Sec. 15. Eligibility.

449 words·~2 min read·/il/chapter-330/act-126/15

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)To be eligible for the Program, a person must:

(1)be a veteran who is not on active duty and who has not been dishonorably discharged

from service or the spouse of such a veteran;

(2)be a resident of the State of Illinois;

(3)be at least 19 years of age and no older than 64 years of age;

(4)be uninsured, as defined by the Department by rule, for a period of time established

by the Department by rule, which shall be no less than 3 months;

(5)not be eligible for medical assistance under the Illinois Public Aid Code or

healthcare benefits under the Children's Health Insurance Program Act or the Covering ALL KIDS Health Insurance Act;

(6)not be eligible for medical benefits through the Veterans Health Administration; and

(7)have a household income no greater than the sum of

(i)an amount equal to 25% of the

federal poverty level plus

(ii)an amount equal to the Veterans Administration means test income threshold at the initiation of the Program; depending on the availability of funds, this level may be increased to an amount equal to the sum of

(iii)an amount equal to 50% of the federal poverty level plus

(iv)an amount equal to the Veterans Administration means test income threshold. This means test income threshold is subject to alteration by the Department as set forth in subsection

(b)of Section 10.

(b)A veteran or spouse who is determined eligible for the Program shall remain eligible for 12 months, provided the veteran or spouse remains a resident of the State and is not excluded under subsection

(c)of this Section and provided the Department has not limited the enrollment period as set forth in subsection

(b)of Section 10.

(c)A veteran or spouse is not eligible for coverage under the Program if:

(1)the premium required under Section 35 of this Act has not been timely paid; if the

required premiums are not paid, the liability of the Program shall be limited to benefits incurred under the Program for the time period for which premiums have been paid and for grace periods as established under subsection (d); if the required monthly premium is not paid, the veteran or spouse is ineligible for re-enrollment for a minimum period of 3 months; or

(2)the veteran or spouse is a resident of a nursing facility or an inmate of a public

institution, as defined by 42 CFR 435.1009.

(d)The Department shall adopt rules for the Program, including, but not limited to, rules relating to eligibility, re-enrollment, grace periods, notice requirements, hearing procedures, cost-sharing, covered services, and provider requirements.