(305 ILCS 5/11‑3) (from Ch. 23, par. 11‑3)
(Text of Section from P.A. 93‑205, Section 890‑25)
Sec. 11‑3.
Assignment and attachment of aid prohibited.
Except as provided
below in this
Section and in Section 11‑3.3, all financial aid given under
Articles III, IV, V, and VI and money payments for child care
services
provided by a child care provider under Articles
IX
and IXA shall not be subject to
assignment,
sale,
attachment, garnishment, or otherwise. Provided, however, that a medical
vendor may use his right to receive vendor payments as collateral for loans
from financial institutions so long as such arrangements do not constitute
any activity prohibited under Section 1902(a)(32) of the Social Security
Act and regulations promulgated thereunder, or any other applicable laws or
regulations. Provided further, however, that a medical or other vendor or a
service provider may assign, reassign, sell, pledge or grant a security
interest in any such financial aid, vendor payments or money payments or
grants which he has a right to receive to the Illinois Health Facilities
Authority, in connection with any financing program undertaken by the
Illinois Health Facilities Authority, or to the Illinois
Finance Authority, in connection with any financing program undertaken by
the Illinois Finance Authority. Each Authority may utilize a
trustee or agent to accept, accomplish, effectuate or realize upon any such
assignment, reassignment, sale, pledge or grant on that Authority's behalf.
Provided further, however, that nothing herein shall prevent the Illinois
Department from collecting any assessment, fee, interest or penalty due under
Article V‑A, V‑B, V‑C, or V‑E by withholding financial aid as payment of such
assessment, fee, interest, or penalty. Any alienation in contravention of this
statute does not diminish and does not affect the validity, legality or
enforceability of any underlying obligations for which such alienation may
have been made as collateral between the parties to the alienation. This
amendatory Act shall be retroactive in application and shall pertain to
obligations existing prior to its enactment.
(Source: P.A. 92‑111, eff. 1‑1‑02; 93‑205, Section 890‑25, eff. 1‑1‑04.)
(Text of Section from P.A. 93‑205, Section 890‑40)
Sec. 11‑3.
Assignment and attachment of aid prohibited.
Except as provided
below in this
Section and in Section 11‑3.3, all financial aid given under
Articles III, IV, V, and VI and money payments for child care
services
provided by a child care provider under Articles
IX
and IXA shall not be subject to
assignment,
sale,
attachment, garnishment, or otherwise. Provided, however, that a medical
vendor may use his right to receive vendor payments as collateral for loans
from financial institutions so long as such arrangements do not constitute
any activity prohibited under Section 1902(a)(32) of the Social Security
Act and regulations promulgated thereunder, or any other applicable laws or
regulations. Provided further, however, that a medical or other vendor or a
service provider may assign, reassign, sell, pledge or grant a security
interest in any such financial aid, vendor payments or money payments or
grants which he has a right to receive to the Illinois Finance
Authority, in connection with any financing program undertaken by the
Illinois Finance Authority, or to the Illinois
Development
Finance Authority, in connection with any financing program undertaken by
the Illinois Development Finance Authority. Each Authority may utilize a
trustee or agent to accept, accomplish, effectuate or realize upon any such
assignment, reassignment, sale, pledge or grant on that Authority's behalf.
Provided further, however, that nothing herein shall prevent the Illinois
Department from collecting any assessment, fee, interest or penalty due under
Article V‑A, V‑B, V‑C, or V‑E by withholding financial aid as payment of such
assessment, fee, interest, or penalty. Any alienation in contravention of this
statute does not diminish and does not affect the validity, legality or
enforceability of any underlying obligations for which such alienation may
have been made as collateral between the parties to the alienation. This
amendatory Act shall be retroactive in application and shall pertain to
obligations existing prior to its enactment.
(Source: P.A. 92‑111, eff. 1‑1‑02; 93‑205, Section 890‑40, eff. 1‑1‑04.)
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(305 ILCS 5/11‑8)
(from Ch. 23, par. 11‑8)
Sec. 11‑8.
Appeals ‑ to whom taken.
Applicants or recipients of aid
may, at any time within 60 days after the decision of the County
Department or local governmental unit, as the case may be, appeal a
decision denying or terminating aid, or granting aid in an amount which
is deemed inadequate, or changing, cancelling, revoking or suspending
grants as provided in Section 11‑16, or determining to make a protective
payment under the provisions of Sections 3‑5a or 4‑9, or a decision by an
administrative review board to impose administrative safeguards as provided
in Section 8A‑8. An appeal shall also lie when an application is not acted
upon within the time period after filing of the application as provided by rule
of the Illinois Department.
If an appeal is not made, the action of the County Department or
local governmental unit shall be final.
Appeals by applicants or recipients under Articles III, IV, or V
shall be taken to the Illinois Department.
Appeals by applicants or recipients under Article VI shall be taken
as follows:
(1) In counties under township organization (except
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such counties in which the governing authority is a Board of Commissioners) appeals shall be to a Public Aid Committee consisting of the Chairman of the County Board, and 4 members who are township supervisors of general assistance, appointed by the Chairman, with the advice and consent of the county board.
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(2) In counties in excess of 3,000,000 population
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and under township organization in which the governing authority is a Board of Commissioners, appeals of persons from government units outside the corporate limits of a city, village or incorporated town of more than 500,000 population, and of persons from incorporated towns which have superseded civil townships in respect to aid under Article VI, shall be to the Cook County Townships Public Aid Committee consisting of 2 township supervisors and 3 persons knowledgeable in the area of General Assistance and the regulations of the Illinois Department pertaining thereto and who are not officers, agents or employees of any township, except that township supervisors may serve as members of the Cook County Township Public Aid and Committee. The 5 member committee shall be appointed by the township supervisors. The first appointments shall be made with one person serving a one year term, 2 persons serving a 2 year term, and 2 persons serving a 3 year term. Committee members shall thereafter serve 3 year terms. In any appeal involving a local governmental unit whose supervisor of general assistance is a member of the Committee, such supervisor shall not act as a member of the Committee for the purposes of such appeal, and the Committee shall select another township supervisor to serve as an alternate member for that appeal. The township whose action, inaction, or decision is being appealed shall bear the expenses related to the appeal as determined by the Cook County Townships Public Aid Committee. A township supervisor's compensation for general assistance or township related duties shall not be considered an expense related to the appeal except for expenses related to service on the Committee.
