Rauner's Budget is Bad Medicine for State's Health Services

The following post originally appeared on Crain's Chicago Business.

The much-anticipated “turnaround budget” from Illinois Gov. Bruce Rauner feels more like a “look back,” parading out failed ideas from past years. Rauner says this budget "preserves services to the state's most vulnerable residents”—but a quick review suggests this is far from true. Instead, we see a budget that:

• Further decimates a fragile community mental health system
• Reduces access to lifesaving drugs for people living with HIV and prevention services for those at risk of HIV
• De-funds critical substance-abuse treatments
• Drastically reduces cost-effective breast and cervical cancer screening services
• Makes it harder, and in some cases impossible, for people with disabilities and seniors to get support to live at home
• Reduces funding for evidence-based tobacco prevention and cessation services
• Eliminates Medicaid benefits for preventive health services, including adult dental care
• Eliminates health insurance for workers with disabilities, coverage unavailable in the private marketplace
• Slashes funding for hospitals serving Medicaid populations
• Eliminates funding for care coordination, originally designed to contain costs
• Secures Illinois' position near the bottom of states for per-enrollee Medicaid funding

It's ironic the governor calls these cuts “tough medicine,” when the proposed budget would deny any medicine and critical health care services to so many. We've been down this road before, and here's what we learned:

• Cuts of $113 million to mental health and addiction treatment services in fiscal years 2009-11 increased state costs by more than $18 million due to increased emergency room visits, hospitalizations and nursing home placements.
• Elimination of Medicaid coverage for adult dental services in 2012 caused spikes in emergency department visits for dental problems. In-patient ER treatment for dental problems averaged $6,498, nearly 10 times the cost of preventive care delivered in a dentist's office.
• Disinvesting in HIV prevention will lead to new infections, for which the Centers for Disease Control estimates lifetime treatment costs of $379,668 per case.
• For every dollar Illinois spends on providing tobacco cessation treatments, it has on average saved $1.29. Cutting funding for smoking cessation services will increase costs by up to $32.3 million annually in health care expenditures and workplace productivity losses.

As proposed, the Rauner budget is not only bad for our health, but it's bad for businesses, too, likely resulting in decreased productivity, loss of jobs and economic activity, and greater health care costs for employers. Some examples:

• The proposed child care “intake freeze” and increase in parent co-pays will lead to increased absenteeism as employees will take time off to care for children. Such absenteeism already is costing American businesses nearly $3 billion annually.
• Planned cuts to Illinois hospitals are expected to result not only in the loss of more than 12,500 jobs but $1.7 billion in economic activity.
• Cuts in funding for health care services, such as cancer screening, most certainly will increase the health care costs of Illinois businesses. One study of major employers found that patients with cancer cost five times as much to insure as patients without cancer ($16,000 versus $3,000 annually).

We urge the governor to listen to the critics of this budget and learn from Illinois' past experiences. We stand prepared to support him on this learning curve.

Barbara A. Otto
CEO
Health & Disability Advocates

From Getting Insurance to Actually Using It

After the 2015 Open Enrollment Period 347,300 Illinoisans purchased plans through the marketplace, and 541,000 people have enrolled in Medicaid since its expansion in 2014. While connecting individuals to coverage is good news, the newly insured are often overwhelmed by having to navigate the overly complex healthcare system and understand the related insurance and medical jargon.  This confusion and lack of experience counteracts one of the healthcare reform law’s major goals: to reduce medical costs by increasing access to primary care. Obtaining coverage will not offset a lifetime of avoiding the doctor’s office and visiting the emergency room for primary care. The newly insured must learn how to find a doctor, fill a prescription and read a prescription label. Without that, they are subject to poor health outcomes and high costs. The newly insured must gain health literacy which can only happen through the combined efforts of consumers, communities, providers and governing bodies.

What is Health Literacy? 

The Centers for Disease Control and Prevention define health literacy as the degree to which an individual can obtain, process, communicate and understand health information and services. People with low health literacy are more likely to be uninsured. Similarly, uninsured individuals show lower health literacy scores compared to those receiving employer-based coverage.

So Why Does Low Health Literacy Matter? 

