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Elizabeth M. Whitehorn, Director

Statutes and Regulations

The HFS Bureau of Collections (BOC) is directly governed by Illinois statutes (state laws) passed by the Illinois Legislature. These statutes grant the BOC the authority to establish its programs and adopt regulations. Regulations (also called Administrative Laws) are rules that set out the requirements and procedures to support the administration and utilization of BOC programs. The links below provide access to existing statutes and regulations relevant to the BOC as well as other state agencies that may provide additional clarification.

Information maintained by the Legislative Reference Bureau

Updating the database of the Illinois Compiled Statutes (ILCS) is an ongoing process. Recent laws may not yet be included in the ILCS database, but they are found on the site as Public Acts soon after they become law. For information concerning the relationship between statutes and Public Acts, refer to the Guide.

Because the statute database is maintained primarily for legislative drafting purposes, statutory changes are sometimes included in the statute database before they take effect. If the source note at the end of a Section of the statutes includes a Public Act that has not yet taken effect, the version of the law that is currently in effect may have already been removed from the database and you should refer to that Public Act to see the changes made to the current law.

Disclaimer: Links below provide access to the Illinois Administrative Code database that is maintained and updated weekly by the Illinois General Assembly. This database is NOT the "official" text of the Illinois Administrative Code. The accuracy of any specific provision originating from this site cannot be guaranteed. For an "official" copy of any administrative rule, contact the Secretary of State's Index Department for a certified copy of the document filed with the Secretary of State. This site should not be cited as an official or authoritative source.                                                                                                                          

Regulations

State Laws

FEDERAL LEGISLATION SUMMARY

Title XIX (Medicaid) of Social Security Act of 1965

Since its inception in 1965, the principal purpose of the Medicaid program has been to provide medical care for individuals with very low incomes and limited assets.

Over time the State organized its Departments of Human Services and Healthcare and Family Services to oversee the Illinois Medicaid program. Many long-term care recipients become eligible for Medicaid assistance by spending down their resources over time and using most of their monthly income to pay a portion of high costs of nursing home care. They may qualify for Medicaid despite owning modest or even substantial assets, most notably equity in a home, which is protected as long as it serves as the principal residence of the recipient or certain close relatives.

However, when this is no longer the case, Medicaid rules guide states to use that equity to pay for long-term care whether prospectively by counting a former home as an available asset and denying Medicaid eligibility on that basis, or retrospectively by recouping Medicaid spending on behalf of a recipient at some time in the future. The State's liens and claims protect Medicaid's interest in the recipient's former home and its right to recover Medicaid spending before the property can be conveyed to another party. TRS works to pursue the assets of Medicaid beneficiaries by asserting property liens and estate claims. 


Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 and amendments of 1993

Since the passage of TEFRA, states have had the option to use liens to prevent Medicaid long-term care recipients from giving away assets -- specifically a home in which they no longer reside -- before they are used to offset long-term care expenses paid by Medicaid on their behalf. The financial interests of Medicaid are given precedence over the interests of adult children or others who reside in or claim an interest in the homes of institutionalized Medicaid recipients who no longer live in them and may never do so again. While estate recovery does not begin until the Medicaid recipient dies, a TEFRA lien may be asserted against the real property of a recipient of any age who is an inpatient of a nursing facility, intermediate care facility for the mentally retarded, or other medical institution, if it has been determined that the patient cannot reasonably be expected to return home. The State must release the lien if the recipient is discharged and returns home. No lien may be placed if any of the following relatives live in the home:

  • A spouse, child under 21, or blind or permanently disabled child of any age;
  • A sibling with an equity interest in the home who lawfully has resided in the home for at least 1 year before the recipient's admission to a medical institution
Omnibus Budget and Reconciliation Act of 1993

Medicaid claims on real property of deceased beneficiaries have been permitted since the beginning of the Medicaid Program. With the passage of the 1993 OBRA, all states were mandated to pursue estate recovery from Medicaid recipients who:

  • Were age 55 or older when they received Medicaid assistance;
  • Had been determined to be permanently institutionalized regardless of age; and
  • Were not survived by a spouse or certain other dependents deemed to have a deserving claim on the estate.


States must pursue recovering costs for medical assistance consisting of:

  • Nursing home or other long-term institutional services;
  • Home and community based services;
  • Hospital and prescription drug services provided while the recipient was receiving nursing facility or home and community-based services;
  • At State option, any other items covered by the Medicaid State Plan.