Governor Quinn Enacts Largest Increase in Health Care Coverage in State History

Governor Pat Quinn today signed legislation that enacts a critical part of President Obama’s Affordable Care Act (ACA) by making Medicaid coverage available to all low-income adults in Illinois. Today’s action delivers on a major priority announced by Governor Quinn in his 2013 State of the State address and is part of his agenda to improve the health of the people of Illinois and increase access to quality health care.

“In the home state of President Obama, we believe access to quality health care is a fundamental right and we proudly embrace the Affordable Care Act,” Governor Quinn said. “This legislation will greatly improve the health of hundreds of thousands of people across Illinois, strengthen our health care system and create thousands of good jobs in the health care field. Thanks to this law and our shared commitment to increasing access to health care coverage in Illinois, the people of Illinois will be healthier and have a higher quality of life.”

Sponsored by State Senator Heather Steans (D-Chicago) and State Representative Sara Feigenholtz (D-Chicago), Senate Bill 26 will make Medicaid coverage available to adults with annual income below 138 percent of the federal poverty line, which is $15,860 for individuals and $21,408 for couples. The measure is expected to enroll 342,000 people by 2017. Currently, Medicaid is only available to children, their parents or guardians, adults with disabilities or seniors. Enrollment for the newly eligible population will begin Oct. 1 with coverage starting on Jan. 1.

Under the ACA, for the first three years, coverage of newly eligible adults will be 100 percent federally funded. The reimbursement rate will phase down to 90 percent by 2020. State officials estimate this will bring more than $12 billion in new federal funding to support the state’s health care system from 2014 to 2020.

“The Affordable Care Act gives Illinois the resources to provide critical health care services to a population that desperately needs it,” Illinois Department of Healthcare and Family Services Director Julie Hamos said. “Under Governor Quinn’s leadership, we are reforming our health care system so that it focuses on delivering coordinated care and keeping people healthy through better preventive care, not just paying the bills when they become sick.”

Under Governor Quinn's leadership, Illinois is also increasing access to health coverage through the Illinois Health Insurance Marketplace, another major feature of the ACA. The Marketplace, which also launches enrollment Oct. 1 with coverage starting Jan. 1, will be accessed through a user-friendly website where individuals, families and small businesses will be able to compare health care policies and premiums and purchase comprehensive health coverage. Those with income between 138 percent and 400 percent of the federal poverty level will receive subsidies on a sliding scale if they obtain coverage through the marketplace.

Governor Quinn has long championed access to decent health care for all people. In August 2001, he joined his then 78-year-old Doctor, Dr. Quentin Young, to walk 167 miles across Illinois to advocate for health care for all.

For more information about Illinois' implementation of the ACA, go to HealthCareReform.illinois.gov.

Related Documents
Senate Bill 26 and the Affordable Care Act (PDF)

(This post was taken directly from the Illinois Government News Network press release)

New Options for States: Facilitating Medicaid and CHIP Renewal & Enrollment in 2014

States must prepare themselves for an efficient enrollment period in order to capitalize on the upcoming changes to Medicaid eligibility under the Affordable Care Act. The Centers for Medicare & Medicaid Services (CMS)/Center for Medicaid & CHIP Services, recently released a letter that identifies enrollment strategies to help with the anticipated increase in applications. These optional strategies may facilitate enrollment while lessening administrative demands on individual states.

Here are the strategies for those states interested in adopting them:

1) Implementing the early adoption of Modified-Adjusted Gross Income, (MAGI)-based rules

Under the ACA, eligibility for all health insurance programs will be determined by MAGI methodology, which uses different income-counting procedures than current Medicaid programs. During the open enrollment period, which begins on October 1st, 2013, individuals applying for coverage in 2013 will determine their eligibility through MAGI methodology. However, individuals renewing and applying for Medicaid during that 4-month period will have their income reviewed by both current rule and MAGI methodology. States can opt to change how they determine eligibility starting October 1st in order to simplify this process.

