after July 1, 2012, a parent or other
14

caretaker relative who is 19 years of age or older when
15

countable income is at or below 133% of the federal
16

poverty level. A person may not spend down to become
17

eligible under this paragraph 15.
18

(b) Eligibility shall be reviewed annually.
19

(c) (Blank).
20

(d) (Blank).
21

(e) (Blank).
22

(f) (Blank).
23

(g) (Blank).
24

(h) (Blank).
25

(i) Following termination of an individual's
26

coverage under this paragraph 15, the individual must

HB4824
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1

be determined eligible before the person can be
2

re-enrolled.
3

16. Subject to appropriation, uninsured persons who
4

are not otherwise eligible under this Section who have
5

been certified and referred by the Department of Public
6

Health as having been screened and found to need
7

diagnostic evaluation or treatment, or both diagnostic
8

evaluation and treatment, for prostate or testicular
9

cancer. For the purposes of this paragraph 16, uninsured
10

persons are those who do not have creditable coverage, as
11

defined under the Health Insurance Portability and
12

Accountability Act, or have otherwise exhausted any
13

insurance benefits they may have had, for prostate or
14

testicular cancer diagnostic evaluation or treatment, or
15

both diagnostic evaluation and treatment. To be eligible,
16

a person must furnish a Social Security number. A person's
17

assets are exempt from consideration in determining
18

eligibility under this paragraph 16. Such persons shall be
19

eligible for medical assistance under this paragraph 16
20

for so long as they need treatment for the cancer. A person
21

shall be considered to need treatment if, in the opinion
22

of the person's treating physician, the person requires
23

therapy directed toward cure or palliation of prostate or
24

testicular cancer, including recurrent metastatic cancer
25

that is a known or presumed complication of prostate or
26

testicular cancer and complications resulting from the

HB4824
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LRB104 18145 KTG 31584 b
1

treatment modalities themselves. Persons who require only
2

routine monitoring services are not considered to need
3

treatment. "Medical assistance" under this paragraph 16
4

shall be identical to the benefits provided under the
5

State's approved plan under Title XIX of the Social
6

Security Act. Notwithstanding any other provision of law,
7

the Department (i) does not have a claim against the
8

estate of a deceased recipient of services under this
9

paragraph 16 and (ii) does not have a lien against any
10

homestead property or other legal or equitable real
11

property interest owned by a recipient of services under
12

this paragraph 16.
13

17. Persons who, pursuant to a waiver approved by the
14

Secretary of the U.S. Department of Health and Human
15

Services, are eligible for medical assistance under Title
16

XIX or XXI of the federal Social Security Act.
17

Notwithstanding any other provision of this Code and
18

consistent with the terms of the approved waiver, the
19

Illinois Department, may by rule:
20

(a) Limit the geographic areas in which the waiver
21

program operates.
22

(b) Determine the scope, quantity, duration, and
23

quality, and the rate and method of reimbursement, of
24

the medical services to be provided, which may differ
25

from those for other classes of persons eligible for
26

assistance under this Article.