It is not altogether surprising that the uninsured and those with low health literacy are less likely to seek preventative care; more likely to experience poor health outcomes; and more likely to encounter higher medical costs. According to the Kaiser Family Foundation, only 1 in 3 uninsured adults said they had a preventive visit with their physician in the previous year, and uninsured adults experienced higher mortality rates than the insured. An Institute of Medicine report found a similar pattern of healthcare use for those with low health literacy, stating this group was less likely to seek preventive care. Research also found that lower health literacy in Medicaid managed care settings is connected with higher mortality. This shows that the uninsured and people lacking health literacy interact with the healthcare system in similar ways: poorly. Using the healthcare system is something people must learn. Giving someone a computer does not mean they know how to type. In the same way, connecting a person with healthcare will not alter their level of health literacy.

Old Habits Die Hard. The newly insured will continue receiving care in ways most familiar to them, which can translate to using the emergency room for non-emergencies. According to the Oregon Health Insurance Experiment, individuals who received Medicaid coverage increased their emergency room use by 40%. Asked to comment on the results, the state director of policy and programs for the National Association of Medicaid Directors alluded to the importance of promoting health literacy in the newly insured. She said, “this is not something that is unexpected” and “the key to getting inappropriate costs down for all patients is educating people about where they should go when it’s not an emergency.”

How to Address Health Literacy

Government Efforts
State initiatives, including an Illinois Emergency Room Diversion Grant are acknowledging the importance of patient education and using outreach to reduce ER use. In Illinois, hospital staff led outreach explaining the proper use of the ER and offered a 24-hour nurse triage line as an alternative. Meanwhile, Maine is targeting ER super-utilizers through community care teams that offer intensive case management including home visits and health coaching. Recognizing state efforts like that of Illinois and Maine, CMS listed patient education as a recommended component of programs targeting ER super-utilizers.

Health Professional Efforts
Beyond education on how to use their health insurance, health professionals can improve the usability of health services by reducing medical speak in patient interactions. Healthcare systems can also create plain-language pamphlets for patients to reference after leaving the doctor’s office. By speaking with patients in a relatable manner and sharing usable information, doctors better position healthcare consumers to adhere to medical recommendations.

Northwestern University’s Division of General Medicine and Geriatrics focuses on improving engagement between providers and patients and has developed plain-language materials that communicate complex health topics. For example, researchers created written information and videos available in Spanish and English that teach patients diabetes self-management. The modules use simple language and rely on pictures to communicate aspects of diabetes care, such as how the disease can impact a person’s eyes. By using these materials when interacting with diabetes patients, health professionals communicate vital aspects of care in an accessible manner, increasing the likelihood that patients adopt the healthy behaviors.

Community Health Literacy Efforts
The Be Covered Illinois campaign is promoting health literacy by generating easy-to-read written and online materials, creating short videos explaining critical concepts and utilizing community partnerships to expand the reach of their communications.  By producing written fact sheets on finding the right doctor and developing web content on using your coverage Be Covered empowers the newly insured with the knowledge to navigate health insurance and health care systems more effectively. Be Covered’s Dr. Lopez video series, presented in both English and Spanish, addresses health insurance topics, chronic disease, prevention and more. Be Covered broadens the reach of their education efforts by partnering with 82 organizations in Illinois, including Illinois Health Matters, that share information and materials with their own constituencies.  As part of that effort, Be Covered provides regular content for social media and shares copies of consumer friendly resources free of charge to partners.

Illinois Health Matters recognizes the importance of not only getting insurance but using insurance. The website features resources such as a Medical Cost Look Up, that allows consumers to estimate out-of-pocket costs for medical services and a resource on Immunizations and the ACA, outlining the vaccines children and adults can access for free because of healthcare reform. The website also has a tip sheet titled What to Know About Provider Networks, explaining steps consumers can take to avoid high medical costs associated with out-of-network care. These are just a few examples.

Illinois Health Matters is taking on the challenge of supporting a more health literate population, but we can’t do it alone. Join us. One great way to start: subscribe to our newsletter to stay informed and share the knowledge with your clients and coworkers. The healthcare community can achieve the vision of the Affordable Care Act, but only through the joint efforts of providers, policymakers and organizations supporting health literacy.

Bryce Marable MSW

Health Policy Analyst 

Health & Disability Advocates

New Study Builds Case for Expanding Medicaid

A new study in the New England Journal of Medicine confirms what consumer health advocates have known for decades: Medicaid is essential for keeping low-income households on stable financial footing. This should come as no surprise, since protecting families from unexpected and devastating medical costs is exactly what health insurance is meant to do. The study also proves that Medicaid coverage significantly improves beneficiaries’ mental health.

