The State Budget Aftermath - What's Next?

On May 25, 2012, the Illinois legislature voted to pass Senate Bill 2840, which will make drastic cuts to the state’s Medicaid program, in order to help close a $2.7 billion deficit. The news has been confusing, but the bottom line is that many of the programs which provide necessary health coverage to vulnerable populations of Illinoisans have been terminated or reduced, which will result in thousands of people losing health care coverage.

While those cuts are devastating, we remind ourselves that there are over 2 million people covered by Medicaid in Illinois—many of them covered through important expansions including the 100% Campaign, All Kids, Health Benefits with Disabilities, and FamilyCare. These coverage expansions largely remain intact and protected. We are heartened by the fact that our advocacy efforts, along with our colleagues, also staved off worse proposed cuts including the loss of coverage for tens of thousands of undocumented children with no health care alternatives.

Along with Senate Bill 2840, several other bills were passed which also affect Illinois’ Medicaid program including:

• HB5007: Amends the December 2010 Medicaid reform law that placed a moratorium on Medicaid expansions until 2013. This amendment extends that moratorium for two more years, until January 25, 2015. However, the bill also creates an exception for expansions that are federally approved and funded solely by federal and local government funds. This exemption was specifically designed to allow the Cook County 1115 waiver proposal (currently waiting for approval from CMS) to move forward, which would expand Medicaid to 250,000 low income, currently uninsured Cook County residents.
• SB 2194: Limits the number of unpaid Medicaid bills that can be rolled over from one year to the next, capping the dollar amount at $700 million in FY 2013. SB 2194, HA 3 sets more substantial definitions of charity care, so that hospitals will know what services they can provide to meet that definition, and thus retain tax exempt status 
• SB 3261 HA 2: Sets standards for eligibility for free care at non-profit hospitals

Moving forward toward the implementation of health care reform in 2014, Health & Disability Advocates will continue working to ameliorate the effect of these cuts by counseling individuals on their coverage options and training providers to build their capacity to help their patients access alternative coverage. There is not a solution to every cut but, in many instances, there are alternative programs to get necessary health care coverage to our populations.

We think it is important that while we all continue to fight against these cuts, we must immediately spring into action to help individuals transition to other coverage if at all possible.

For example, the elimination of the Illinois Cares Rx program is expected to affect over 100,000 low income older adults and people with disabilities who use the program to help them pay the premiums, deductibles, and cost-sharing of the Medicare Part program. If you or your clients have Illinois Cares Rx stories to share, please have them submit them to a special Facebook page here.

We have scheduled a webinar for June 15th to train providers how to ensure that their clients and patients use past medical bills to meet Medicaid spenddown, thus making them eligible for the federal Extra Help program which will cover all cost-sharing. We expect that tens of thousands of Illinois Cares Rx recipients could become eligible for Extra Help under this strategy.

We will continue to advocate as well as to move forward by counseling individuals, training providers and providing technical assistance to our partners to ensure that we maximize health care coverage and access in every way possible.

Stephanie Altman
Programs & Policy Director
Health & Disability Advocates

The Affordable Care Act Will Not Replace Illinois Cares Rx

Illinois Cares Rx is one of the many health programs on the chopping block in Governor Quinn's Medicaid budget plan. This will affect 160,000 low income seniors and people with disabilities who receive Illinois Cares Rx to help them pay for life-saving medications, typically for chronic health conditions such as Multiple Sclerosis, heart disease or Alzheimer’s.

There are no "good" choices when it comes to budget cuts in health & human services in Illinois - but it's critical for state legislators to separate the myths from the facts when decision time arrives. One of the myths being spread around is that Illinois Cares Rx can be cut because the Affordable Care Act will replace it in 2014.

Simply put, that is not true:

• Illinois Cares Rx pays for Medicare Part D premiums; the Affordable Care Act will not.
• Illinois Cares Rx covers Medicare Part D deductibles; the Affordable Care Act will not.
• Illinois Cares Rx reduces the cost of medications when seniors and people with disabilities hit the "donut hole;" while the Affordable Care Act has begun to close the donut hole it will not completely close it until 2020.

See a full comparison chart here that shows what Illinois Cares Rx currently provides for low income seniors and people with disabilities and how it intersects with the Affordable Care Act. You can see that the overlap is minimal.

Please call your legislators and make sure that they have the facts about Illinois Cares Rx cuts which affects all districts in Illinois. Call 1-888-616-3322 which will connect you directly to your legislators and tell them to “Preserve Funding for Illinois Cares Rx.”


John Coburn
Senior Policy Attorney
Health & Disability Advocates

Whose Budget Problem is Worse than Illinois?

Illinois has a budget problem.   Ironically, our state leaders all agree that one of the ways to solve this problem is to pass it along to the household budgets of some of our most vulnerable seniors and people with disabilities. How?   Eliminate Illinois Cares Rx. 

  

State leaders, editorials, and other opinion leaders would lead you to believe Illinois Cares Rx is some “extra” program that we can no longer afford.    What they always fail to talk about is how this “extra” program helps real people.  And, they have no good answer for what these folks are supposed to do after Illinois Cares Rx is eliminated. 