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LRB104 18145 KTG 31584 b
1

(c) Restrict the persons' freedom in choice of
2

providers.
3

18. Beginning January 1, 2014, persons aged 19 or
4

older, but younger than 65, who are not otherwise eligible
5

for medical assistance under this Section 5-2, who qualify
6

for medical assistance pursuant to 42 U.S.C.
7

1396a(a)(10)(A)(i)(VIII) and applicable federal
8

regulations, and who have income at or below 133% of the
9

federal poverty level plus 5% for the applicable family
10

size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
11

applicable federal regulations. Persons eligible for
12

medical assistance under this paragraph 18 shall receive
13

coverage for the Health Benefits Service Package as that
14

term is defined in subsection (m) of Section 5-1.1 of this
15

Code. If Illinois' federal medical assistance percentage
16

(FMAP) is reduced below 90% for persons eligible for
17

medical assistance under this paragraph 18, eligibility
18

under this paragraph 18 shall cease no later than the end
19

of the third month following the month in which the
20

reduction in FMAP takes effect.
21

19. Beginning January 1, 2014, as required under 42
22

U.S.C. 1396a(a)(10)(A)(i)(IX), persons older than age 18
23

and younger than age 26 who are not otherwise eligible for
24

medical assistance under paragraphs (1) through (17) of
25

this Section who (i) were in foster care under the
26

responsibility of the State on the date of attaining age

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1

18 or on the date of attaining age 21 when a court has
2

continued wardship for good cause as provided in Section
3

2-31 of the Juvenile Court Act of 1987 and (ii) received
4

medical assistance under the Illinois Title XIX State Plan
5

or waiver of such plan while in foster care.
6

20. (Blank).
7

21. Persons who are not otherwise eligible for medical
8

assistance under this Section who may qualify for medical
9

assistance pursuant to 42 U.S.C.
10

1396a(a)(10)(A)(ii)(XXIII) and 42 U.S.C. 1396(ss) for the
11

duration of any federal or State declared emergency due to
12

COVID-19. Medical assistance to persons eligible for
13

medical assistance solely pursuant to this paragraph 21
14

shall be limited to any in vitro diagnostic product (and
15

the administration of such product) described in 42 U.S.C.
16

1396d(a)(3)(B) on or after March 18, 2020, any visit
17

described in 42 U.S.C. 1396o(a)(2)(G), or any other
18

medical assistance that may be federally authorized for
19

this class of persons. The Department may also cover
20

treatment of COVID-19 for this class of persons, or any
21

similar category of uninsured individuals, to the extent
22

authorized under a federally approved 1115 Waiver or other
23

federal authority. Notwithstanding the provisions of
24

Section 1-11 of this Code, due to the nature of the
25

COVID-19 public health emergency, the Department may cover
26

and provide the medical assistance described in this

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LRB104 18145 KTG 31584 b
1

paragraph 21 to noncitizens who would otherwise meet the
2

eligibility requirements for the class of persons
3

described in this paragraph 21 for the duration of the
4

State emergency period.
5

In implementing the provisions of Public Act 96-20, the
6
Department is authorized to adopt only those rules necessary,
7
including emergency rules. Nothing in Public Act 96-20 permits
8
the Department to adopt rules or issue a decision that expands
9
eligibility for the FamilyCare Program to a person whose
10
income exceeds 185% of the Federal Poverty Level as determined
11
from time to time by the U.S. Department of Health and Human
12
Services, unless the Department is provided with express
13
statutory authority.
14

The eligibility of any such person for medical assistance
15
under this Article is not affected by the payment of any grant
16
under the Senior Citizens and Persons with Disabilities
17
Property Tax Relief Act or any distributions or items of
18
income described under subparagraph (X) of paragraph (2) of
19
subsection (a) of Section 203 of the Illinois Income Tax Act.
20

The Department shall by rule establish the amounts of
21
assets to be disregarded in determining eligibility for
22
medical assistance, which shall at a minimum equal the amounts
23
to be disregarded under the Federal Supplemental Security
24
Income Program. The amount of assets of a single person to be
25
disregarded shall not be less than $2,000, and the amount of
26
assets of a married couple to be disregarded shall not be less

HB4824
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LRB104 18145 KTG 31584 b
1
than $3,000.
2

To the extent permitted under federal law, any person
3
found guilty of a second violation of Article VIIIA shall be
4
ineligible for medical assistance under this Article, as
5
provided in Section 8A-8.
6

The eligibility of any person for medical assistance under
7
this Article shall not be affected by the receipt by the person
8
of donations or benefits from fundraisers held for the person
9
in cases of serious illness, as long as neither the person nor
10
members of the person's family have actual control over the
11
donations or benefits or the disbursement of the donations or
12
benefits.
13

Notwithstanding any other provision of this Code, if the
14
United States Supreme Court holds Title II, Subtitle A,
15
Section 2001(a) of Public Law 111-148 to be unconstitutional,
16
or if a holding of Public Law 111-148 makes Medicaid
17
eligibility allowed under Section 2001(a) inoperable, the
18
State or a unit of local government shall be prohibited from
19
enrolling individuals in the Medical Assistance Program as the
20
result of federal approval of a State Medicaid waiver on or
21
after June 14, 2012 (the effective date of Public Act 97-687),
22
and any individuals enrolled in the Medical Assistance Program
23
pursuant to eligibility permitted as a result of such a State
24
Medicaid waiver shall become immediately ineligible.
25

Notwithstanding any other provision of this Code, if an
26
Act of Congress that becomes a Public Law eliminates Section

HB4824
- 19 -
LRB104 18145 KTG 31584 b
1
2001(a) of Public Law 111-148, the State or a unit of local
2
government shall be prohibited from enrolling individuals in
3
the Medical Assistance Program as the result of federal
4
approval of a State Medicaid waiver on or after June 14, 2012
5
(the effective date of Public Act 97-687), and any individuals
6
enrolled in the Medical Assistance Program pursuant to
7
eligibility permitted as a result of such a State Medicaid
8
waiver shall become immediately ineligible.
9

Effective October 1, 2013, the determination of
10
eligibility of persons who qualify under paragraphs 5, 6, 8,
11
15, 17, and 18 of this Section shall comply with the
12
requirements of 42 U.S.C. 1396a(e)(14) and applicable federal
13
regulations.
14

The Department of Healthcare and Family Services, the
15
Department of Human Services, and the Illinois health
16
insurance marketplace shall work cooperatively to assist
17
persons who would otherwise lose health benefits as a result
18
of changes made under Public Act 98-104 to transition to other
19
health insurance coverage.
20
(Source: P.A. 104-9, eff. 1-1-26
.)

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