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(3) In counties described in paragraph (2) appeals
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of persons from a city, village or incorporated town of more than 500,000 population shall be to the Illinois Department.
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(4) In counties not under township organization,
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appeals shall be to the County Board of Commissioners which shall for this purpose be the Public Aid Committee of the County.
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In counties designated in paragraph (1) the Chairman or President of
the County Board shall appoint, with the advice and consent of the
county board, one or more alternate members of the Public Aid Committee.
All regular and alternate members shall be Supervisors of General
Assistance. In any appeal involving a local governmental unit whose
Supervisor of General Assistance is a member of the Committee, he shall
be replaced for that appeal by an alternate member designated by the
Chairman or President of the County Board, with the advice and consent
of the county board. In these counties not more than 3 of the 5 regular
appointees shall be members of the same political party unless the
political composition of the Supervisors of the General Assistance
precludes such a limitation. In these counties at least one member of the
Public Aid Committee shall be a person knowledgeable in the area of general
assistance and the regulations of the Illinois Department pertaining
thereto. If no member of the Committee possesses such knowledge, the
Illinois Department shall designate an employee of the Illinois Department
having such knowledge to be present at the Committee hearings to advise
the Committee.
In every county the County Board shall provide facilities for the
conduct of hearings on appeals under Article VI. All expenses incident
to such hearings shall be borne by the county except that in counties
under township organization in which the governing authority is a Board
of Commissioners (1) the salary and other expenses of the Commissioner
of Appeals shall be paid from General Assistance funds available for
administrative purposes, and (2) all expenses incident to such hearings
shall be borne by the township and the per diem and traveling expenses
of the township supervisors serving on the Public Aid Committee shall be
fixed and paid by their respective townships. In all other counties the
members of the Public Aid Committee shall receive the compensation and
expenses provided by law for attendance at meetings of the County Board.
In appeals under Article VI involving a governmental unit receiving
State funds, the Public Aid Committee and the Commissioner of Appeals
shall be bound by the rules and regulations of the Illinois Department
which are relevant to the issues on appeal, and shall file such reports
concerning appeals as the Illinois Department requests.
The members of each Public Aid Committee and the members of the Cook
County Townships Public Aid Committee are immune from personal liability in connection with their service on the committee to the same extent as an elected or appointed judge in this State is immune from personal liability in connection with the performance of his or her duties as judge. This immunity applies only to causes of action accruing on or after the effective date of this amendatory Act of the 94th General Assembly.
An appeal shall be without cost to the appellant and shall be made, at
the option of the appellant, either upon forms provided and prescribed by
the Illinois Department or, for appeals to a Public Aid Committee, upon
forms prescribed by the County Board; or an appeal may be made by calling a
toll‑free number provided for that purpose by the Illinois Department and
providing the necessary information. The Illinois Department may assist
County Boards or a Commissioner of Appeals in the preparation of appeal
forms, or upon request of a County Board or Commissioner of Appeals may
furnish such forms. County Departments and local governmental units shall
render all possible aid to persons desiring to make an appeal. The
provisions of Sections 11‑8.1 to 11‑8.7, inclusive, shall apply to all
such appeals.
(Source: P.A. 93‑295, eff. 7‑22‑03; 94‑524, eff. 8‑10‑05.)
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(305 ILCS 5/11‑9) (from Ch. 23, par. 11‑9)
Sec. 11‑9.
Protection of records ‑ Exceptions.
For the protection of applicants and recipients, the Illinois Department,
the county departments and local governmental units and their respective
officers and employees are prohibited, except as hereinafter provided, from
disclosing the contents of any records, files, papers and communications,
except for purposes directly connected with the administration of public
aid under this Code.
In any judicial proceeding, except a proceeding directly concerned with
the administration of programs provided for in this Code, such records,
files, papers and communications, and their contents shall be deemed
privileged communications and shall be disclosed only upon the order of the
court, where the court finds such to be necessary in the interest of justice.
The Illinois Department shall establish and enforce reasonable rules and
regulations governing the custody, use and preservation of the records,
papers, files, and communications of the Illinois Department, the county
departments and local governmental units receiving State or Federal funds
or aid. The governing body of other local governmental units shall in like
manner establish and enforce rules and regulations governing the same matters.
The contents of case files pertaining to recipients under Articles IV, V,
and VI shall be made available without subpoena or formal notice to the
officers of any court, to all law enforcing agencies, and to such other persons
or
agencies as from time to time may be authorized by any court.
In particular, the contents of those case files shall be made available upon
request to a law enforcement agency for the purpose of determining the current
address of a recipient with respect to whom an arrest warrant is outstanding,
and
the current address of a recipient who was a victim of a felony or a
witness to a felony shall be made available upon
request to a State's Attorney of this State or a State's Attorney's
investigator. Information shall also be disclosed to
the Illinois State Scholarship
Commission pursuant to an investigation or audit by the Illinois State
Scholarship Commission of a delinquent student loan or monetary award.
This Section does not prevent the Illinois Department and local governmental
units from reporting to appropriate law enforcement officials the desertion
or abandonment by a parent of a child, as a result of which financial aid
has been necessitated under Articles IV, V, or VI, or reporting
to
appropriate law enforcement officials instances in which a mother under
age 18 has a child out of wedlock and is an applicant for or recipient of
aid under any Article of this Code. The Illinois Department may provide
by rule for the county departments and local governmental units to initiate
proceedings under the Juvenile Court Act of 1987 to have children declared
to be neglected when they deem
such action necessary to protect the children from immoral influences
present in their home or surroundings.
