MEDICAID-NO CO-PAYMENTS

Illinois General Assembly - Full Text of SB2813

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Introduced

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Introduced

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB2813

Introduced 1/13/2026, by Sen. Mike Simmons

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-4.1

from Ch. 23, par. 5-4.1

Amends the Medical Assistance Article of the Illinois Public Aid
Code. Provides that the Department of Healthcare and Family Services shall
not require any medical assistance recipient to pay a co-payment for
services or prescription medications. Requires the Department to apply for
any State Plan amendment or federal approval necessary to implement the
amendatory Act, if required.
LRB104 16865 KTG 30275 b

A BILL FOR

SB2813
LRB104 16865 KTG 30275 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 5-4.1 as follows:

6

(305 ILCS 5/5-4.1)

(from Ch. 23, par. 5-4.1)
7

Sec. 5-4.1.
Co-payments
prohibited
.
The Department shall
8
not require any recipient of medical assistance under any
9
Article of this Code to pay a co-payment for services or
10
prescription medications. The Department shall apply for any
11
State Plan amendment or federal approval necessary to
12
implement this Section, if required.

The Department may by
13
rule provide that recipients under any Article of this Code
14
shall pay a federally approved fee as a co-payment for
15
services. No co-payment requirement can exist for renal
16
dialysis, radiation therapy, cancer chemotherapy, or insulin,
17
and other products necessary on a recurring basis, the absence
18
of which would be life threatening, or where co-payment
19
expenditures for required services and/or medications for
20
chronic diseases that the Illinois Department shall by rule
21
designate shall cause an extensive financial burden on the
22
recipient, and provided no co-payment shall exist for
23
emergency room encounters which are for medical emergencies.

SB2813
- 2 -
LRB104 16865 KTG 30275 b
1
The Department shall seek approval of a State plan amendment
2
that allows pharmacies to refuse to dispense drugs in
3
circumstances where the recipient does not pay the required
4
co-payment. Co-payments may not exceed $10 for emergency room
5
use for a non-emergency situation as defined by the Department
6
by rule and subject to federal approval.

7
(Source: P.A. 101-209, eff. 8-5-19.)

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