Illinois Takes Three Big Steps Forward in Health Reform Implementation

After the November election confirmed the permanent status of the Affordable Care Act (ACA), Illinois wasted no time getting the law’s reforms under way. In less than a month, three big changes have brought the state closer to ACA implementation:

1. On November 19, 2012, Cook County opened enrollment into “County Care,” the Medicaid expansion program for eligible county residents. Through a Section 1115 Waiver approved by the federal government, Cook County will pilot the ACA’s Medicaid expansion in 2013 – a full year before the rest of the state. The program will provide eligibility and access to care to approximately 250,000 low income adults in the County and will operate on a “medical home” model – which means the county’s patients would have a doctor, a nurse, a social worker, and a medical assistant assigned to manage their health care. Stay tuned for County Care progress reports.

2. Not to be out-done by Cook County, Illinois legislators filed a bill (HB 6253) earlier this week to expand Medicaid to all low income Illinoisans (earning up to 138% FPL or about $16,000/year). The Medicaid expansion is a cornerstone of the ACA’s success: it will provide comprehensive medical benefits to 600,000 individuals and is a fiscal boon to the state - bringing in an estimated $5.7 billion in Medicaid provider payments (through 2016) with no net state costs. It will also reduce hospital, Township and local government costs to cover the uninsured. To learn more, check out these fact sheets – one by Health & Disability Advocates and one by the Department of Health & Family Services.

3. The Illinois Department of Insurance was also busy this month, submitting on November 16, 2012, the state’s application to run a Partnership Health Insurance Exchange. In a partnership model, the state and federal government will share responsibilities for administering the online marketplace that will help over one million individuals and small businesses shop for quality health coverage. The state will need to decide soon how it will roll out its Navigator and in person consumer assistance programs. Once the blueprint becomes public, we will post it on Illinois Health Matters.

Finally, we'd be remiss if we didn't mention major policy activity on the federal level, too: right before Thanksgiving HHS published proposed rules governing the ACA's Essential Health Benefits provision, wellness programs and private insurance market reforms. Health Affairs has a great blog post summarizing these federal notices.

Illinois Health Matters will be following all of these federal and state developments closely. Check back for news and updates! Or feel free to ask us a question directly: email us at info@illinoishealthmatters.org.
 
Stephani Becker
Project Director, Illinois Health Matters

The Cook County Health & Hospitals System (CCHHS) 1115 Medicaid Waiver—What is CountyCare?

Blog Post by Margie Schaps, Executive Director, Health & Medicine Policy Research Group 

Last month the Cook County Health & Hospitals System received word from the Federal Centers for Medicaid and Medicare that their request for an 1115 Waiver to the Illinois Medicaid system had been conditionally approved, pending the State of Illinois officially accepting the “terms and conditions” of the Waiver. So, as of right now, the expectation is that the State will make this official within the next couple of weeks.

CountyCare, as the new Medicaid program will be known, has been provided for through the Affordable Care Act. CountyCare will allow the CCHHS to enroll tens of thousands of currently uninsured people into this Medicaid Program. People can begin applying on November 5th by phone 312-8648200 or toll free at 855-6718883. Coverage will start January 1, 2013.

This provides a great opportunity and enormous challenge for the health system to transform care by creating patient-centered medical homes rather than relying on expensive and inefficient use of emergency rooms. The focus of the program will be primary care centric with all specialty care, diagnostic and inpatient services coordinated through the medical home.

Eligible people include:

• Live in Cook County 

• Be 19-64 years old 

• Have income at or below 133% FPL 

• Not be eligible for “state Plan” Medicaid 

• Not be eligible for Medicare 

• Be a legal immigrant for 5 years of more or a US citizen 

• Have a social security number of have applied for one 

Not all doctors within the CCHHS system will be part of the network, and there will be many community health centers that will be part of the network (this list has not officially been released yet)

The CCHHS website has a list of answers to Frequently Asked Questions: http://www.cookcountyhhs.org/patient-services/county-care/


Advocates, providers and patients still have unanswered questions, many of which have been submitted by us to the CCHHS leadership and consultants. We anticipate getting answers to these in the coming weeks and will provide updates to this blog post as we get the information.

Moving Forward: Current Waivers for Coordinated Care Projects in Illinois

“Care Coordination,” along with related terms like “managed care” and “medical home” have become the buzz words of health care reform. The terms refer to new types of health care delivery models that many states and programs are turning to as the key to reforming the costly and arguably inefficient health care system.  Currently, the health care system mostly operates as a “fee-for-service” model, which critics argue incentivizes overutilization of medical services and shifts the focus away from effective preventative care, leading to excessive costs. Organizing groups of health care providers around patients, with a greater level of communication between doctors and a greater focus on care that keeps patients from getting ill could streamline health care delivery in a way that lowers costs and improving quality of care (for a more in-depth look at coordinated and managed care, go here or here).

In recent years, federal health programs, like CMS, have started to investigate the potential of care coordination via demonstration projects, grants and waivers for states or health care providers willing to participate. The Affordable Care Act also encourages exploration of these new care delivery models. In 2011, Illinois passed Public Act 096-1501, also known as Medicaid Reform, and began the Illinois Innovations project. As a part of that reform, the state is currently utilizing these waivers and grants:

The Integrated Care Program (ICP) is a 5-year pilot program that transfers all Medicaid (but not Medicare) eligible adults in Suburban Cook County to a Managed Care organization (MCOs). The 40,000 people included in the program, have two MCOs to choose from, one Aetna Better Health and IlliniCare Health Plan, Inc. The program is currently in Phase I, which focused on medical care. Phase II will focus on long-term care (set to begin September 2012), excluding long term care for those with developmental disabilities, which will be the focus of Phase III (no current implementation date).

Coordinated Care Entities (CCE) is a project intended to help Illinois enroll 50% of Medicaid clients into coordinated care projects (as called for by Public Act 096-1501). The CCEs are looking to cover at least 500 enrollees in a Health Home, FFS, Shared Savings or Bundled Payment model of care delivery. Illinois decided to release a request for proposals to medical care providers, in order to test the interest and capacity of community health organizations to offer coordinated care to patients, instead of simply enrolling Medicaid clients into Health Maintenance Organizations (HMOs). In January, Illinois released requests for proposals for Health Homes for chronically ill adults. Awards are expected to be announced by May 2012. HFS plans to release requests for proposals for CCEs to target children with complex medical needs by June 2012.

The proposed Cook County 1115 Waiver, currently pending with CMS, seeks to cover up to 200,000 uninsured patients who will become eligible for Medicaid once Affordable Care Act Medicaid Expansion takes place in 2014.

The Dual Eligibles program targets those who are eligible for both Medicaid and Medicare. The program would integrate the care that dual eligibles receive into one Managed Care Program. The proposal was open to a 30-day public comment period that closed in late March, and will be sent to CMS for approval.

Under the We Choose Health Community Transformations grant, the Center for Disease control has given the Illinois Department of Public Health $4,781,121 to serve the state of Illinois, excluding large counties. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. This grant will dovetail with Illinois’ State Health Improvement Plan (SHIP), a prevention-focused, comprehensive approach to improving the health of Illinois residents.

The State has proposed changes and possible mergers of the Home and Community Based Waiver programs including the DORS Home Services Program and the Community Care Program. The major proposal affecting the HCBS waivers is a proposed change from a Determination of Need (DON) threshold of 29 to 37 in order to obtain services. DORS has also proposed reducing the Service Cost Maximums in the HSP program to the levels in the CCP program.