But opponents of Medicaid have distorted the study’s results; they claim it supports their agenda to block millions of low-income, uninsured families from accessing this vital coverage program. Their arguments are misinformed at best. The new study only strengthens the case for expanding Medicaid.

What the study tells us: Medicaid Works!

The researchers looked at the health and finances of low-income, uninsured Oregon residents who were given the opportunity to enroll in Medicaid through a one-time lottery, and compared it to their peers who remained uninsured.

The study shows that Medicaid virtually eliminated all catastrophic medical expenditures (medical expenses exceeding 30 percent of household income) for its beneficiaries. It also indicates that people with Medicaid coverage are significantly less likely to face any medical debt, borrow money to pay bills, or skip payments.

These results are extremely promising, especially in light of the fact that medical bills currently prompt more than 60 percent of U.S. bankruptcies. If we want to reduce the drag bankruptcies create on our economy and the ruin they leave behind in our communities, providing low-income families with Medicaid coverage is a good place to start.

The study also found that Medicaid is a powerful tool in combating mental illness. Medicaid beneficiaries in the study were 30 percent less likely to suffer from depression than those who remained uninsured. Given that suicide takes more lives in the US than any other form of injury and that depression accounts for more than $83 billion in the US between lost productivity and medical expenses, the impact of Medicaid on depression deserves attention and celebration.

File Under: Non sequitur

Instead of celebrating, opponents of Medicaid are arguing this study makes the case for withholding Medicaid coverage from millions of low-income, uninsured families. They base this on the study’s failure to detect statistically significant improvements in a handful chronic disease measures — blood pressure, cholesterol, or hemoglobin levels — in those with Medicaid compared to those without coverage.

That’s like saying because your blood pressure didn’t go down, we are going to prevent you from getting coverage for cancer treatment or a pap smear.

It’s certainly true that the U.S. health care system needs to be better at managing chronic conditions. We routinely lag behind other industrialized nations on measures of chronic care management, such as following medical guidelines for treating hypertension and diabetes. Plus, this study only looks at the impact of two years of coverage; significant improvements in these persistent chronic illnesses may take much longer to materialize.

This is hardly a reason to block millions of low-income families from gaining health coverage they need and deserve. We have no evidence that people with private insurance or Medicare fare any better than Medicaid beneficiaries on these measures, yet no one is suggesting we should all drop our health insurance.

Getting people covered is the first step in creating an effective health care system that works for everyone, but it is not the only step. The ACA contains numerous initiatives to improve the quality of health care.

File under: extremely relevant

Meanwhile, dozens of states are still trying to decide whether or not to take up the option to extend Medicaid coverage to millions of low-income, uninsured adults. This study confirms Medicaid can give beneficiaries peace of mind that they won’t go bankrupt when they experience that unexpected illness, and make staggering improvements in their mental health. It adds to the growing list of reasons why this decision should be a no-brainer for all 50 states.

Katherine Howitt, Senior Policy Analyst
Community Catalyst

(This blog was first published on the Community Catalyst Blog)

Dual Eligibles Next to Move into Managed Care in Illinois

On February 22, the U.S. Department of Health and Human Services announced a Memorandum of Understanding (MOU) with the state of Illinois for a demonstration project that will enroll approximately 136,000 dual eligibles in northeastern and central Illinois into managed care plans. (“Dual eligibles” are individuals who have coverage through both Medicare and Medicaid.) Illinois is the fourth state to receive an MOU for this demonstration, known nationally as the Medicare Medicaid Financial Alignment Initiative (MMAI).

AgeOptions and other organizations that serve older adults have been following the development of this new project, as it will significantly affect the lives of our clients. Here is what we have learned about this new initiative from our research and communications with the entities involved, including the Illinois Department of Healthcare and Family Services and various managed care organizations:

The MMAI project is part of a national effort to better coordinate care for dual eligible beneficiaries. Dual eligibles tend to be sicker and cost more than other Medicare and Medicaid beneficiaries. To address this, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services created a Medicare-Medicaid Coordination Office (MMCO) to “make sure Medicare-Medicaid enrollees have full access to seamless, high quality health care and to make the system as cost-effective as possible.” One of the MMCO’s first projects has been working with states to implement initiatives to coordinate care for dual eligibles.

