MEDICAID-MFTD RATES

Illinois General Assembly - Full Text of HB5622

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5622

Introduced 2/13/2026, by Rep. Anne Stava

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-2b

Amends the Medical Assistance Article of the Illinois Public Aid
Code. Increases the rate of reimbursement by 20% for providers of private
duty nursing services for medically fragile and technology dependent
children and for nursing and personal care services for non-waiver
customers beginning January 1, 2027, subject to federal approval.
Effective immediately.
LRB104 16407 KTG 29797 b

A BILL FOR

HB5622
LRB104 16407 KTG 29797 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 5-2b as follows:

6

(305 ILCS 5/5-2b)
7

Sec. 5-2b.
Medically fragile and technology dependent
8
children eligibility and program; provider reimbursement
9
rates.

10

(a) Notwithstanding any other provision of law except as
11
provided in Section 5-30a, on and after September 1, 2012,
12
subject to federal approval, medical assistance under this
13
Article shall be available to children who qualify as persons
14
with a disability, as defined under the federal Supplemental
15
Security Income program and who are medically fragile and
16
technology dependent. The program shall allow eligible
17
children to receive the medical assistance provided under this
18
Article in the community and must maximize, to the fullest
19
extent permissible under federal law, federal reimbursement
20
and family cost-sharing, including co-pays, premiums, or any
21
other family contributions, except that the Department shall
22
be permitted to incentivize the utilization of selected
23
services through the use of cost-sharing adjustments. The

HB5622
- 2 -
LRB104 16407 KTG 29797 b
1
Department shall establish the policies, procedures,
2
standards, services, and criteria for this program by rule.
3

(b) Notwithstanding any other provision of this Code,
4
subject to federal approval, on and after January 1, 2024
5
through December 31, 2024
, the reimbursement rates for nursing
6
paid through Nursing and Personal Care Services for non-waiver
7
customers and to providers of private duty nursing services
8
for children eligible for medical assistance under this
9
Section shall be 20% higher than the reimbursement rates in
10
effect for nursing services on December 31, 2023.
11

(c) Notwithstanding any other provision of this Code,
12
subject to federal approval, on and after January 1, 2025
13
through December 31, 2026
, the reimbursement rates for nursing
14
paid through Nursing and Personal Care Services for non-waiver
15
customers and to providers of private duty nursing services
16
for children eligible for medical assistance under this
17
Section shall be 7% higher than the reimbursement rates in
18
effect for nursing services on December 31, 2024.
19

(d) The Department shall conduct an evaluation to study
20
the program, including service provision and design, waiver
21
operations, and methodologies and policies for setting rates
22
and reimbursements for services and supports that are provided
23
to (i) individuals under the age of 21 who are approved by the
24
Department for in-home shift nursing services and (ii)
25
individuals over the age of 21 who are receiving in-home shift
26
nursing services under the Home and Community-Based Services

HB5622
- 3 -
LRB104 16407 KTG 29797 b
1
Waiver for Medically Fragile and Technology Dependent
2
Children, including, but not limited to, in-home shift nursing
3
services and related home and community-based services and
4
supports, made to nursing agencies for such services. As
5
needed, the Department shall consult with Department-enrolled
6
providers of in-home shift nursing services to ensure accurate
7
information is considered in the evaluation, and the
8
Department may, to the extent it deems necessary and
9
appropriate, contract with an outside entity to assist or
10
provide further analysis in the support of the evaluation.
11

(e) Notwithstanding any other provision of this Code,
12
subject to federal approval, on and after January 1, 2027, the
13
reimbursement rates for nursing paid through Nursing and
14
Personal Care Services for non-waiver customers and to
15
providers of private duty nursing services for children
16
eligible for medical assistance under this Section shall be
17
20% higher than the reimbursement rates in effect for nursing
18
services on December 31, 2026.

19
(Source: P.A. 103-102, eff. 1-1-24; 103-593, eff. 6-7-24;
20
104-9, eff. 6-16-25.)

21

Section 99.
Effective date.
This Act takes effect upon
22
becoming law.

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