Medicaid Reform in Illinois: Moving Backward Before Going Forward

1. Medicaid Reform in Illinois:Moving Backward Before Going Forward Stephanie Altman, Programs & Policy Director Health & Disability Advocates www.hdadvocates.org 312-223-9600 saltman@hdadvocates.org

2. About HDA • Since 1992 • Chicago-based, state/national in scope • Advance health, education, workforce and income equity for people with special health care needs • Staff: Lawyers, MSWs, Policy Analysts • Client Representation, Medical Legal Collaboration, Training/Consulting to States on Public Benefits and Employment • Policy/Advocacy • Health and Workforce Equity, Special Education, People with Disabilities, etc. • Since 2010, main focus on Affordable Care Act celebrating 20 years of helping vulnerable populations thrive Like us on on.fb.me/hdadv Follow us on Twitter @hdadvocates www.hdadvocates.org

3. Overview of 2012 Medicaid Reform Legislation • SB 2840: Save Medicaid Access and Resources Together Act (cuts) • SB 2194: Cigarette Tax • HB 5007: authorizes Cook County Medicaid waiver, extends moratorium on expansion to 2015, with an exception for those that don’t cost Illinois any money • SB 3397: Reforms practice of pushing Medicaid bills to next year • SB 3261: Hospital charity care

4. Overview of SB2840 • Assumes $1.3B in savings for FY13 • Eligibility and program cuts • Utilization controls • New cost-sharing requirements • Other: • Rate reductions • Care coordination

5. Eligibility and Program Cuts in SB2840 • FamilyCare – Reduced eligibility for adults and relative caregivers to 133% FPL (~$30,600/year for family of four) • Illinois Cares RX – Eliminated prescription drug assistance program for seniors and persons with disabilities • General Assistance – Eliminated • Medically Fragile/Technology Dependent waiver program – Capped eligibility at 500% FPL and new cost-sharing requirements

6. Utilization Controls in SB2840 • 4 prescription drugs/month • Annual limits on certain adult therapy services • Elimination of dental for adults, except in an emergency • Elimination of podiatry for adults, except for diabetics • Elimination of adult chiropractic services • Eyeglasses for adults limited to every two years • Change in DON from 29 to 37 • Payment for non-medically necessary c-sections

7. New Cost-Sharing Requirements in SB2840 • Cost-sharing increased to maximum allowed by federal law • MF/TD cost-sharing based on co-payment for certain services • Children and pregnant women continue to be exempt from co-pays

8. Other Provisions Contained in SB2840 • Medicaid payment reductions for Nursing Facility Services and some hospitals • Supports moving forward with care coordination • Elimination of technical assistance payments to All Kids Application Agents • Requires contact with private vendor for verification of renewal applications

9. Implementation of SB2840 • Information and notices to Medicaid beneficiaries and providers -- doctors, hospitals, pharmacies, etc. • http://www2.illinois.gov/hfs/agency/Pages/Budget.aspx • Rules issued in Illinois Register and available for public comment                           • http://www.cyberdriveillinois.com/departments/index/register/home.html • Regular and emergency rules - Joint Committee on Administrative Rules • http://www.ilga.gov/commission/jcar/ILRulemakingProcess.pdf

10. Updates on other Medicaid-related legislation • SB 2194: Cigarette Tax - $1/per pack increase currently in effect • HB 5007: Cook County waiver is still pending with the federal government • SB 3397: Legislation phases-in changes – limits to $700M in FY 2013 and $100M in fiscal years after 2013 • SB 3261: Hospital charity care – rules are currently being developed

11. Advocacy Opportunities • Joint Committee on Administrative Rules • HFS website – www.hfs.illinois.gov • Medicaid Advisory Committee Meetings – next meeting will be on Friday, September 21 • http://www2.illinois.gov/hfs/PublicInvolvement/BoardsandCommisions/MAC/Pages/default.aspx

12. Effects of the ACA on current and newly un- and underinsured • Medicaid available to those with income up to 138% FPL (~$15,000/year for a single person) • Tax credits and subsidies to help pay for private insurance • Competitive health insurance marketplace, i.e. The Exchange • Navigators – HMA report at http://www2.illinois.gov/gov/healthcarereform/Documents/Health%20Reform%20Implementation/IL%20Navigator%20Final%20Report.pdf • Essential Health Benefits – Recommendation made on 9/29/2012 to CMS http://www2.illinois.gov/gov/healthcarereform/Pages/default.aspx • IPXP, Dependent Coverage, and Cook County Expansion

13. What Now? • Veto session scheduled for November 27-29 and December 4-6 • Governor’s Health Reform Implementation Council • Medicaid Advisory Committee • Refer individuals who have lost coverage to advocacy and legal aid organizations to assess whether there are alternative coverage sources or appeals available • Resources: • http://www.ilmaternal.org/docs/factsheets/IMCHChealthresourcesdocument.pdf (primarily for clients) • http://www.ilmaternal.org/hcr/InformationonMedicaidReformforProviders.pdf (primarily for providers) For webinar technical support, please call 800-263-6317 and press options 2, 1, 1or visit http://support.gotomeeting.com

14. What You Can Do • Track the impact on your clients; educate your legislators; refer patients and clients to advocacy and legal aid organizations for individual assistance. • Invite us to present and suggest future topics • Bookmark www.illinoishealthmatters.org and join FB, Listserv, and Twitter

15. Resources