Currently, dual eligibles must navigate and manage multiple systems of coverage in order to access the health care they need (Medicare, Medicare Part D prescription drug plans, and Medicaid). This can be very complex and taxing for individuals who have multiple complex health needs. Therefore, the goals of the MMAI project are to simplify this process and provide higher quality and more coordinated care for dual eligibles.

In January 2014, dual eligibles in the greater Chicago area and parts of Central Illinois will be enrolled into managed care plans. These plans must provide care managers and other supports to coordinate their members’ care, in addition to paying for members’ medical services and long term services and supports (LTSS). In exchange, these plans will be paid a capitated rate by the state of Illinois and CMS. (“Capitated rate” means the plans will receive a flat rate for each member that they serve, instead of being paid for each individual service that a member receives.) The inclusion of long term services and supports in this project is significant, as these services may be ‘new territory’ to some managed care organizations. In addition to providing coverage for LTSS provided in long term care facilities, MMAI plans will be responsible for covering home and community based services, such as the Community Care Program. This may cause confusion for dual eligible beneficiaries who are used to receiving Community Care Program services through the existing system, so agencies working with older adults will have to provide education and assistance to help our clients understand these new changes.

Illinois has selected eight managed care plans to provide MMAI coverage. Those eight plans are:

• Chicago area: Aetna Better Health, Blue Cross/Blue Shield of Illinois, HealthSpring, Humana, IlliniCare (Centene), and Meridian Health Plan of Illinois
• Central Illinois: Molina Healthcare, Health Alliance

Dual eligible beneficiaries in the target counties will be able to enroll in these plans voluntarily beginning October 2013. In January 2014, the state will begin passively enrolling additional beneficiaries into the plans. This passive enrollment will be conducted in phases, so it will take about 6 months to enroll everyone who will be affected. After a beneficiary has been passively enrolled into a plan, s/he may change plans at any time and will have some ability to opt out of the program (though this opt out privilege may be limited in certain cases).

Counties that will be part of the MMAI project:

• Greater Chicago area: Cook, DuPage, Lake, Kane, Kankakee, and Will counties

• Central Illinois: Christian, Champaign, DeWitt, Ford, Knox, Logan, Macon, McLean, Menard, Peoria, Piatt, Sangamon, Stark, Tazewell, and Vermilion counties

For more information about the Illinois MMAI project, please see the following resources:

CMS fact sheet
Illinois Memorandum of Understanding
Illinois Department of Healthcare and Family Services webpage on Illinois Care Coordination Initiatives (see section on MMAI)

Written by Erin Weir, Manager of Health Care Access at AgeOptions
erin.weir@ageoptions.org

The Negative Impact of SMART Act Cuts

This post originally appeared as a letter from Age Options to the IL House of Representatives human Services Appropriations Committee, submitted on Feb. 20, 2013

The cuts to Medicaid that were implemented July 1, 2012 as a result of the SMART Act have had a serious negative impact on the lives of our clients. In particular, we would like to bring to your attention the hardship caused by the elimination of the Illinois Cares Rx program. Illinois Cares Rx provided critical pharmaceutical assistance to more than 160,000 older adults and people with disabilities in Illinois. Without this program, many of these individuals are struggling to pay for their medications.

Contrary to popular belief, implementation of the Affordable Care Act has not resolved the need for a state pharmaceutical assistance program. The ACA does not close the Medicare Part D “donut hole” until 2020. Further, Illinois Cares Rx provided much needed assistance with expensive Medicare Part D deductibles and copayments – the ACA does not do anything to address this.

To illustrate the difficulties that older adults are facing without this critical program, we would like to share with you the story of one of our clients. Lillian is an 89 year old resident of Berwyn, Illinois.  A widow for 53 years, Lillian worked multiple jobs to support her two children and pay off her mortgage. She had no money left over to save for retirement. Now, Lillian’s income of $1,648/month puts her above the income limits for assistance programs like Medicaid and the Part D Extra Help program, but is barely enough for Lillian to make ends meet with her expenses. She pays premiums each month for her Medicare and Part D prescription coverage. She also pays for an expensive Medicare Supplement Plan to cover her injections for macular degeneration, which cost $4,000 every two weeks, and bills for dental services out of pocket (Medicare does not provide dental coverage). In addition to all of her health care expenses, Lillian must continue to pay her utility bills, property taxes, and homeowner’s insurance. At the end of each month, Lillian has no extra money left in her bank account. In fact, lately she has had to put some of her bills onto a credit card, and then she skimps on groceries the following month to pay off the credit card bill.

