EXPANDING COVERAGE IN CHALLENGING TIMES

1. EXPANDING COVERAGE IN CHALLENGING TIMES Anne Marie Murphy, Ph.D. Medicaid Director Illinois Department of Public Aid

2. FY2005 APPROPRIATIONS BY AREAAll Funds$11,998.8 Million Medical Programs • Hospital Assessment $1080.0M 9.5% Managed Care $181.9M(1.6%) Special Education Match $240.0M (2.1%) $778.1M 6.9% Remaining Medical • Energy Assistance • $312.4 M (3%) Practitioners $642.3M 5.7% P.A. Recoveries $28.0M (.2%) $2037.0.M 18% Drugs Administration $102.7M (1%) Inspector General $19.7M (.0%) $1,765.8M 15.6% Long Term Care Medical Services $11,330.5M (94.3%) Child Support $205.5M (2.%) $2,154.5M 19% Cook County & U of I Hospitals $2,450.9M 21.6%

3. Where there is a will, there is usually a way! In spite of tough budget times, Governor Blagojevich has prioritized health care. Illinois was the only state last year to do major coverage expansions without cutting provider rates, without cutting other eligibilities without increasing beneficiary out-of-pocket costs.

4. KidCare Now Covers Over 1 million Illinois Children Phase 2 of Kidcare implemented 10-1-1998 Phase 1 of Kidcare implemented 1-1-1998

5. Children 2002Actual Enrollment vsCensus Population Survey (CPS) According to CPS data, the uninsured rate for children in Illinois has decreased from 14.6% in 1998 to 11.35% in 2002 Total Medicaid Enrollment – Actually Enrolled 959,600 Total Medicaid Enrollment – CPS Data 637,288

7. KidCare/FamilyCare Expansions • July 03 – KidCare expansion from 185% FPL to 200% of FPL • July 04 – FamilyCare expansion from 49% FPL to 90% FPL • FY05 proposal – FamilyCare expansion from 90% FPL to 133% FPL

8. KidCare Rebate for those with Employer-sponsored Health Care • With private sector insurance rates increasing at close to 14%, this is leading to increased costs for employees • Originally funded at state expense. • No wrap-around benefits requirements • Benefit requirements – physician and hospital inpatient • No employer contribution requirements

9. SeniorCare • Implemented 05/02 as an 1115 pharmacy Waiver • Comprehensive prescription benefits for seniors with income up to 200% of FPL • Much more generous than Medicare drug bill

11. Illinois Healthy Women • Implemented 04/04 • Family planning waiver • Yearly physicals, family planning services, mammograms/treatment for STD and HIV detected at family planning visit • Currently, covering at state expense for multivitamins with folic acid

12. Show Me The Money! • In our HIFA waiver, we got federal match for programs that were previously state funded. • In our “unborn” SCHIP amendment, we got federal match for births that the state was previously paying for. • In our SeniorCare waiver we converted a state funded program to a federally matched program • We appropriated new dollars.

13. Federal Matching Funds for Rebate Program • Medicaid funding for Rebate (premium assistance program) • Medicaid funding for insured children who choose direct coverage • Insured children can move from premium assistance to direct coverage at any time

14. Federal Matching Funds for State Only Programs • Illinois Comprehensive Health Insurance Program (ICHIP) - state program for uninsurable persons • State Hemophilia Program – provides medical services to persons with hemophilia

15. Not just a program on Paper -Really getting Children enrolled ! • KidCare Application Agents (1100) $50 for an approved complete application 90% approval rating for apps received $7 million paid in Technical Assistance Payments (TAP) • General Outreach Gives hundreds of presentations on the KidCare program Work with community groups, employers, schools, hospitals, etc. throughout Illinois Promote KidCare at many county fairs, the Illinois and DuQuoin State Fairs • Targeted Outreach Hotline number included on Child Support checks disbursed throughout the state Osco-Albertsons Pharmacies – displayed posters and handed out applications Worked with SEIU to distribute KidCare material to all its members

16. Previous Simplifications • Eliminated asset requirement • No face-to-face interview required for application or redetermination • Two page mail-in application • 12 Months Continuous Eligibility

17. “One Pay Stub”January 2004 • Reduced income verification to require proof of one payment • Accept family’s statement regarding amount of child care paid • Denial rate for failure to provide verifications reduced by over 10%

18. Presumptive Eligibility Began 05/04 Authorized by state eligibility staff when application for medical benefits is received if: • Declared family income equal to less than 200% • No PE within last 12 months • No evidence that immigration status not met • Continues until decision is made on application • Authorized PE to over 3,000 families in first 10 days of program

19. Future Plans • Web-Based Application – December 2004 • Processing all mail-in applications within two weeks of receipt – end of summer • Looking at ways to streamline renewals

20. Future Initiatives for Federal Funding • Rebate for mandatory populations • Coverage for immigrant children in U.S. less than 5 years • Allow claiming for PE under Title XIX • Allow enhanced match for enrollment of Medicaid children above the level enrolled prior to SCHIP