This Section does not preclude the full exercise of the powers of the Board
of Public Aid Commissioners to inspect records and documents, as provided
for all advisory boards pursuant to Section 5‑505 of the
Departments of State Government Law (20 ILCS 5/5‑505).
This Section does not preclude exchanges of information among the Illinois
Department of Public Aid, the Department of Human Services (as successor to the
Department of Public Aid), and the Illinois Department of Revenue for the
purpose of verifying sources and amounts of income and for other purposes
directly connected with the administration of this Code and of the Illinois
Income Tax Act.
The provisions of this Section and of Section 11‑11 as they apply to
applicants and recipients of public aid under Article V shall
be operative only to the extent that they do not conflict with any Federal
law or regulation governing Federal grants to this State for such programs.
The Illinois Department of Public Aid and the Department of Human Services
(as successor to the Illinois Department of Public Aid) shall enter into an
inter‑agency agreement with the
Department of Children and Family Services to establish a procedure by which
employees of the Department of Children and Family Services may have immediate
access to records,
files, papers, and communications (except medical, alcohol or drug assessment
or treatment, mental health, or any other medical records) of the Illinois
Department, county
departments, and local governmental units receiving State or federal funds or
aid, if the Department of Children and Family Services determines the
information is necessary to perform its duties under the Abused and Neglected
Child Reporting Act, the Child Care Act of 1969, and the Children and Family
Services Act.
(Source: P.A. 92‑111, eff. 1‑1‑02; 93‑311, eff. 1‑1‑04.)
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(305 ILCS 5/11‑15) (from Ch. 23, par. 11‑15)
Sec. 11‑15.
Application requirements.
(1) An application for financial
aid shall be filed in writing by the person requesting aid and, in the case
of a request for family aid, by the head of that family, except as
otherwise permitted in paragraph (2). Applications for aid under Articles
III, IV, and V shall be filed in writing with the county
department of
the county in which the applicant resides in the manner prescribed by the
Illinois Department. Applications for aid under Article VI shall be filed
in writing with the local governmental unit upon forms approved by the
Illinois Department.
Each applicant shall provide information as to the amount of
property, real and personal, owned by him or her within the period of time
preceding
the application as required under Sections 3‑1.3, 4‑1.11, and 5‑2.1 of this
Code. The
applicant shall also furnish information concerning
all income, money contributions, and other support from any source, and
the beneficiary and the amount or cash surrender or loan value of all
insurance policies held by himself or herself or any member of his family
for whom aid is requested.
(2) An application, in all instances to be in writing, may be filed
in behalf of a person considered to be in need of financial aid under
Articles III, IV, V, or VI only if the person
(a) has been adjudged to be under legal disability; |
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(b) is unable because of minority or physical or
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mental disability, to execute the application; or
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(c) in the case of need for funeral and burial, died
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before an application was filed and the application is filed not more than 30 days after the person's death, excluding the day on which the death occurred.
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Applications in behalf of persons specified in (a) and (b) shall be
filed by the applicant's legal guardian or, if a
guardian has not been appointed or the applicant has no legal
guardian or the guardian is not available, by a relative or other
person, acceptable under the rules of the Illinois Department, who is
able to furnish the required information. Applications in behalf of
persons specified in (c) shall be filed by any next of kin of the deceased
who is not under legal disability or, if there are no such next of kin or
they are unknown or unavailable, by a person, acceptable under the rules of
the Illinois Department, who is able to furnish the required information.
(3) The application shall contain a written declaration to be signed
by the applicant, or in behalf of the applicant by a person qualified
under paragraph (2), in substantially the following form, the
parenthetical references being applicable to an application filed by a
person in behalf of the applicant:
"I declare under penalties of perjury that I have examined this form
and all accompanying statements or documents pertaining to the income
and resources of myself (the applicant) or any member of my family (the
applicant's family) included in this application for aid, or pertaining
to any other matter having bearing upon my (the applicant's) eligibility
for aid, and to the best of my knowledge and belief the information
supplied is true, correct, and complete".
(4) If an application for financial aid is filed for a family, and any
person in that family is under 18 years of age, the application shall be
accompanied by the following for each such person under 18 years of age:
(i) a copy of the person's birth certificate, or
(ii) other reliable proof, as determined by the
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Department, of the person's identity and age.
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The Illinois Department shall provide information to all families, orally
by an intake
worker and in writing when the application is filed, about the availability and
location of immunization services.
(Source: P.A. 92‑111, eff. 1‑1‑02.)
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(305 ILCS 5/11‑20) (from Ch. 23, par. 11‑20)
Sec. 11‑20.
Employment registration; duty to accept employment.
This
Section applies to employment and training
programs other than those for recipients of assistance under Article IV.
(1) Each applicant or recipient and dependent member of
the family age 16 or over who is able to engage in employment and who is
unemployed, or employed for less than the full working time for the occupation
in which he or she is engaged, shall maintain a current registration for
employment or additional employment with the system of free public employment
offices maintained in this State by the State Department of Employment
Security under the Public Employment Office Act and shall utilize the job
placement
services and other facilities of such offices unless the Illinois
Department otherwise provides by rule for programs administered by the
Illinois Department.
(2) Every person age 16 or over shall be deemed "able to engage in
employment", as that term is used herein, unless (a) the person has an
illness certified by the attending practitioner as precluding his or her
engagement in employment of any type for a time period stated in the
practitioner's certification; or (b) the person has a medically determinable
physical or mental impairment, disease or loss of indefinite duration and
of such severity that he or she cannot perform labor or services in any
type of gainful work which exists in the national economy, including work
adjusted for persons with physical or mental handicap; or (c) the person
is among the classes of persons exempted by paragraph 5 of this Section.
