Chapter 305 — PUBLIC AID

(305 ILCS 5/4-23) Sec. 4-23. Civil rights impact statement. (a) The Department of Human Services must submit to the Governor and the General Assembly on January 1 of each even-numbered year a written report that details the disparate impact of various provisions of the TANF progr…

(305 ILCS 5/4-3) (from Ch. 23, par. 4-3) Sec. 4-3. (Repealed). (Source: Laws 1967, p. 122. Repealed by P.A. 92-111, eff. 1-1-02.)

(305 ILCS 5/4-3a) (from Ch. 23, par. 4-3a) Sec. 4-3a. No otherwise qualified child with a disability receiving special education and related services under Article 14 of The School Code shall solely by reason of his or her disability be excluded from the participation in or be de…

(305 ILCS 5/4-4) (from Ch. 23, par. 4-4) Sec. 4-4. Entitlement to medical assistance. Children and adults qualified for aid shall be entitled to receive, under Article V, all necessary medical assistance. (Source: Laws 1967, p. 122.)

(305 ILCS 5/4-4.1) Sec. 4-4.1. Immunizations. (a) The Department of Healthcare and Family Services (formerly Illinois Department of Public Aid) shall develop and implement and that Department and the Department of Human Services shall jointly continue by rule a program to ensure …

(305 ILCS 5/4-5) (from Ch. 23, par. 4-5) Sec. 4-5. (Repealed). (Source: Laws 1967, p. 122. Repealed by P.A. 90-17, eff. 7-1-97.)

(305 ILCS 5/4-6) (from Ch. 23, par. 4-6) Sec. 4-6. (Repealed). (Source: P.A. 85-195. Repealed by P.A. 92-111, eff. 1-1-02.)

(305 ILCS 5/4-7) (from Ch. 23, par. 4-7) Sec. 4-7. Home Visits, Interviews or Communications. Each family receiving aid shall be interviewed in person or communicated with in investigations of applications for aid and at least once in each subsequent 12 month period to ascertain …

(305 ILCS 5/4-8) (from Ch. 23, par. 4-8) Sec. 4-8. Mismanagement of assistance grant. (a) If the County Department has reason to believe that the money payment for basic maintenance is not being used, or may not be used, in the best interests of the child and the family and that …

(305 ILCS 5/4-9) (from Ch. 23, par. 4-9) Sec. 4-9. Protective payment to substitute payee. If the parent or other grantee relative persistently mismanages the grant to the detriment of the child and the family but there is reason to believe that, with specialized counseling and g…

(305 ILCS 5/5-1) (from Ch. 23, par. 5-1) Sec. 5-1. Declaration of purpose. It is the purpose of this Article to provide a program of essential medical care and rehabilitative services for persons receiving basic maintenance grants under this Code and for other persons who are una…

(305 ILCS 5/5-1.1) (from Ch. 23, par. 5-1.1) Sec. 5-1.1. Definitions. The terms defined in this Section shall have the meanings ascribed to them, except when the context otherwise requires. (a) "Nursing facility" means a facility, licensed by the Department of Public Health under…

(305 ILCS 5/5-1.2) Sec. 5-1.2. Recipient eligibility verification. (a) The Illinois Department shall initiate a statewide system by which providers and sites of medical care can electronically verify recipient eligibility for aid under this Article. High-volume providers and site…

(305 ILCS 5/5-1.3) Sec. 5-1.3. Payer of last resort. To the extent permissible under federal law, the State may pay for medical services only after payment from all other sources of payment have been exhausted, or after the Department has determined that pursuit of such payment i…

(305 ILCS 5/5-1.4) Sec. 5-1.4. Moratorium on eligibility expansions. Beginning on January 25, 2011 (the effective date of Public Act 96-1501), there shall be a 4-year moratorium on the expansion of eligibility through increasing financial eligibility standards, or through increas…

(305 ILCS 5/5-1.5) Sec. 5-1.5. COVID-19 public health emergency. Notwithstanding any other provision of Articles V, XI, and XII of this Code, the Department may take necessary actions to address the COVID-19 public health emergency to the extent such actions are required, approve…

(305 ILCS 5/5-1.6) Sec. 5-1.6. Continuous eligibility; ex parte redeterminations. (a) By July 1, 2022, the Department of Healthcare and Family Services shall seek a State Plan amendment or any federal waivers necessary to make changes to the medical assistance program. The Depart…