2) Extending the Medicaid renewal period

Anyone who has a Medicaid renewal which falls in the first quarter of 2013 will also have to have their eligibility determined by both pre-MAGI and MAGI rules. Extending the renewal period will allow the states to use only the MAGI eligibility rules for simplicity.

3) Enrolling individuals into Medicaid based on Supplemental Nutrition Assistance Program, (SNAP), eligibility

The majority of non-elderly, non-disabled individuals who receive SNAP benefits are also eligible for Medicaid. Enrolling individuals in Medicaid who also receive SNAP benefits without a separate, MAGI-based income determination can help ease a state’s administrative burden. This enrollment opportunity can be implemented for a limited amount of time as states handle the demands of the increase in applications.

4) Enrolling parents into Medicaid based on their children’s Medicaid eligibility

A large number of parents with Medicaid-eligible children will also be eligible for Medicaid when changes go into effect. Enrolling parents based on their children’s eligibility can also serve as a temporary way to facilitate enrollment.

5) Adopting 12 month continuous-eligibility for parents and other adults

Many states already have 12-month continuous-eligibility for children, meaning that children are guaranteed their Medicaid coverage for a full year despite changes to their family’s income. Extending this guarantee to families will reduce the amount of “churning” between different plans, and ensure that entire families have more consistent coverage.

States that wish to implement any of these strategies must get authorization from the federal government. CMS also is encouraging states to propose any other creative strategy that will facilitate enrollment.

Illinois should consider whether some or all of these options are optimal. Implementing these strategies could lessen the administrative burden on the state, maximize enrollment of uninsured populations, maximize eligibility for low income families, and increase federal financing for health care in the state.

Stephanie Altman & Kathryn Bailey
Health & Disability Advocates

Medicaid Expansion Passes Both Houses of the Illinois General Assembly

Earlier this week, the Illinois Legislature passed a bill (SB 26) to implement the Medicaid expansion option for adults without minor children on January 1, 2014. This expansion is a cornerstone of the Affordable Care Act and has the potential to cover over 600,000 low income adults in Illinois under the Medicaid program. The bill has overcome many hurdles along the way and now will be sent to the Governor's desk for his signature.

A year ago, the Supreme Court made the Medicaid expansion to adults an option that states did not have to take. However, the expansion is financially advantageous for states because the federal government pays all of the costs of the new Medicaid adult group for the first three years and thereafter, the state pays no more than 10% of the costs - making this the most lucrative Medicaid program in history for state governments. This coverage program will bring needed revenue to Illinois including to local entities such as Cook County and the City of Chicago as well as to hospitals and other safety net providers.

Illinois will begin accepting Medicaid applications for this new adult group on October 1, 2013, and coverage will begin on January 1, 2014.  For residents of Cook County, they can enroll right now and begin getting coverage into the CountyCare program which is an early implementation of the Medicaid expansion. The passage of SB 26 ensures that CountyCare enrollees will be able to continue to be covered under Medicaid along with the rest of the state in 2014.

In addition, SB 26 makes other changes to the Medicaid program including "fixing" some of the SMART Act Medicaid cuts by partially restoring dental care to pregnant women. Some mental health advocates were opposed to an amendment added onto the bill, that allowed a new category of mental health facilities for short term crises. For any questions, you can contact me at saltman@hdadvocates.org.
 
Stephanie Altman
Programs & Policy Director
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)

Illinois Should Accept Federal Funds to Fill the Gap in Medicaid

We strongly encourage the General Assembly to accept new federal Medicaid funding that will be made available to Illinois in 2014 to fill a historic gap in the Medicaid program and provide health care coverage for hundreds of thousands of the lowest income uninsured Illinois residents. The measure will strengthen the financial health of our hospitals and other health care providers and boost our local economies as federal funds create jobs.