Since Illinois Cares Rx was eliminated, Lillian has been unable to afford the costs of her medications. She takes nine prescription drugs every month, including two drugs that cost $70/month each in Part D copayments. Lillian has not been able to afford her three most expensive medications since January, so she has been going without them. These drugs help control Lillian’s blood pressure, cholesterol, and hypothyroidism; going without these medications is dangerous for her health and has the potential to instigate expensive emergency room or hospital care.  Unfortunately, without Illinois Cares Rx, Lillian has no other option to pay for her medications, so these are risks that she has been forced to take.

As a result of the SMART Act, thousands of older adults and people with disabilities in Illinois are in situations just like Lillian’s. They must make difficult choices every month regarding whether to pay for food, utility bills, or medications. The elimination of Illinois Cares Rx has created a tremendous financial burden for these individuals, and it is likely to create a significant financial burden for the state via costly emergency room and hospital care for individuals who cannot afford their prescription drugs.

We ask that the committee consider these burdens in future action regarding cuts to Medicaid, as well as in considering restoration of pharmaceutical assistance for older adults and people with disabilities. AgeOptions and the Illinois Association of Area Agencies on Aging fully support HB1286 (sponsored by Representative Jakobsson and cosponsored by Representatives Beiser and Burke), which would reinstate a pharmaceutical assistance program of this nature. 

Illinois Medicaid Redetermination -- What It is & What To Tell Your Clients

In 2012, the Illinois Legislature passed the Save Medicaid and Resources Together (SMART) Act. One portion of this Act aimed to address the backlog of Medicaid redeterminations that has accumulated over the years. From this Act came the 'Illinois Medicaid Redetermination Project' (ILRP), more informally known as "Enhanced Eligibility Verification" (EEV).

The goal of EEV is to determine the eligibility status of current Medicaid recipients and adjust or eliminate benefits accordingly. This will be the system that redetermines Medicaid eligibility annually for current and newly enrolled recipients. The circumstances under which individuals may be removed from Medicaid include death, relocation out of state, or excess income, amongst many others.

The State has contracted with MAXIMUS Health Services Inc. and developed a case review system that categorizes Medicaid cases as those most likely eligible and those potentially ineligible for medical services. To this end, MAXIMUS has begun its operation and as early as this week will be reaching out to current Medicaid recipients who they believe are no longer eligible for Medicaid benefits.

As early as this week, these enrollees will receive a letter in the mail from the Illinois Medicaid Redetermination Project requesting they submit the appropriate eligibility verification documents.

PLEASE NOTE:

• The envelope that the redetermination letter will arrive in is non-descript with nothing distinguishing it from junk mail. Advocates have made HFS aware of this issue and they have said they will be changing it.
• Current Medicaid enrollees will have only 10 business days to submit the proper eligibility verifying documents.

Once Medicaid enrollees submit the necessary verifying information, the file will be sent back to their case manager in the local office. At this time, the case manager will have 20 days to review the information provided and make a determination of eligibility. To be clear, MAXIMUS will not make final decisions related to Medicaid eligibility, but will collect all necessary and relevant information for the Department of Human Services who will use that to make a final decision.

If Medicaid enrollees fail to provide the proper documentation after receiving a letter of notice in the mail, their file will also be sent back to a case manager and their benefits likely eliminated. Although the state has implemented a new system to redetermine Medicaid eligibility, the appeal rights of applicants remains intact.

As Medicaid enrollees will only have 10 business days to submit the required verifying documentation, it's extremely important that advocates and providers provide support to their participants who receive Medicaid benefits that may need to submit such additional documents. With such a short turn-around time and in order to ensure continuity of care, it's imperative that Medicaid enrollees understand what they must provide and submit that information within the allotted time frame.

Contact information for the Illinois Medicaid Redetermination Project can be found below and summary of the program can be found here.

Illinois Medicaid Redetermination Program Hotline Information
Hours of Operation: Monday - Friday, 7:00 am - 9:00 pm, Central Time
Saturday, 8:00 am - 1:00 pm, Central Time
Phone Number: 1-855-HLTHYIL (1-855-458-4945)
TTY: 1-855-694-5458

Mailing Address: Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992
FAX: 1-855-394-8066

Nadeen Israel & Molly McAndrew
Heartland Alliance for Human Needs & Human Rights

The 12 Days of … Medicaid?