A person described in clauses (a), (b) or (c) of the preceding sentence
shall be classified as "temporarily unemployable". The Illinois Department
shall provide by rule for periodic review of the circumstances of persons
classified as "temporarily unemployable".
(3) The Illinois Department shall provide through rules and regulations
for sanctions against applicants and recipients of aid under this Code
who fail or refuse to cooperate, without good cause, as defined by rule of
the Illinois Department, to accept a bona fide offer of employment in which
he or she is able to engage either in the community of the person's
residence or within reasonable commuting distance therefrom.
The Illinois Department may provide by rule for the grant or continuation
of aid for a temporary period, if federal law or regulation so permits or
requires, to a person who refuses employment without good cause if he or
she accepts counseling or other services designed to increase motivation
and incentives for accepting employment.
(4) Without limiting other criteria which the Illinois Department may
establish, it shall be good cause of refusal if
(a) the wage does not meet applicable minimum wage |
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(b) there being no applicable minimum wage as
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determined in (a), the wage is certified by the Illinois Department of Labor as being less than that which is appropriate for the work to be performed, or
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(c) acceptance of the offer involves a substantial
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threat to the health or safety of the person or any of his or her dependents.
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(5) The requirements of registration and acceptance of employment shall
not apply (a) to a parent or other person needed at home
to provide personal care and supervision to a child or children unless,
in accordance with the rules and regulations of the Illinois Department,
suitable arrangements have been or can be made for such care and
supervision
during the hours of the day the parent or other person is out of the home
because of employment; (b) to a person age 16 or over in regular attendance
in school, as defined in Section 4‑1.1; or (c) to a person whose presence
in the home on a substantially continuous basis is required because of the
illness or incapacity of another member of the household.
(Source: P.A. 91‑357, eff. 7‑29‑99; 92‑111, eff. 1‑1‑02.)
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(305 ILCS 5/11‑20.1) (from Ch. 23, par. 11‑20.1)
Sec. 11‑20.1.
Employment; Rights of recipient and obligations of
Illinois Department when recipients become employed; Assistance when
a recipient has employment or earned income or both.
(a) When a recipient reports employment or earned income, or both, or
the Illinois Department otherwise learns of a recipient's employment or
earned income, or both, the Illinois Department shall provide the recipient
with:
(1) An explanation of how the earned income will |
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affect the recipient's eligibility for a grant, and whether the recipient must engage in additional work activities to meet the recipient's monthly work activities requirement and what types of activities may be approved for that purpose, and whether the employment is sufficient to cause months of continued receipt of a grant not to be counted against the recipient's lifetime eligibility limit.
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(2) An explanation of the Work Pays budgeting
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process, and an explanation of how the first month's income on a new job will be projected, and how the recipient should report the new job to avoid the Department overestimating the first month's income.
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(3) An explanation of how the earned income will
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affect the recipient's eligibility for food stamps, whether the recipient will continue to receive food stamps, and, if so, the amount of food stamps.
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(4) The names and telephone numbers of all
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caseworkers to whom the recipient's case or cases are assigned or will be transferred, an explanation of which type of case each worker will be handling, and the effective date of the transfer.
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(5) An explanation of the recipient's
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responsibilities to report income and household circumstances, the process by which quarterly reporting forms are sent to recipients, where and to whom the reports should be returned, the deadline by which reports must be returned, instructions on how to fill out the reports, an explanation of what the recipient should do if he or she does not receive the form, advice on how to prove the report was returned by the recipient such as by keeping a copy, and an explanation of the effects of failure to file reports.
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(6) If the recipient will continue to receive a
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grant, an explanation of the recipient's new fiscal month and a statement as to when the recipient will receive his or her grant.
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(7) An explanation of Kidcare, Family Assist, Family
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Care, and the 12 month extension of medical assistance that is available when a grant is cancelled due to earned income.
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(8) An explanation of the medical assistance the
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person may be eligible for when the 12 month extension expires and how to request or apply for it.
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(9) An explanation of the availability of a child
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care subsidy to all families below the child care assistance program's income limit, how to apply for the benefit through the Child Care Resource and Referral or site‑administered child care program or both, the nature of the child care program's sliding scale co‑payments, the availability of the 10% earned income disregard in determining eligibility for child care assistance and the amount of the parent co‑payment, the right to use the subsidy for either licensed or license exempt legal care, and the availability of benefits when the parent is engaged in an education and training program.
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(10) (Blank).
(11) (Blank).
(11a) (Blank).
(12) (Blank).
(13) An explanation of the availability of payment
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for initial expenses of employment and how to request or apply for it.
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(14) An explanation of the job retention component
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and how to participate in it, and an explanation of the recipient's eligibility to receive supportive services to participate in education and training programs while working.
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(15) A statement of the types of assistance that
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will be provided to the person automatically or continued and a statement of the types of assistance for which the person must apply or reapply.
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(16) If the recipient will not continue to receive a
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cash grant and the recipient has assigned his or her right to child support to the Illinois Department, an explanation of the recipient's right to continue to receive child support enforcement services, the recipient's right to have all current support paid after grant cancellation forwarded promptly to the recipient, the procedures by which child support will be forwarded, and the procedures by which the recipient will be informed of the collection and distribution of child support.
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(17) An explanation of the availability of payments
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if the recipient experiences a decrease in or loss of earned income during a calendar quarter as to which the monthly grant was previously budgeted based upon the higher income.
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(18) If the recipient will not continue to receive a
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cash grant, an explanation of the procedures for reapplying for cash assistance if the person experiences a decrease in or loss of earned income.
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(19) An explanation of the earned income tax credit
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and the procedures by which it may be obtained and the rules for disregarding it in determining eligibility for and the amount of assistance.
