Section 118.760  Program Limitations

There is no entitlement to medical services under this Subpart and those services are available only to the extent that payments made for individuals eligible under this Subpart do not exceed the funding available for this Program. The Department may take any action it deems necessary to assure payments for this Program do not exceed available funding, including but not limited to: ceasing or limiting enrollment, changing standards of eligibility that are not statutorily required, changing enrollment practices, changing eligibility time periods, and reducing available medical services.

a)         The Department shall publish notice of the opening or closing of enrollment via the Department's website at https://hfs.illinois.gov/info/legal/publicnotices.html no later than fourteen (14) calendar days prior to the action.

b)         Co-payments or cost sharing may be charged for services provided to the population by a health care provider as described below, except for practitioner visits scheduled for family planning services.

1)         Co-payment and cost sharing requirements are as follows, unless the services meet the requirement under 89 Ill. Adm. Code 120.310(b)(4) as an emergency medical condition or are otherwise covered under Department rule without a co-pay:

A)        Inpatient hospitalizations, $250 per hospital stay; and

B)        Hospital or Ambulatory Surgical Treatment Center outpatient services set forth at 89 Ill. Adm. Code 148.140(b), 10 percent of the Department rate as set forth in 89 Ill. Adm. Code 128.350(c).

2)         Providers are responsible for collecting co-payments.

3)         Providers may elect not to charge co-payments. If co-payments are charged, the co-payment may not exceed the amounts established in this Section.

c)         Any large public hospitals, as defined in Section 148.25(a), having received payments in excess of the rates paid to non-large public hospitals, as authorized under 89 Ill. Adm. Code 148.160 and 148.170, shall be required to reimburse the State for any excess payment in a method and amount as determined by the Department.

(Source:  Amended at 49 Ill. Reg. 8960, effective July 1, 2025)