On the 1st day of Medicaid the IL House should give us Medicaid for 342K uninsured, 2 of 3 working.
BACKGROUND: HB 6253 will cover an estimated 342,000 uninsured Illinoisans. According to data from the Kaiser Family Foundation (link to http://www.kff.org/uninsured/upload/8350.pdf), over 60% of these newly eligible individuals are employed, but working at low-wage or part-time jobs that offer don’t offer health insurance at all, or offer coverage that is not affordable.

On the 2nd day of Medicaid the Gen Assembly should provide coverage to 342K, feds pay 100% thru 2016.
BACKGROUND: HB 6253 will leverage $5.7 billion in Medicaid funding to cover low-income, uninsured people in Illinois. The best part? It will cost Illinois nothing in 2014-2016 because the federal government will pay 100% of the cost. The state pays no more than 10% through 2020. Support HB 6253! Click here to send a message to your Illinois legislator. http://wfc2.wiredforchange.com/o/8810/p/dia/action3/common/public/?action_KEY=8966

On the 3rd day of Medicaid the Gen Assembly should create new health care jobs.
BACKGROUND: Covering newly eligible people will create jobs and generate revenue. A substantial number of jobs will be generated by the Affordable Care Act’s $5.7 billion in federal funding for Medicaid due to its multiplier effect throughout the economy. State and local revenue increase when Illinois residents pay income, sales, and other taxes generated by the federal funding for covering newly eligible people; this revenue would offset much, perhaps all, of any additional costs. Source: http://www.theshriverbrief.org/2012/07/articles/health-care-justice/expanding-medicaid-the-choice-is-clear/

On the 4th day of Medicaid the Gen Assembly should cut $1K hidden health tax on people w/insurance.
BACKGROUND: Every family with health insurance pays an additional $1,000 per year to pay for care for the uninsured.  Hospitals and doctors raise the rates they charge people with insurance to cover bills for people who can’t pay them, which are then passed along in the form of higher insurance rates.  Covering 342,000 Illinoisans through new Medicaid will reduce uncompensated care and slow the rise in costs of private insurance for all of us. Read the Families USA report, and then take action and tell your Illinois legislator to support HB 6253.


On the 5th day of Medicaid the Gen Assembly should give IL $5.7 b federal $ for 342K newly insured.
BACKGROUND: HB 6253 will leverage $4.6 billion in new federal Medicaid funding for Illinois in 2014-16. This will allow the state to provide comprehensive health care coverage for an estimated 342,000, low-income people who are currently uninsured. Most importantly, the federal government will pay 100% of the cost of care for this new population in 2014-17, dropping to 90% by 2020.

On the 6th day of Medicaid the Gen Assembly should provide 342k Illinoisans access to preventive services.
BACKGROUND: Today, low-income uninsured people have limited access to cost-saving prevention services like mammograms, diabetes or heart disease screens, HIV tests, flu shots, or counseling to stop smoking. These services lead to early detection and treatment of costly and life-threatening medical conditions that can cause disability or death. HB 6253 will leverage federal Medicaid funding and bend the health care cost curve by providing these and other prevention services to 342,000 low-income, uninsured Illinoisans.

On the 7th day of Medicaid the Gen Assembly should provide a healthier workforce by passing HB 6253.
BACKGROUND: Over 60% of people newly eligible for Medicaid as a result of HB 6253 are working. Providing Medicaid to this group would improve their health, as shown by a New England Journal of Medicine study of Oregon (http://www.nejm.org/doi/full/10.1056/NEJMp1108222). The study demonstrated that newly enrolled individuals were 25% more likely to report that they were in good health. Other research shows that Medicaid coverage reduces the death rate (http://www.nytimes.com/2012/07/26/health/policy/medicaid-expansion-may-lower-death-rate-study-says.html?pagewanted=all&_r=0).

On the 8th day of Medicaid, the IL General Assembly should see a local map of new Medicaid eligibles.
BACKGROUND: Health & Disability Advocates has built a great tool that maps where individuals newly eligible for Medicaid live. You can dive down to your community area for details and demographics. Check it out!  http://visualizingreform.illinoishealthmatters.org/uninsured#40,25|-88,5|7|-1|4Legislative district data will be available online in January 2013!