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(20) An explanation of the education and training
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opportunities available to recipients.
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(b) The information listed in subsection (a) shall be provided to the
recipient on an individual basis during an in‑person meeting with a
representative of the Illinois Department. The individual in‑person
meeting shall be held at a time which does not conflict with the
recipient's work schedule within 30 days of the date the recipient begins
working. If the recipient informs the Illinois Department that an
in‑person meeting would be inconvenient, the Illinois Department may
provide the information during a home visit, by telephone, or by mail
within 30 days of the date the recipient begins working, whichever the
client prefers.
(c) At the conclusion of the meeting described in subsection (b), the
Illinois Department shall ensure that all case transfers and calculations
of benefits necessitated by the recipient's employment or receipt of earned
income have been performed, that applications have been made or provided
for all benefits for which the person must apply or reapply, and that the
person has received payment for initial expenses of employment.
(Source: P.A. 93‑598, eff. 8‑26‑03.)
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(305 ILCS 5/11‑22)
(from Ch. 23, par. 11‑22)
Sec. 11‑22.
Charge upon claims and causes of action for injuries.
The Illinois Department shall have a charge upon all claims, demands and
causes of action for injuries to an applicant for or recipient of (i)
financial aid under Articles III, IV, and V, (ii) health care benefits provided under the Covering ALL KIDS Health Insurance Act, or (iii) health care benefits provided under the Veterans' Health Insurance Program Act for the total
amount of
medical assistance provided the recipient from the time of injury to the
date of recovery upon such claim, demand or cause of action. In addition, if
the applicant or recipient was employable, as defined by the Department, at
the time of the injury, the Department shall also have a charge upon any
such claims, demands and causes of action for the total amount of aid
provided to the recipient and his
dependents, including all cash assistance and medical assistance
only to the extent includable in the claimant's action, from the
time of injury to the date of recovery upon such
claim, demand or cause of action. Any definition of "employable"
adopted by the Department shall apply only to persons above the age of
compulsory school attendance.
If the injured person was employable at the time of the injury and is
provided aid under Articles III, IV, or V and any dependent or
member of his family is provided aid under Article VI, or vice versa,
both the Illinois Department and the local governmental unit shall have
a charge upon such claims, demands and causes of action for the aid
provided to the injured person and any
dependent member of his family, including all cash assistance, medical
assistance and food stamps, from the time of the injury to the date
of recovery.
"Recipient", as used herein, means (i) in the case of financial aid provided under this Code, the grantee of record and any
persons whose needs are included in the financial aid provided to the
grantee of record or otherwise met by grants under the appropriate
Article of this Code for which such person is eligible, (ii) in the case of health care benefits provided under the Covering ALL KIDS Health Insurance Act, the child to whom those benefits are provided, and (iii) in the case of health care benefits provided under the Veterans' Health Insurance Program Act, the veteran to whom benefits are provided.
In each case, the notice shall be served by certified mail or
registered mail, upon the party or parties against whom the applicant or
recipient has a claim, demand or cause of action. The notice shall
claim the charge and describe the interest the Illinois Department, the
local governmental unit, or the county, has in the claim, demand, or
cause of action. The charge shall attach to any verdict or judgment
entered and to any money or property which may be recovered on account
of such claim, demand, cause of action or suit from and after the time
of the service of the notice.
On petition filed by the Illinois Department, or by the local
governmental unit or county if either is claiming a charge, or by the
recipient, or by the defendant, the court, on written notice to all
interested parties, may adjudicate the rights of the parties and enforce
the charge. The court may approve the settlement of any claim, demand
or cause of action either before or after a verdict, and nothing in this
Section shall be construed as requiring the actual trial or final
adjudication of any claim, demand or cause of action upon which the
Illinois Department, the local governmental unit or county has charge.
The court may determine what portion of the recovery shall be paid to
the injured person and what portion shall be paid to the Illinois
Department, the local governmental unit or county having a charge
against the recovery.
In making this determination, the court shall conduct an evidentiary hearing
and shall consider competent evidence pertaining
to the following matters:
(1) the amount of the charge sought to be enforced
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against the recovery when expressed as a percentage of the gross amount of the recovery; the amount of the charge sought to be enforced against the recovery when expressed as a percentage of the amount obtained by subtracting from the gross amount of the recovery the total attorney's fees and other costs incurred by the recipient incident to the recovery; and whether the Department, unit of local government or county seeking to enforce the charge against the recovery should as a matter of fairness and equity bear its proportionate share of the fees and costs incurred to generate the recovery from which the charge is sought to be satisfied;
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(2) the amount, if any, of the attorney's fees and
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other costs incurred by the recipient incident to the recovery and paid by the recipient up to the time of recovery, and the amount of such fees and costs remaining unpaid at the time of recovery;
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(3) the total hospital, doctor and other medical
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expenses incurred for care and treatment of the injury to the date of recovery therefor, the portion of such expenses theretofore paid by the recipient, by insurance provided by the recipient, and by the Department, unit of local government and county seeking to enforce a charge against the recovery, and the amount of such previously incurred expenses which remain unpaid at the time of recovery and by whom such incurred, unpaid expenses are to be paid;
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(4) whether the recovery represents less than
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substantially full recompense for the injury and the hospital, doctor and other medical expenses incurred to the date of recovery for the care and treatment of the injury, so that reduction of the charge sought to be enforced against the recovery would not likely result in a double recovery or unjust enrichment to the recipient;
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(5) the age of the recipient and of persons
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dependent for support upon the recipient, the nature and permanency of the recipient's injuries as they affect not only the future employability and education of the recipient but also the reasonably necessary and foreseeable future material, maintenance, medical, rehabilitative and training needs of the recipient, the cost of such reasonably necessary and foreseeable future needs, and the resources available to meet such needs and pay such costs;
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(6) the realistic ability of the recipient to repay
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in whole or in part the charge sought to be enforced against the recovery when judged in light of the factors enumerated above.