Medicaid has never covered all low-income individuals. It has always had a gap. Even if you are very poor, you do not qualify for Medicaid unless you are also elderly, disabled, pregnant, parenting or a minor child. Eliminating this gap in Medicaid opens the door for coverage to people with income under $16,000 who are ages 18-65, not officially disabled and not raising a minor child. For example, vital health coverage would be available to young adults just coming out of high school or college and starting their working lives; other young adults experiencing underemployment after a tour in the military (Illinois has 43,000 uninsured veterans); older adults whose children have passed age 18 who are not high earners; and people troubled with mental health and other issues that block their efforts at employment.

The State of Illinois, its localities, and all of the rest of us have been filling this Medicaid gap. We do it through charity care programs, safety net healthcare arrangements funded by property taxes, and state-funded human services programs that could be covered by Medicaid if the individual were eligible. The average U.S. family and their employers pay an extra $1,000 in health insurance premiums each year to compensate for health care for the uninsured. The Kaiser Family Foundation estimates that total uncompensated care in Illinois will decline by approximately $953 million from 2013 - 2022. Townships and General Assistance providers will be relieved from paying for coverage of those who are uninsured and are currently ineligible for Medicaid.

The brunt of the Medicaid gap also falls on those not covered – poor health, premature death, lowered employability and productivity, lost opportunity, medical bankruptcy and more. SB 26 will allow the State of Illinois to use federal funds to close the Medicaid coverage gap, address these health inequities, and begin to address the problem of rising health care costs due to uncompensated care for the uninsured.

The Federal government will provide 100 percent of the cost of filling the Medicaid gap for the first three years ($4.6 billion for the Illinois economy), and 90 percent of the cost after that ($21 billion over the first ten years). This means nearly 20,000 new jobs, which means paychecks being spent in stores and restaurants. The tax revenue resulting from this federal investment in our state’s health care system will more than cover the state’s small financial contribution.

In announcing that she would accept the federal money to fill the Medicaid gap in her state, Arizona’s Governor Jan Brewer simply said, “I did the math”. Seven Republican governors, all at one time vocal opponents of the measure, have now joined this pragmatic and sensible chorus. It is just too obviously in the best interests of their people and their states to reject.

Health care coverage keeps people healthier and reduces overall health system costs. That’s why we, the undersigned organizations – a diverse constituency of consumers, providers, hospitals, local governments, businesses and insurance companies throughout the state – support SB 26 and urge the Illinois General Assembly to pass this bill.

Signed,

AARP Illinois
Aetna, Inc.
AIDS Foundation of Chicago
Heartland Alliance for Human Needs & Human Rights
Illinois Hospital Association Illinois Maternal and Child Health Coalition
Illinois Primary Health Care Association
Meridian Health Plan of Illinois
Sargent Shriver National Poverty Law Center
SEIU Healthcare Illinois Indiana

A New Year and New Medicaid Awaits Us

What an amazing and historic beginning to the start of 2013. This week an Illinois legislative body advanced a major piece of the Affordable Care Act (ACA), when the House Human Services Appropriation Committee passed HB 6253, Medicaid Financing for the Uninsured.

After the committee vote, the waning hours of the current term of the General Assembly did not provide enough time to advance the bill further. Nevertheless, our momentum continues with renewed commitment and excitement.

This effort brought together an unusual mixture of health care providers, business interests, patients and advocates, demonstrating as great a degree of consensus on an issue like this as you are likely ever to find. We know it is right and advantageous for Illinois to accept new federal Medicaid funding, fill a historic gap in the Medicaid program and provide health care coverage for hundreds of thousands of the lowest income uninsured Illinois residents.

The fight continues and we have laid the scaffolding for us to build upon as we enter the 98th General Assembly today. Illinois House and Senate members will file new Medicaid bills, and once the new General Assembly begins, your voices will need to be heard again with in-district meetings, emails and phone calls to your Senators and Representatives, many of whom will be new in office or serving from redrawn districts. It will be critical that these legislators hear from you.

Thank you for all you have done. And thank you, in advance, for all the help you will provide in helping to achieve federal Medicaid funding for the uninsured in Illinois.