  

The typical Illinois Cares Rx enrollee is the one who always has just a little too much income to qualify for our traditional needs-based poverty programs but not enough income to afford the cost of their healthcare and other necessities.  He or she typically has a chronic health condition such as Multiple Sclerosis, or heart disease or Alzheimer’s and lives on the edge financially…carefully saving their money, trying to stay within a budget that does not have a lot of “wiggle room,” and often having to do this with little to no help from their government or anybody else.   

Illinois Cares Rx steps in to help this group so that they don’t have to make choices to skip doses of specialized medication, cancel a doctor’s appointment, pay rent late, or receive shut off threats from the utility companies.      

Here is a budget problem more difficult than the one our state leaders are facing: 

A typical Illinois Cares Rx enrollee might have $1500 per month in income from Social Security.  After premiums, co-payments and deductibles, the enrollee might be left with about $1300 per month, if they are lucky.  Illinois Cares Rx provides about $100 in benefits to the average enrollee each month.  So, we will be reducing their available income another $100 to $1200 per month if Illinois Cares Rx goes away. Now, what do we cut to make up for this?  Food?   Utilities?   Rent?   A follow up visit to the doctor?   And state leaders thought they had a tough job with the Illinois budget…

Call the AARP Illinois Hotline which will connect you with your state legislator. Contact them now and tell them to protect this vital program while budget negotiations are still happening. Call 1-888-616-3322 and tell them to “Preserve Funding for Illinois Cares Rx.”

John Coburn

Senior Policy Attorney

Health & Disability Advocates

Cutting Illinois Cares Rx Would be Penny-Wise & Pound Foolish

The Chicago Tribune recent editorial, "Time to move on medicaid spending," correctly points out that Illinois must look at its Medicaid spending and implement innovative ways to cut costs while preserving care to its very poor and sick participants.

However, the suggestion to cut the small but extremely crucial program, Illinois Cares Rx, to assist in this important endeavor would be penny-wise and pound foolish. Illinois Cares Rx plays an important role in our medical safety net system. By assisting Illinois Cares Rx participants with deductibles and co-payments for their Medicare Part D plan, the cost of which are otherwise out of reach for them, we don’t force them to cut corners on taking their medicines or skip filling prescriptions altogether. This, in turn, keeps our Medicare beneficiaries healthier and out of hospitals and nursing homes, where Medicare beneficiaries quickly become Medicaid recipients. By investing in prescription access now, we avoid greater costs later.

Just because the federal government does not foot the bill does not mean it is not a good idea.

John V. Coburn
Senior Policy Attorney
Health & Disability Advocates

Why We Must Save Illinois Cares Rx

Governor Quinn's proposed budget includes the elimination of the entire Illinois Cares Rx program, which provides prescription drug assistance to low income seniors and people with disabilities.

The benefits of the Illinois Cares Rx Program to its enrollees are crucial to their health and well-being. Without this assistance, many seniors and people with disabilities on fixed incomes will not be able to afford their needed medications. They will be forced to ration their medications or make choices between paying for rent, food, or medications.  There simply is not a lot of “wiggle room” in their budgets to take on the cost of what the Illinois Cares Rx Program provides.  

For most, Illinois Cares Rx is a benefit that assists in paying the premium and initial co-pays under Medicare Part D, which can get extremely high, especially if a person is taking several medications.  For Illinois Cares Rx enrollees, this assistance has literally meant the difference between going with or without their medications.  In addition to the Part D premium, Illinois Cares Rx pays the deductible ($310 this year) and helps with the co-pays; each prescription filled costs much less with this coverage (e.g., $6.30 instead of $50).  It is an enormous savings, especially valuable for individuals with multiple health problems and multiple medications, which is common among Illinois Cares Rx consumers.

A few important things to know about Illinois Cares Rx:

• Illinois Cares Rx serves approximately 200,000 low income older adults and people with disabilities each year to pay for necessary and costly medications.
• Governor Quinn has proposed eliminating the entire program without seeking cost savings from other measures first.
• The health care reform law - the Affordable Care Act (ACA) - does not fix the problem that Illinois Cares Rx addresses. The ACA only addresses the Medicare Part D donut hole by closing that gap slowly over the next several years. Low-income older adults and people with disabilities in Illinois still need help paying for premiums, co-pays and donut hole coverage in 2011 and beyond. In other words, even if the donut hole were closed this year, low income seniors and people with disabilities would STILL need Illinois Cares Rx.

The Chicago Tribune published the following story about the cuts to Illinois Cares Rx and the Circuit Breaker program and how the elimination of these programs affects an already vulnerable group of older adults and people with disabilities. The issue was also recently profiled in the StatehouseNewsOnline.com. Please contact the Governor and your state legislators. Ask them to take Illinois Cares Rx off the chopping block and consider other cost saving measures first.

John Coburn
Co-Director, Make Medicare Work Coalition