On the 9th day of Medicaid, the Gen Assembly should replace state funding w/ federal $$ for mental health care.
BACKGROUND: Illinois now spends millions of dollars in state general funds on mental health services for low-income, uninsured people. The Center on Budget & Policy Priorities estimates that State and local governments provided 44 percent of the funding for state mental health agencies in 2009, amounting to $17 billion. By passing HB 6253 and providing Medicaid coverage to these individuals, Illinois can leverage federal funding to cover half or more of the cost of these services, significantly reducing the cost to the state.

On the 10th day of Medicaid, the IL Gen Assembly should bring health coverage to +12K uninsured #vets in Illinois with HB 6253.
BACKGROUND: Covering newly eligible people will provide Medicaid coverage for Illinois’ veterans. Not all veterans are able to get care at a Veterans Affairs hospital. And, in fact, according to the Social IMPACT Research’s Center, filling the Medicaid gap would bring health coverage to 1,800 of the new veterans in Illinois (military service members who have been deployed in 2001 or later) and 12,600 of all veterans. Illinois needs to take care of veterans, and filling the Medicaid gap will do just that for many of them. Nationally, in 2014, nearly half of uninsured veterans will likely qualify for the new Medicaid coverage. 

On the 11th day of Medicaid the Gen Assembly should provide more support for community health centers.
BACKGROUND: Today, community health centers (also called Federally Qualified Health Centers) are one of the only sources of free health care for hundreds of thousands of low-income, uninsured people in Illinois. HB 6253 will provide many of those individuals with health insurance through Medicaid, helping community health centers to strengthen their finances and provide better, more comprehensive care, including prevention services. More information on community health centers and health reform can be found here.

On the 12th day of Medicaid the Gen Assembly should simply do the right thing & pass HB 6253
BACKGROUND:The Medicaid expansion is simply the right thing to do. We have a chance, through the incredible leveraging of federal funds, to provide health coverage—and the chance for better health and upward mobility—to hundreds of thousands of our state’s most vulnerable, needy residents. We can create a system that expands its circle of moral concern to include the uninsured, recognizing as Justice Ruth Bader Ginsburg wrote in N.F.I.B. v. Sebelius, that “[v]irtually everyone … consumes health care at some point in his or her life.”
 

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Starting today, we’re kicking off a new feature called the “12 Days of Medicaid.” It’s a social media advocacy campaign designed to educate Illinoisans about the importance of passing the Medicaid Eligibility Expansion (HB 6253) in early January 2013.

The bill will allow Illinois to leverage over $5 billion in federal Medicaid funding to provide comprehensive health care coverage to over 342,000 low-income individuals. The new funding was made available through the Affordable Care Act. The Illinois General Assembly needs to pass HB 6253 by January 9, 2013, the end of the current legislative session, to ensure programs and systems are in place just 12 months from now when one of the largest parts of health care reform begins.

For more information on HB 6253, here are several fact sheets: 
Medicaid Financing for the Uninsured Under the Affordable Care Act 
What is the Medicaid Expansion? Fact Sheet and Client Stories 
Medicaid Opportunity Fact Sheet With List of Supporters

So stay tuned for a social media message of the day every weekday from now through December 24. 

Please share the messages on Facebook and Twitter and urge your friends and family members to tell their legislators to support common-sense, fiscally sound legislation in Illinois. 

AIDS Foundation of Chicago
Health & Disability Advocates
Heartland Alliance
Illinois Maternal & Child Health Coalition
Sargent Shriver National Center on Poverty Law

Update:Illinois’ Care Coordination and Managed Care System

In January 2011, the Illinois legislature passed a bill that requires 50% of the State’s Medicaid population to be covered in a risk-based care coordination program by 2015. Subsequently, in May 2012, the State Legislature passed the SMART Act, cutting Medicaid services and projecting cost savings through various care coordination initiatives.

The care coordination, or managed care, initiatives referenced through this bill are: the Integrated Care Program, the Dual Eligibles Capitation Demonstration and the Innovations Program. All three of these initiatives have a goal to better coordinate primary, acute, behavioral health and long-term supports and services thereby improving the delivery of health services and lowering health costs.

The move to better coordinate care across primary, acute, behavioral health and long-term supports and services is in alignment with the federal Affordable Care Act (ACA), passed in March 2010. In fact, Illinois has made an effort to take advantage of several of the ACA provisions to move towards a better coordinated and integrated health system.

