HOW ACA WILL AFFECT THE ILLINOIS MEDICAID PROGRAM

1. HOW ACA WILL AFFECT THE ILLINOIS MEDICAID PROGRAM Town Hall Meeting September 27, 2012

2. Key Things to Know About Medicaid • Medicaid is not Medicare, which is mostly for seniors, of any income – it’s 100% federally funded • Medicaid is healthcare for low-income adults and children – a mix of people with needs not otherwise covered by traditional insurance or Medicare • Medicaid is a state program, jointly funded by federal and state government – 50%/50% in Illinois (varies by federal formula) • Medicaid must comply with many federal laws as well as state laws

3. Our Medicaid Clients Today • Under current law, Medicaid clients must fit into a certain category to qualify, no matter how poor they are: • Children under 19 (called “AllKids”) • Persons with disabilities who meet the Social Security definition • Seniors aged 65 and older • Other adults • Parents and other caretakers of dependent children (called “FamilyCare”) • Pregnant women (called “Moms and Babies”)

4. Our Medicaid Clients, cont’d. • 2.7 million adults and children are currently enrolled • Children under 19 1,656,209 • Adults with disabilities 258,672 • Seniors 166,104 • Other adults 623,807

5. Our Medicaid Clients, cont’d.

6. But Small % of Medicaid Clients Incur Majority of Medicaid Costs 16% of clients who are Seniors and Persons with Disabilities (SPD) cost 55% of Medicaid budget (all agencies) – they have most complex health/behavioral health needs

7. Current Income Limits Under Medicaid • Medicaid is for low-income people • It is a “means-tested“ program, based on income • Includes asset tests for some groups (e.g., disabled) • But a person also has to fit into a category • Today, income limits are different for different groups • 300% federal poverty level for children • 133% federal poverty level for parents/caretakers • 200% federal poverty level for pregnant women • 100% federal poverty level for seniors and disabled, with an asset test

8. “New” Medicaid Under ACA • Under ACA, “new Medicaid” clients will qualify on basis of income, with a consistent national standard, not the current categories • Income level = 133% of federal poverty level (in 2012 about $25,390 per year or $2,116 per month for a family of 3) • In Illinois, additional 500,000 are expected to enroll in Medicaid • 2/3 could be “new Medicaid” clients who will qualify based on income • 1/3 could be currently eligible but are not yet enrolled (“old Medicaid”) • Federal government will pay 100% for “new Medicaid” through 2017; phase to 90% by 2022 • “Old Medicaid” will still be reimbursed at 50/50%

9. ACA Challenges for Medicaid • Need law setting out eligibility standards for “new Medicaid” clients • Need General Assembly action during 2012 veto session or by early 2013, at latest • Need healthcare providers willing to serve 500,000 more Medicaid clients • Alternative healthcare professionals to expand pool of doctors • More outpatient clinics in all neighborhoods, reflecting diverse cultures, languages, etc. • Need “new Medicaid” clients to fit into redesigned Medicaid service delivery system • In process of moving at least 50% of clients into care coordination/managed care by 2015

10. ACA Challenges for Medicaid, cont’d. • Need to manage continuity of care for clients moving from Medicaid to Exchange, and back, from one year to next (“churn”) • Don’t know medical history of “new Medicaid” clients – mostly single adults • Need to be ready to enroll “new Medicaid” clients as well as applicants to the Exchange, by Oct., 2013 • New Integrated Eligibility System (IES) will handle seamless application process • New system will include modern database matching to prevent fraud • Deloitte just won bid, and work is starting