The foundation of the health care safety net, Medicaid is a federal program administered by the state that covers more than 3.0 million children, seniors and individuals with disabilities in Illinois.
Medicaid is an entitlement program, which guarantees coverage for those who meet certain eligibility requirements. The program is funded by a combination of state and federal tax dollars, with federal funding guaranteed by matching the amount spent by the state. The state has flexibility regarding the amount that it determines should be spent on the program, allowing states to grant more resources to the program or expand coverage to other populations.
Sixty cents of every dollar coming to AMITA Health is from a government source, mainly Medicare and Medicaid. These funds, largely allocated to pay for services for those who cannot afford private insurance, allow us to continue to provide compassionate care for our communities.
Medicaid is different from Medicare, which is another government program that provides health insurance. Medicare is another federal government program that provides health insurance. If you are 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD). The Centers for Medicare & Medicaid Services (CMS) is the federal agency that runs Medicare. The program is funded in part by Social Security and Medicare taxes you pay on your income, in part through premiums that people with Medicare pay, and in part by the federal budget. Also, eligible individuals can have both Medicare and Medicaid and are known as dual-eligibles.
In Illinois, Medicaid is administered by the Department of Healthcare and Family Services (HFS). Under the Pritzker Administration, HFS is led by Theresa Eagleson who previously spent 15 years in leadership positions at HFS, including as Medicaid Director.
Over the past few months HFS has been focused on COVID-19 response and efforts to implement new and previously unimagined services, flexibilities, authorities, policies, and procedures to serve Medicaid clients. Some of the things on which HFS is working include:
- Telehealth emergency and administrative rules for the COVID-19 pandemic
- Eligibility changes postponing redeterminations
- Improvements on the backlog of Medicaid applications and LTC applications
- COVID testing for the uninsured
- Remote Patient Monitoring and Pandemic Heath Worker Programs available around the State
- Implementing a new Medicaid-like program for low-income immigrant seniors over age 65
- Returning Pay-For-Performance dollars to the Medicaid MCOs so they can use those funds to support providers, especially behavioral health providers during the pandemic, as well as getting stability funding to the State’s hospitals
- Working with advocates and MCO partners on things such as providing blood pressure cuffs for pregnant and postpartum women at no cost, and without Prior Authorization, so they can monitor their health from home and have telehealth visits with their OB-GYN during the pandemic
- Federal CMS Approval of 1115 Waiver for 12-month Postpartum Coverage (still pending)
- Preparing to roll out the YouthCare program
A legislative working group made up of members from both parties and both chambers has been discussing pain points in the Medicaid program. The group worked with HFS and the hospital community to negotiate phase two of the hospital assessment, which was passed in the 2020 Spring session and provided much needed additional funding to Illinois hospitals and physicians.
Integrated Health Homes
HFS has re-started discussions around Illinois’ 1115 behavioral health waiver, which creates Integrated Health Homes for Illinois Medicaid enrollees. The waiver was originally approved in June 2018 but implementation has been delayed. They are now in the third year of program development. HFS is re-examining the program’s components and placing a renewed focus on addressing social inequities. The agency is also working to refine the care management model and tailor it more to complex individuals.
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Illinois is hiring hundreds of frontline workers to resolve major delays of its Medicaid application and renewal processes.
Crain's Chicago Business + July 01, 2019 + View Article