Health Care Reform and the Impact on Vulnerable Populations in Illinois

1
Health Care Reform and the Impact on Vulnerable
Populations in Illinois

• Stephanie Altman, Programs Policy Director
• saltman_at_hdadvocates.org
• John Bouman, President, Shriver National Center
  on Poverty Law, johnbouman_at_povertylaw.org
• Nelson Soltman, Supervisory Attorney, LAFMC,
  nsoltman_at_lafchicago.org

2
Key components of Affordable Care Act

• Individual Responsibility (the individual
  mandate)
• Employer Responsibility (the employer mandate)
• Employers with 50 or more employees are required
  to offer coverage or pay a free rider penalty
  if one of their employees is eligible for and
  receives a subsidy to purchase insurance through
  the exchange.
• Create state-based Exchanges through which
  individuals and small businesses ( of employees
  to be determined by state) can purchase coverage.
• Premium and cost-sharing credits available to
  individuals/families with income between 100-400
  FPL.
• Qualified health plans will be sold through the
  exchanges
• Large Expansion of Medicaid to Childless Adults
  up to 138 FPL.
• Significant Private Insurance Market Reforms
  including elimination of underwriting based on
  health status and ban on pre-existing condition
  exclusions.

3
Essential Benefits Package

• The minimum contents of the essential health
  benefits package, which will be detailed in
  regulations to be issued in 2012, comprise the
  following categories mandated in the Affordable
  Care Act (all health plans sold through the
  health care exchange must cover the essential
  benefits package at a minimum)

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder
  services
• Prescription drugs
• Rehabilitative and habilitative services and
  devices
• Laboratory services
• Preventive and wellness services including
  chronic disease management
• Pediatric services including oral and vision
  care.

4
Status of ACA Litigation

• Circuit Court Decisions and the Individual
  Mandate
• Can the ACA survive without the individual
  mandate?
• Supreme Court Cert in Virginia and Florida Case
• Political Considerations in Congress of the
  threat to repeal and replace.

5
Medicaid in Illinois Now

• Medicaid Categorical Eligibility (All Kids
  Family Care Moms and Babies AABD GA/TA)
• The Disability Determination SSI and SSDI
• Medicaid Medically Needy (Spend down)
• Medicaid Buy-In for Workers with Disabilities
• Medicaid Home and Community Based Waivers

6
Illinois Medicaid 2010- 2014

• Same mandatory and optional categories.
• Maintenance of Effort Provision (exceptions All
  Kids Family Care Illinois Cares Rx Provider
  Reimbursement.)
• Option to cover individuals in newly eligible
  below the 138 FPL category prior to 2014.

7
Medicaid Expansion in 2014

• In 2014, anyone up to 133 FPL is eligible for
  Medicaid, called newly eligible Medicaid.
• Must be under 65, not entitled to or enrolled in
  Medicare A or enrolled in Part B.
• Modified gross income test and no asset test,
  which is different from current Medicaid and
  SCHIP Programs.
• Federal government pays for much greater
  percentage of this expansion.
• Potential to alleviate challenge of the Medicare
  waiting period dependent upon coverage package.
• Most applications will be filed electronically
  through a Health Insurance Exchange. Others will
  be filed through more traditional methods.

8
Enrollment and Eligibility Issues in 2014

• Enrollment Procedures for Medicaid and Health
  Care Exchange applications online, by mail and in
  person
• Eligibility Determinations
• Due Process Issues

9
Going Backward Before We go Forward

• Medicaid Reform Legislation passed in Illinois in
  December 2010 and signed by Governor
• Caps All Kids at 300 FPL for new enrollees after
  7/1/2011.
• Grandfathers in current All Kids enrollees over
  300 FPL until 7/1/2012.
• Imposed new verification and eligibility barriers
  for Medicaid which have been disallowed by CMS.
• Imposes moratorium on Medicaid expansions until
  2013.
• Requires 50 of Medicaid enrollees to be in risk
  based coordinated care by 2015.

10
Integrated Care Pilot

• Pilot project for enrollment of 40,000 AABD
  recipients (non-dual eligibles) into managed
  care.
• Cook and Collar Counties with exception of City
  of Chicago.
• Enrollment through Illinois Health Connect and
  managed care through Aetna and Illinicare.
• Network issues and exception policies.
• Single Care Agreements and Continuity of Care.

11
Health care reform implementation in Illinois
illinoishealthmatters.org

• Governor Quinn signed an executive order on July
  30, 2010 to create the Illinois Health Care
  Reform Implementation Council to help implement
  ACA.
• The council issued recommendations to
• establish a health insurance exchange and other
  consumer protection reforms
• reform Medicaid
• assure high quality care
• identify federal grants and other
  non-governmental funding sources and
• foster the widespread adoption of electronic
  medical records.

12
ACA Provisions Already In Place

• IPXP Illinois Preexisting Insurance Program at
  http//insurance.illinois.gov/ipxp/
• Dependent Coverage up to age 26.
• No pre-existing condition exclusions or denial of
  coverage based on health status for children.
• Small Business Tax Credits available.
• Insurance Rescissions are only allowed in cases
  of intentional fraud or intentional
  misrepresentation.

13
Health Care Exchange Legislation

• SB 1555 (now Public Act 097-0142) was signed into
  law in August 2011 by the Governor.
• Creates a Legislative Task Force to Recommend
  Implementation and Design of the Illinois Health
  Care Exchange.
• Governance and Financial Sustainability are the
  major issues.
• Recommendations are due by Veto Session 2011 in
  order to continue to receive federal funding for
  the implementation planning process.
• State must continue to progress toward an
  implementation design and then get approval for
  final implementation by January 1, 2013 to
  continue to get federal funding.

14
Illinois Health Matters, a website, Facebook page
and Twitter feed, on health care reform in
Illinois, is producing multimedia snapshots on
how the Affordable Care Act is affecting or will
affect the residents in the South and West Sides
of Chicago. See our Neighborhood Stories site
herehttp//www.illinoishealthmatters.org/neighbo
rhood-stories.aspx