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The burden of producing evidence sufficient to support the exercise by
the court of its discretion to reduce the amount of a proven charge sought
to be enforced against the recovery shall rest with the party seeking such reduction.
The court may reduce and apportion the Illinois
Department's lien proportionate to the recovery of the claimant. The court may
consider the nature and extent of the injury, economic and noneconomic
loss, settlement offers, comparative negligence as it applies to the case
at hand, hospital costs, physician costs, and all other appropriate costs.
The Illinois Department shall pay its pro rata share of the attorney fees
based on the Illinois Department's lien as it compares to the total
settlement agreed upon. This Section shall not affect the priority of an
attorney's lien under the Attorneys Lien Act. The charges of
the Illinois Department described in this Section, however, shall take
priority over all other liens and charges existing under the laws of the
State of Illinois with the exception of the attorney's lien under said statute.
Whenever the Department or any unit of local government
has a statutory charge under this Section against a recovery for damages
incurred by a recipient because of its advancement of any assistance, such
charge shall not be satisfied out of any recovery until the attorney's claim
for fees is satisfied, irrespective of whether or not an action based on
recipient's claim has been filed in court.
This Section shall be inapplicable to any claim, demand or cause of
action arising under (a) the Workers' Compensation Act or the predecessor
Workers' Compensation Act
of
June 28, 1913, (b) the Workers' Occupational Diseases Act or the predecessor
Workers' Occupational
Diseases Act of March 16, 1936; and (c) the Wrongful Death Act.
(Source: P.A. 94‑693, eff. 7‑1‑06; 94‑816, eff. 5‑30‑06.)
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(305 ILCS 5/11‑22b)
(from Ch. 23, par. 11‑22b)
Sec. 11‑22b.
Recoveries.
(a) As used in this Section:
(1) "Carrier" means any insurer, including any
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private company, corporation, mutual association, trust fund, reciprocal or interinsurance exchange authorized under the laws of this State to insure persons against liability or injuries caused to another and any insurer providing benefits under a policy of bodily injury liability insurance covering liability arising out of the ownership, maintenance or use of a motor vehicle which provides uninsured motorist endorsement or coverage.
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(2) "Beneficiary" means any person or their
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dependents who has received benefits or will be provided benefits under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act because of an injury for which another person may be liable. It includes such beneficiary's guardian, conservator or other personal representative, his estate or survivors.
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(b)(1) When benefits are provided or will be provided to a beneficiary
under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act because of an injury for which another person is liable, or
for which a carrier is liable in accordance with the provisions of any
policy of insurance issued pursuant to the Illinois Insurance Code, the
Illinois Department shall have a right to recover from such person or carrier
the reasonable value of benefits so provided. The Attorney General may, to
enforce such right, institute and prosecute legal proceedings against the
third person or carrier who may be liable for the injury in an appropriate
court, either in the name of the Illinois Department or in the name of the
injured person, his guardian, personal representative, estate, or survivors.
(2) The Department may:
(A) compromise or settle and release any such claim
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for benefits provided under this Code, or
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(B) waive any such claims for benefits provided
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under this Code, in whole or in part, for the convenience of the Department or if the Department determines that collection would result in undue hardship upon the person who suffered the injury or, in a wrongful death action, upon the heirs of the deceased.
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(3) No action taken on behalf of the Department pursuant
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to this Section or any judgment rendered in such action shall be a bar to any action upon the claim or cause of action of the beneficiary, his guardian, conservator, personal representative, estate, dependents or survivors against the third person who may be liable for the injury, or shall operate to deny to the beneficiary the recovery for that portion of any damages not covered hereunder.
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(c)(1) When an action is brought by the Department pursuant to
subsection (b), it shall be commenced within the period prescribed by
Article XIII of the Code of Civil Procedure.
However, the Department may not commence the action prior
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to 5 months before the end of the applicable period prescribed by Article XIII of the Code of Civil Procedure. Thirty days prior to commencing an action, the Department shall notify the beneficiary of the Department's intent to commence such an action.
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(2) The death of the beneficiary does not abate any right
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of action established by subsection (b).
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(3) When an action or claim is brought by persons
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entitled to bring such actions or assert such claims against a third person who may be liable for causing the death of a beneficiary, any settlement, judgment or award obtained is subject to the Department's claim for reimbursement of the benefits provided to the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act.
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(4) When the action or claim is brought by the
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beneficiary alone and the beneficiary incurs a personal liability to pay attorney's fees and costs of litigation, the Department's claim for reimbursement of the benefits provided to the beneficiary shall be the full amount of benefits paid on behalf of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act less a pro rata share which represents the Department's reasonable share of attorney's fees paid by the beneficiary and that portion of the cost of litigation expenses determined by multiplying by the ratio of the full amount of the expenditures of the full amount of the judgment, award or settlement.
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(d)(1) If either the beneficiary or the Department brings an action or
claim against such third party or carrier, the beneficiary or the
Department shall within 30 days of filing the action give to the other
written notice by personal service or registered mail of the action or
claim and of the name of the court in which the
action or claim is brought. Proof of such notice shall be filed in such
action or claim. If an action or claim is brought by either the Department
or the beneficiary, the other may, at any time before trial on the facts,
become a party to such action or claim or shall consolidate his action or
claim with the other if brought independently.
(2) If an action or claim is brought by the Department
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pursuant to subsection (b)(1), written notice to the beneficiary, guardian, personal representative, estate or survivor given pursuant to this Section shall advise him of his right to intervene in the proceeding, his right to obtain a private attorney of his choice and the Department's right to recover the reasonable value of the benefits provided.