(305 ILCS 5/5-10) (from Ch. 23, par. 5-10) Sec. 5-10. Entitlement to Social Services. Persons receiving medical assistance shall be entitled to receive, under Article IX and the Illinois Act on the Aging, such rehabilitative, training or other social services as are appropriate t…

(305 ILCS 5/5-11) (from Ch. 23, par. 5-11) Sec. 5-11. Co-operative arrangements; contracts with other State agencies, health care and rehabilitation organizations, and fiscal intermediaries. (a) The Illinois Department may enter into co-operative arrangements with State agencies …

(305 ILCS 5/5-11.1) Sec. 5-11.1. Cooperative arrangements; contracts. The Illinois Department may enter into cooperative arrangements with State agencies responsible for administering or supervising the administration of health services and vocational rehabilitation services to m…

(305 ILCS 5/5-11a) Sec. 5-11a. Health Benefit Information Systems. (a) It is the intent of the General Assembly to support unified electronic systems initiatives that will improve management of information related to medical assistance programs. This will include improved managem…

(305 ILCS 5/5-12) (from Ch. 23, par. 5-12) Sec. 5-12. Funeral and burial. Upon the death of a recipient who qualified under class 2, 3 or 4 of Section 5-2, if his estate is insufficient to pay his funeral and burial expenses and if no other resources, including assistance from le…

(305 ILCS 5/5-13) (from Ch. 23, par. 5-13) Sec. 5-13. Claim against estate of recipients. To the extent permitted under the federal Social Security Act, the amount expended under this Article (1) for a person of any age who is an inpatient in a nursing facility, an intermediate c…

(305 ILCS 5/5-13.1) Sec. 5-13.1. Cost-effectiveness waiver, hardship waivers, and making information about waivers more accessible. (a) It is the intent of the General Assembly to ease the burden of liens and estate recovery for correctly paid benefits for participants, applicant…

(305 ILCS 5/5-13.2) Sec. 5-13.2. Notice of claim for payment or against estate. If the Illinois Department determines, more than 120 days after a person becomes an institutionalized person, that (i) the institutionalized person, the institutionalized person's spouse, or any other…

(305 ILCS 5/5-13.5) Sec. 5-13.5. (Repealed). (Source: P.A. 88-670, eff. 12-2-94. Repealed by P.A. 102-1037, eff. 6-2-22.)

(305 ILCS 5/5-14) (from Ch. 23, par. 5-14) Sec. 5-14. Exemption for Townships. Nothing in this Article shall be construed as requiring townships to provide, in whole or in part, medical assistance to persons who are not residents of the State of Illinois. In all instances under t…

(305 ILCS 5/5-15) (from Ch. 23, par. 5-15) Sec. 5-15. (a) The Illinois Department is authorized to contract with community based organizations serving low income communities for a three year period to demonstrate how and the extent to which preventive health programs can decrease…

(305 ILCS 5/5-15.5) Sec. 5-15.5. Preventive physical examinations; demonstration program. (a) The Illinois Department may establish and implement a demonstration program of preventive physical examinations over a 3-year period commencing on January 1, 1994, for persons receiving …

(305 ILCS 5/5-16) (from Ch. 23, par. 5-16) Sec. 5-16. Managed Care. The Illinois Department may develop and implement a Primary Care Sponsor System consistent with the provisions of this Section. The purpose of this managed care delivery system shall be to contain the costs of pr…

(305 ILCS 5/5-16.1) (from Ch. 23, par. 5-16.1) Sec. 5-16.1. Case Management Services. The Illinois Department may develop, implement and evaluate a Case Management Services Program which provides services consistent with the provisions of this Section, and the Inter-Agency Agreem…

(305 ILCS 5/5-16.10) Sec. 5-16.10. Managed care entities; marketing. A managed health care entity providing services under this Article V may not engage in door-to-door marketing activities or marketing activities at an office of the Illinois Department or a county department in …

(305 ILCS 5/5-16.11) Sec. 5-16.11. Uniform standards applied to managed care entities. Any managed care entity providing services under this Code shall use a pharmacy formulary that is no more restrictive than the Illinois Department's pharmaceutical program. (Source: P.A. 92-370…

(305 ILCS 5/5-16.12) Sec. 5-16.12. Managed Care Reform and Patient Rights Act. The medical assistance program and other programs administered by the Department are subject to the provisions of the Managed Care Reform and Patient Rights Act. The Department may adopt rules to imple…

(305 ILCS 5/5-16.13) Sec. 5-16.13. (Repealed). (Source: P.A. 93-674, eff. 6-10-04. Repealed internally, eff. 12-31-04.)