Ramon Gardenhire
Director of Government Relations
AIDS Foundation of Chicago

Start Your Week Right! Contact Springfield Today.

 
Leveraging Federal Financing for the Uninsured (HB 6253) Reaches the Illinois House THIS WEEK!

This week (and possibly TODAY)  the Illinois House will consider HB 6253 House Amendment 1 (HA 1), a bill to leverage federal financing of the state’s Medicaid program in 2014 to cover the uninsured, made eligible by the Affordable Care Act (ACA).

In Illinois today, thousands of low-income adults without dependent children are not eligible for Medicaid. This major gap in healthcare coverage would be eliminated by HB 6253 under the ACA. This Medicaid option is expected to bring $4.6 billion additional federal dollars into the state of Illinois just in the first three years, making it a great fiscal deal for Illinois!

HB 6253 authorizes Illinois to take advantage of the ACA to provide Medicaid to about 342,000 low-income Illinois citizens who are currently uninsured. Because of the ACA, Illinois can offer Medicaid to this population at no expense to the state for the first three years, and in later years the state will never pay more than 10% of the cost of this coverage (with federal funds covering the remaining 90%). Learn more about HB 6253 HA1.

2 Ways to Take Action TODAY:

1. Tell your Illinois Representative to support HB 6253 today! Call the easy and toll-free ‘Illinois Affordable Health Care Hotline’ 1-888-616-3322 to be connected to your legislator. Need some talking points? Click here.  You can also look up your Illinois Representative’s contact information directly using this easy online tool!  Click here.
2. Submit an electronic witness slip in favor of the bill: You can click here to file an electronic witness slip today.  Click on the icon on the right of the Appropriations committee to find the listing for HB 6253. Once you find HB 6253, click on “Create Witness Slip.” You should check the “proponent” box for House Amendment #1 (HA #1) and the “Record of Appearance Only” box.

*The 'Illinois Affordable Health Care Hotline’ is a function of the AARP Hotline. Please, do not be alarmed by the AARP phone recording. This phone line is open to everyone.
*The original House bill number (HB 5019) has changed since the recording of the Hotline to HB 6253, and may change again! Please, do not be alarmed by the incorrect bill number. This phone line is still active to support 'Medicaid Financing for the Uninsured'.
Thank you!

Questions? Contact Stephani Becker (312.265.9072) or Stephanie Altman (312.265.9070) at HDA.

Five Myths about the Medicaid Expansion

The Supreme Court's June 2012 Affordable Care Act ruling was decisive about the implications of the individual mandate; however, it was less decisive about the ACA's Medicaid expansion. The court gave flexibility to each state to decide whether to expand Medicaid to its low income uninsured (below 138% FPL) residents. This flexibility has caused some confusion (some legitimate and some purposeful) about the implications of the Supreme Court decision. Below we address some of the myths vs. realities of the Medicaid Expansion and what it means for Illinois residents:

Medicaid Myth #1: Few states will expand their Medicaid programs.
Reality: As of 12/12/12, according to health care experts Avalere Health, 18 states have signaled that they will expand, 10 have said that they won't and 23 are undecided. Another health care expert, the Advisory Board Company, shows 14 states in the "not participating" or "leaning toward not participating" group while 18 states are in the participating or leaning toward participating group. Notably, this week, Nevada's Republican Governor and GOP leaders just signaled that they will opt in.

Medicaid Myth #2: Many low-income residents would be eligible for federal subsidies on the exchange if a state does not expand Medicaid. Expanding Medicaid takes away their opportunity to purchase private insurance.
Reality: The reality is that people living under 100% FPL WILL NOT qualify for subsidies to buy health insurance on the Exchanges and will be the only ones (besides undocumented immigrants) left out in the cold if Illinois doesn't expand Medicaid. Without the new Medicaid eligibility category, these individuals are in a new “donut hole” and will likely be priced out of affordable health insurance through the Exchange because they won’t qualify for the federal financial help. The Urban Institute estimates that of the newly eligible population, approximately 431,000 Illinoisans with household incomes less than 100% FPL will be left in the cold if Illinois does not implement the new Medicaid eligibility category. They will have to continue to access safety-net providers and emergency rooms for care, driving up costs for these providers and showing up sicker. In addition, we all pay more when others are uninsured: according to a study conducted by Millman, Inc., an independent actuarial consulting firm, every family with health insurance pays an additional $1,000 per year to pay for care for the uninsured.