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(e) In the event of judgment or award in a suit or claim against such
third person or carrier:
(1) If the action or claim is prosecuted by the
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beneficiary alone, the court shall first order paid from any judgment or award the reasonable litigation expenses incurred in preparation and prosecution of such action or claim, together with reasonable attorney's fees, when an attorney has been retained. After payment of such expenses and attorney's fees the court shall, on the application of the Department, allow as a first lien against the amount of such judgment or award the amount of the Department's expenditures for the benefit of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act, as provided in subsection (c)(4).
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(2) If the action or claim is prosecuted both by the
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beneficiary and the Department, the court shall first order paid from any judgment or award the reasonable litigation expenses incurred in preparation and prosecution of such action or claim, together with reasonable attorney's fees for plaintiffs attorneys based solely on the services rendered for the benefit of the beneficiary. After payment of such expenses and attorney's fees, the court shall apply out of the balance of such judgment or award an amount sufficient to reimburse the Department the full amount of benefits paid on behalf of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act.
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(f) The court shall, upon further application at any time
before the judgment or award is satisfied, allow as a further lien the
amount of any expenditures of the Department in payment of additional
benefits arising out of the same cause of action or claim provided on
behalf of the beneficiary under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act, when such benefits were
provided or became payable subsequent to the original order.
(g) No judgment, award, or settlement in any action or claim by a
beneficiary to recover damages for injuries, when the Department has an
interest, shall be satisfied without first giving the Department notice and
a reasonable opportunity to perfect and satisfy its lien.
(h) When the Department has perfected a lien upon a judgment or award in
favor of a beneficiary against any third party for an injury for which the
beneficiary has received benefits under this Code, under the Covering ALL KIDS Health Insurance Act, or under the Veterans' Health Insurance Program Act, the Department shall be
entitled to a writ of execution as lien claimant to enforce payment of said
lien against such third party with interest and other accruing costs as in
the case of other executions. In the event the amount of such judgment or
award so recovered has been paid to the beneficiary, the Department shall
be entitled to a writ of execution against such beneficiary to the extent of
the Department's lien, with interest and other accruing costs as in the case
of other executions.
(i) Except as otherwise provided in this Section, notwithstanding any
other provision of law, the entire amount of any settlement of the injured
beneficiary's action or claim, with or without suit, is subject to the
Department's claim for reimbursement of the benefits provided and any lien
filed pursuant thereto to the same extent and subject to the same
limitations as in Section 11‑22 of this Code.
(Source: P.A. 94‑693, eff. 7‑1‑06; 94‑816, eff. 5‑30‑06.)
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(305 ILCS 5/11‑26) (from Ch. 23, par. 11‑26)
Sec. 11‑26.
Recipient's abuse of medical care; restrictions on access to
medical care.
(a) When the Department determines, on the basis of statistical norms and
medical judgment, that a medical care recipient has received medical services
in excess of need and with such frequency or in such a manner as to constitute
an abuse of the recipient's medical care privileges, the recipient's access to
medical care may be restricted.
(b) When the Department has determined that a recipient is abusing his or
her medical care privileges as described in this Section, it may require that
the recipient designate a primary care provider, primary care pharmacy, or
health maintenance organization of the recipient's own choosing to assume
responsibility for the recipient's care. Instead of requiring a recipient to
make a designation as provided in this subsection, the Department, pursuant to
rules adopted by the Department and without regard to any choice of an entity
that the recipient might otherwise make, may initially designate a primary care
provider, primary care pharmacy, or health maintenance organization to assume
responsibility for the recipient's care, provided that the primary care
provider, primary care pharmacy, or health maintenance organization is willing
to provide that care.
(c) When the Department has requested that a recipient designate a
primary care provider, primary care pharmacy or health maintenance
organization and the recipient fails or refuses to do so, the Department
may, after a reasonable period of time, assign the recipient to a primary care
provider, primary care pharmacy or health maintenance organization of its own
choice and determination, provided such primary care provider, primary care
pharmacy or health maintenance organization is willing to provide such care.
(d) When a recipient has been restricted to a designated primary care
provider, primary care pharmacy or health maintenance organization, the
recipient may change the primary care provider, primary care pharmacy or
health maintenance organization:
(1) when the designated source becomes unavailable, |
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as the Department shall determine by rule; or
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(2) when the designated primary care provider,
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primary care pharmacy or health maintenance organization notifies the Department that it wishes to withdraw from any obligation as primary care provider, primary care pharmacy or health maintenance organization; or
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(3) in other situations, as the Department shall
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The Department shall, by rule, establish procedures for providing medical or
pharmaceutical services when the designated source becomes unavailable or
wishes to withdraw from any obligation as primary care provider, primary care
pharmacy or health maintenance organization, shall, by rule, take into
consideration the need for emergency or temporary medical assistance and shall
ensure that the recipient has continuous and unrestricted access to medical
care from the date on which such unavailability or withdrawal becomes effective
until such time as the recipient designates a primary care source or a primary
care source willing to provide such care is designated by the Department
consistent with subsections (b) and (c) and such restriction becomes effective.
(e) Prior to initiating any action to restrict a recipient's access to
medical or pharmaceutical care, the Department shall notify the recipient
of its intended action. Such notification shall be in writing and shall set
forth the reasons for and nature of the proposed action. In addition, the
notification shall:
(1) inform the recipient that (i) the recipient has
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a right to designate a primary care provider, primary care pharmacy, or health maintenance organization of the recipient's own choosing willing to accept such designation and that the recipient's failure to do so within a reasonable time may result in such designation being made by the Department or (ii) the Department has designated a primary care provider, primary care pharmacy, or health maintenance organization to assume responsibility for the recipient's care; and
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(2) inform the recipient that the recipient has a
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right to appeal the Department's determination to restrict the recipient's access to medical care and provide the recipient with an explanation of how such appeal is to be made. The notification shall also inform the recipient of the circumstances under which unrestricted medical eligibility shall continue until a decision is made on appeal and that if the recipient chooses to appeal, the recipient will be able to review the medical payment data that was utilized by the Department to decide that the recipient's access to medical care should be restricted.