(305 ILCS 5/5-16.2) Sec. 5-16.2. Long range plan for case management. The Illinois Department shall develop a long range plan for the implementation of case management services, as defined in Section 5-16.1 of this Act, throughout Illinois. The long range plan shall include: (i) …

(305 ILCS 5/5-16.3) Sec. 5-16.3. (Repealed). (Source: P.A. 90-742, eff. 8-13-98. Repealed by P.A. 92-370, eff. 8-15-01.)

(305 ILCS 5/5-16.4) Sec. 5-16.4. (Repealed). (Source: P.A. 95-331, eff. 8-21-07. Repealed by P.A. 99-933, eff. 1-27-17.)

(305 ILCS 5/5-16.5) Sec. 5-16.5. Expedited payments. (a) (Blank). (b) In a county with a population of 3,000,000 or more, a managed care community network shall receive expedited payment of its capitated reimbursement for each of its managed care enrollees if both of the followin…

(305 ILCS 5/5-16.6) Sec. 5-16.6. Provider compliance with certain requirements. The Illinois Department shall inquire of appropriate State agencies concerning the status of all providers' compliance with State income tax requirements, child support payments in accordance with Art…

(305 ILCS 5/5-16.7) Sec. 5-16.7. Post-parturition care. The medical assistance program shall provide the post-parturition care benefits required to be covered by a policy of accident and health insurance under Section 356s of the Illinois Insurance Code. (Source: P.A. 103-720, ef…

(305 ILCS 5/5-16.7a) Sec. 5-16.7a. Reimbursement for epidural anesthesia services. In addition to other procedures authorized by the Department under this Code, the Department shall provide reimbursement to medical providers for epidural anesthesia services when ordered by the at…

(305 ILCS 5/5-16.8) (Text of Section from P.A. 104-73, 104-324, and 104-379) Sec. 5-16.8. Required health benefits. The medical assistance program shall (i) provide the post-mastectomy care benefits required to be covered by a policy of accident and health insurance under Section…

(305 ILCS 5/5-16.8a) Sec. 5-16.8a. Rules concerning continuous glucose monitor coverage. The Department shall adopt rules to implement the changes made to Section 356z.59 of the Illinois Insurance Code, as applied to the medical assistance program. The rules shall, at a minimum, …

(305 ILCS 5/5-16.9) Sec. 5-16.9. Access to obstetrical and gynecological care. The medical assistance program is subject to the provisions of Section 356r of the Illinois Insurance Code. The Illinois Department shall adopt rules to implement the requirements of Section 356r of th…

(305 ILCS 5/5-17) (from Ch. 23, par. 5-17) Sec. 5-17. Programs to improve access to hospital care. (a) (1) The General Assembly finds: (A) That while hospitals have traditionally provided charitable care to indigent patients, this burden is not equally borne by all hospitals oper…

(305 ILCS 5/5-18) (from Ch. 23, par. 5-18) Sec. 5-18. (Repealed). (Source: P.A. 87-895. Repealed by P.A. 92-275, eff. 8-7-01.)

(305 ILCS 5/5-18.10) Sec. 5-18.10. Reimbursement for postpartum visits. (a) In this Section: "Certified lactation counselor" means a health care professional in lactation counseling who has demonstrated the necessary skills, knowledge, and attitudes to provide clinical breastfeed…

(305 ILCS 5/5-18.3) Sec. 5-18.3. Birth center; facility fee. (a) Reimbursement for services covered under this Article and provided at a birth center as defined in Section 5 of the Birth Center Licensing Act shall include: (1) Beginning January 1, 2025, subject to federal approva…

(305 ILCS 5/5-18.5) Sec. 5-18.5. Perinatal doula and evidence-based home visiting services. (a) As used in this Section: "Home visiting" means a voluntary, evidence-based strategy used to support pregnant people, infants, and young children and their caregivers to promote infant,…