One of the ACA provisions Illinois is interested in is called Medicaid health homes for individuals with chronic conditions. To date, Illinois has filed a draft Medicaid state plan amendment to create health homes. The other federal ACA inititiave relating to care coordination that Illinois interested in is the Medicare-Medicaid Alignment Initiative, or the Dual Eligibles Demonstration Project. Illinois has submitted a proposal for this demonstration project.

For more details about the various care coordination, or managed care, initiatives in Illinois, please reference the document “Illinois Health Reform 2012: Care Coordination, Managed Care and Long-Term Services and Supports” developed by Health & Medicine Policy Research Group.

Kristen Pavle
Associate Director, Center for Long-Term Care Reform
Health & Medicine Policy Research Group

The Outlook for "Obamacare" in Two Maps

By Tracy Weber and Charles Ornstein; originally posted at ProPublica, Nov. 8, 2012, 10:30 a.m.

It wasn't just President Barack Obama who won Tuesday. His signature health care plan did as well. But while the Affordable Care Act remains alive, less clear is how its various mandates will proceed and who will participate.
To a large extent, the success of the health overhaul lies in how many of the nation's uninsured get coverage. And that is largely in the hands of the states, which have been all over the map in their willingness to cooperate.
We mean that literally. The maps here show the lack of consensus on two key parts of the act: Creating insurance exchanges and expanding Medicaid.
Here's why each map matters.

Map 1: Where Will We Buy Insurance?

Source: Kaiser Family Foundation, current as of Sept. 27, 2012.

The health care act requires all Americans who aren't already insured to buy coverage. But where? That's where insurance exchanges come in.
States have to decide whether to set up these online marketplaces, where individuals can choose among different insurance plans. Setting up an exchange allows states to customize the offerings to the needs of their residents.
States can also partner with the federal government on exchanges. But if they elect not to, the federal government will take over with its one-size-fits all exchange. States are supposed to decide which course to take by Nov. 16.
Along the West coast, legislatures have already voted to set up exchanges. Other states, including Texas, Maine and Alaska, have decided to punt.
But many states in the Midwest and South haven't committed either way. Some governors, such as New Jersey's Gov. Chris Christie, have held off setting up a state insurance exchange until after the election.
A health care consultant group predicted yesterday that 20 states will elect to operate exchanges.

Map 2: Will States Cover More Poor People?

Source: The Advisory Board Company
Obamacare hopes to expand coverage to 30 million of the country's 48 million uninsured residents. A big part of that would come though Medicaid.
States must also decide whether to expand Medicaid to all residents under 133 percent of the federal poverty line (about $14,893 for an individual and $30,657 for a family of four).  Medicaid currently covers poor children, pregnant women, seniors and some disabled adults. The federal government will pay the full cost for the expanded coverage for three years, and then gradually reduce its contribution to 90 percent over the next three years.
As passed in 2010, the Affordable Care Act required states to expand Medicaid or risk losing all federal matching funds for the program. But the U.S. Supreme Court ruled in June that it was coercive to force states to expand their program just to keep money they were already getting.
Now, states that don't opt in will keep their current funding, but residents who might have qualified under an expansion will likely remain uninsured. There isn't a deadline for the expansion, but the federal government says states will receive less federal help if they decide to expand later, according to The New York Times.
As with exchanges, the states are divided.
So far, a handful u2013 including California, Washington and Illinois u2013 have already embraced the expansion. Florida, South Carolina, Mississippi and Louisiana have opted out.
(The states marked with scales participated in litigation against the Act that culminated in June's U.S. Supreme Court decision.)

Too Murky to Map  
Not everything is left to states. Other issues remain murky about the law, perhaps because the deadlines are further in the future.
The requirement for individuals to either buy insurance or pay a fee to the IRS begins Jan. 14, 2014. But the federal government has not made clear how vigorously it plans to pursue those who don't comply.
Here's a flow chart showing who has to pay and who doesn't.
Also unclear is the impact on employers, who will be required to provide health insurance to full-time workers beginning in 2014. Some, according to The Wall Street Journal, are responding by moving employees to part-time positions.
Finally, the Act's opponents in Congress and on the grassroots level will likely do what they can to delay or dilute these requirements, which are among its most unpopular.
If you're interested in comparing the politics further, here's a link to the final presidential election results by state.
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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.