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(f) The Department shall, by rule or regulation, establish procedures for
appealing a determination to restrict a recipient's access to medical care,
which procedures shall, at a minimum, provide for a reasonable opportunity
to be heard and, where the appeal is denied, for a written statement
of the reason or reasons for such denial.
(g) Except as otherwise provided in this subsection, when a recipient
has had his or her medical card restricted for 4 full quarters (without regard
to any period of ineligibility for medical assistance under this Code, or any
period for which the recipient voluntarily terminates his or her receipt of
medical assistance, that may occur before the expiration of those 4 full
quarters), the Department shall reevaluate the recipient's medical usage to
determine whether it is still in excess of need and with such frequency or in
such a manner as to constitute an abuse of the receipt of medical assistance.
If it is still in excess of need, the restriction shall be continued for
another 4 full quarters. If it is no longer in excess of need, the restriction
shall be discontinued. If a recipient's access to medical care has been
restricted under this Section and the Department then determines, either at
reevaluation or after the restriction has been discontinued, to restrict the
recipient's access to medical care a second or subsequent time, the second or
subsequent restriction may be imposed for a period of more than 4 full
quarters. If the Department restricts a recipient's access to medical care for
a period of more than 4 full quarters, as determined by rule, the Department
shall reevaluate the recipient's medical usage after the end of the restriction
period rather than after the end of 4 full quarters. The Department shall
notify the recipient, in writing, of any decision to continue the restriction
and the reason or reasons therefor. A "quarter", for purposes of this Section,
shall be defined as one of the following 3‑month periods of time:
January‑March, April‑June, July‑September or October‑December.
(h) In addition to any other recipient whose acquisition of medical care
is determined to be in excess of need, the Department may restrict the medical
care privileges of the following persons:
(1) recipients found to have loaned or altered their
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cards or misused or falsely represented medical coverage;
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(2) recipients found in possession of blank or
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forged prescription pads;
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(3) recipients who knowingly assist providers in
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rendering excessive services or defrauding the medical assistance program.
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The procedural safeguards in this Section shall apply to the above
individuals.
(i) Restrictions under this Section shall be in addition to and shall
not in any way be limited by or limit any actions taken under Article
VIII‑A of this Code.
(Source: P.A. 88‑554, eff. 7‑26‑94 .)
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(305 ILCS 5/11‑27) (from Ch. 23, par. 11‑27)
Sec. 11‑27.
Obtaining benefits after termination.
(a)
For the purpose of this Section, the term "entity" includes persons,
firms, corporations, associations and agencies.
(b) Subject to the provisions of Sections 8A‑7, 8A‑8 and 12‑4.25, no
entity which has had its receipt of benefits or payments under this Code
terminated or suspended or its future receipt
barred by the Department shall,
while such disability
remains in effect, directly or indirectly:
(1) serve as a technical or other advisor to any entity which obtains,
attempts to obtain or seeks to obtain benefits or payments under this Code; or
(2) be an incorporator or member of the board of directors of any entity
which obtains, attempts to
obtain or seeks to obtain benefits or payments under this Code; or
(3) be an investor with or in any entity which obtains, attempts
to obtain or seeks to obtain benefits or payments under this Code.
(c) The Director may, by rule, establish procedures for any entity
aggrieved by the application of this Section to seek special permission to
continue receiving benefits or
payments under this Code or to seek reinstatement of benefits or
payments under this Code. Such entity must be otherwise eligible to
receive benefits or payments under this Code and in compliance with any
applicable requirement of this Code for reinstatement. If the Director
determines that the entity seeking such permission or reinstatement had no
part in the actions or conduct upon which the decision to suspend,
terminate or bar benefits was based, he may authorize the continued
participation by or reinstatement of the entity in such program or programs
as he may deem appropriate under all the circumstances and upon such terms
and conditions and under such probationary or other restrictions as he or
other provisions of this Code may require.
(d) Any entity which knowingly violates the provisions of this Section
or knowingly attempts or
conspires to violate the provisions of this Section shall be civilly liable
in a court of law for damages in an amount 3 times the value of all benefits or payments
obtained by such entity or $10,000, whichever sum is greater.
(e) The civil liability imposed under this Section shall be joint and
several and shall extend to any entity knowingly
seeking or attempting to obtain benefits under this
Code which, having the authority to refuse, knowingly associates with or
permits the association of a suspended, terminated or barred
entity as prohibited herein. Such liability
shall also extend to any
entity found guilty in a court of law of such unlawful association,
including the suspended, terminated or
barred entity. Liability shall arise when any such
entity knew, or under all of the circumstances reasonably should
have known, that it was engaging in or authorizing any activity prohibited herein.
(f) The Attorney General, or the State's Attorney in actions involving a
local governmental unit, may initiate court proceedings to recover benefits
or payments obtained in violation of this Section and shall, in addition to
any judgment obtained, be entitled to recover all court costs.
(g) Notwithstanding any provision of The Freedom of Information Act
or other State law, the Department shall make public the identity and
business address of every entity which has had its receipt of benefits or
payments under this Code suspended or terminated or its future receipt barred by the
Department. Each month, the Department shall publish a list of such
identities and addresses, which shall be mailed by the Department without
charge to associations and societies, including their affiliates and
components, of vendors providing goods, services or both to recipients of
medical assistance under this Code. The Department shall also mail such
list without charge to any other person or organization upon request.
(h) Nothing in this Section shall prohibit the Department from
pursuing and implementing any other remedy provided by this Code in
connection with the suspension, termination or reinstatement of receipt of
benefits or payments under this Code or the barring of receipt of future
benefits or payments under this Code.
(Source: P.A. 84‑1254; 84‑1438.)
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