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 currently 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. 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.
A legislative working group made up of members from both parties and both chambers has been discussing pain points in the Medicaid Managed Care program over the past year and a half in order to draft legislation. The culmination of that work is SB 1321 which is moving through the process as the 2019 legislative deadlines loom. Click here to learn more about Illinois’ Managed Medicaid Care program.
Under the Pritzker Administration, the Department of Healthcare and Family Services (HFS) is led by Theresa Eagleson who previously spent 15 years in leadership positions at HFS and served two Republican governors’ administrations. She brought in Doug Elwell, previously the Deputy CEO, Finance & Strategy for Cook County Bureau of Health, to serve as Illinois’ Medicaid Director. He held this same position in Indiana prior to coming to Illinois.
In addition to managed care issues, HFS must negotiate phase two of the hospital assessment and has re-started discussions around Illinois’ 1115 behavioral health waiver. Both the new hospital assessment and the 1115 behavorial health wavier were approved in June 2018 with implementation slated to begin July 1, 2018 at the start of the state’s new fiscal year. The hospital assessment went into effect, however federal CMS has granted some leeway to the state to implement the 1115 behavioral health waiver.
Illinois’ move to a privately managed Medicaid care system, the expansion of Medicaid coverage and the need for critical funding are all significant components of this complex program impacting the communities we serve. Each section below provides a deeper look on these key areas and includes links to recent articles, which can also be found in Featured News.
Medicaid Managed Care
In 2018, Illinois expanded the Medicaid managed care program to cover all counties in Illinois. As of April 2019, 2,097,951 individuals eligible for Medicaid were enrolled.
The program was initially created in 2011 when the Illinois General Assembly passed legislation mandating 50 percent of the Medicaid population to be covered in a risk-based care coordination program, or managed care program, by 2015. Governor Pat Quinn signed the Save Medicaid Access & Resources Together (SMART) Act (Public Act 96-1501) into law. The state’s goal was to create integrated delivery systems that provide quality care and result in better health outcomes for Medicaid recipients at reduced costs. Initially, this approach sought to save the state $16.1 million by integrating care for the most complex Medicaid beneficiaries.
Most recently, a legislative working group was formed and worked for nearly a year to increase transparency and address issues in the implementation of Illinois’ Medicaid managed care program.
Expanded Medicaid Coverage
Beginning in January 2014, under the Affordable Care Act (ACA), states were optionally allowed to expand those who are eligible to receive Medicaid coverage to include low income, non-elderly and non-disabled adults without dependent children, with incomes up to 138 percent of the federal poverty level ($16,394 for a single person in 2016). As of 2016, more than 637,000 individuals, or 20 percent of the 3.2 million Medicaid recipients in Illinois, had gained access to coverage under the ACA.
Funding for Medicaid
States design their Medicaid programs within broad federal rules; in return, Medicaid provides a guarantee of federal matching payments with no pre-set limit. There are special match rates for the ACA population, administrative costs and other specific services. Medicaid also provides “disproportionate share hospital” payments to hospitals serving a large number of Medicaid and uninsured patients.
Recent efforts to repeal and replace the ACA have challenged the way that Medicaid is funded. Many repeal and replace proponents believe states should have more flexibility in how they manage their Medicaid spending. Two major alternatives being discussed, block grants and per capita cap funding, would result in dramatic cuts to future federal funding for the Medicaid program.
Information from third-party organizations that can be resources for you to continue to learn about the issues at hand.