The only "low-income" residents that are either eligible for subsidies on the Exchange OR can participate in Medicaid if Illinois expands Medicaid are people living between 100% -138% FPL. This is a small number of people. Even among those small numbers who DO qualify for exchange subsidies and take up that coverage, the greater cost-sharing requirements for exchange coverage than in Medicaid means that these adults will experience greater financial burdens associated with meeting their health care needs.

 
Medicaid Myth #3: The state will pay for the Medicaid expansion but will not pay for federal insurance subsidies.
Reality: Not true. The state will not pay for Medicaid Expansion from 2014 through 2016. The federal government pays 100% of the expansion. From 2017 through 2020, the state will slowly start picking up a very small percentage that will slowly increase from 5% to 10% by 2020. In 2020 and beyond, the state will only be responsible for 10% of the cost of the Expansion population.

Medicaid Myth #4: The federal government is already trying to shift more Medicaid expansion costs to the states as a major part of the fiscal year 2013 budget.
Reality: We have no reason to believe that this will happen and the reality is that President Obama is committed to ensuring full implementation of the Medicaid Expansion by states. On December 10, the Obama administration backed away from roughly $100 billion in Medicaid savings it had proposed during deficit-reduction talks earlier this year. In its December 10, 2012 FAQ to states, CMS notes: "The Supreme Court decision has made the higher matching rates available in the Affordable Care Act for the new groups covered even more important to incentivize states to expand Medicaid coverage. The Administration is focused on implementing the Affordable Care Act and providing assistance to states in their efforts to expand Medicaid to these new groups." We have no reason to believe that the federal government will change its mind about the 90% match in the year 2020 and beyond for the Expansion population.

Medicaid Myth #5: Overloading a broken Medicaid program hurts the most vulnerable. Adding so many more people to the Medicaid program will only make these problems worse. 
Reality: The poor who are also uninsured right now still get sick and use health care services. They just don't receive care when they need in the appropriate setting because they end up waiting until their conditions worsens or becomes an emergency. The Medicaid Expansion will allow this group for the first time to have health insurance, and therefore greater access to care at the right time, in the right setting. In addition, in a report released by the GAO (Government Accountability Office) last month, the GAO found that "in calendar years 2008 and 2009, less than 4 percent of beneficiaries who had Medicaid coverage for a full year reported difficulty obtaining medical care, which was similar to individuals with full-year private insurance." In fact, IL received a bonus payment of over $15 million last year for meeting quality and other standards in the CHIP program

The current Illinois Medicaid program is not broken; it is efficiently run. Nationally, the per enrollee cost growth in Medicaid (6.1%) is lower than the per enrollee cost growth in comparable coverage under Medicare (6.9%), private health insurance (10.6%), and monthly premiums for employer-sponsored coverage (12.6%). Illinois’ average annual growth in Medicaid spending for FY2007-FY2010 was 6.6%. While it is true that Medicaid in Illinois pays providers less than they typically receive from private insurance (and therefore fewer providers accept patients with Medicaid), to address this issue, beginning January 2013, the Affordable Care Act will be increasing Medicaid payments for primary care doctors.

These aren't the only myths about the Medicaid expansion; the opponents are so bereft of data that they have to result to myth-making. The reality is that the Medicaid expansion makes good fiscal sense and will make a huge difference in the lives of literally hundreds of thousands of Illinois residents. The reality is that the Medicaid expansion is an excellent deal for the state of Illinois.


Health & Disability Advocates
Heartland Alliance for Human Needs and Human Rights
Sargent Shriver National Center on Poverty Law