This page is dedicated to the ongoing discussion of healthcare reform in Illinois and its impact on community-based human service providers.
Illinois is launching a new public-private partnership experiment for children who are jointly engaged in juvenile justice and child welfare programs in order to give investors an opportunity to weigh in on the way the State delivers social services.
The initiative is supported by Social Impact Bonds, which is funding from the private sector, foundations, and wealthy individuals that invest in programs to improve upon the delivery of human services. The appeal? If the program works, then investors will be reimbursed and earn a profit. The government also reduces upfront payments to cover these services and discovers efficient means to address certain societal problems. The downfall? Well, if the program produces zero results then investors lose their investment, and the government fails to reach their target of discovering new models for services. The concern? There’s recent criticism involving a similar program that was launched in Utah. Researchers identified a number of irregularities in the way success was measured for this program. So, the investor made money, but the program might not have had the intended impact.
Judge for yourself and check out how people weighed in using the links above.
Medicaid Managed Care Transformation to “HealthChoice Illinois”
HFS has launched a new Medicaid Managed Care Program called HealthChoice Illinois. All individuals enrolled with a FHP/ACA, ICP, or MLTSS managed care health plan will be transitioned to the HealthChoice Illinois program.
Exiting health plans are Aetna Better Health, Community Care Alliance, Family Health Network and Humana Health Plan, but are required to continue ensuring care until 11:59pm December 31, 2017.
Seven health plans are scheduled to begin operations on January 1, 2018: Blue Cross Blue Shield of Illinois, CountyCare (available only in Cook County), Harmony Health Plan, IlliniCare Health Plan, Meridian Health, Molina Healthcare of Illinois, and NextLevel Health (available only in Cook County).
HFS has also created a portal for providers to seek support for resolving issues with MCOs for the Medicaid Managed Care transformation.
HEALTHY ILLINOIS 2021 – Click Here to access information regarding Public Hearings on the State Health Assessment and State Health Improvement Plan this month
The State Health Improvement Plan (SHIP), State Health Assessment (SHA), and State Innovation Model (SIM) are three statewide initiatives that focus on improving the health of Illinois residents. Collectively, these initiatives are called Healthy Illinois 2021. These processes help us understand the current health status in Illinois and establish health improvement strategies that address needs and gaps and engage all aspects of the public health system. Participants in focus groups, presentations, and webinars will be asked to provide feedback on the current state of health and their work related to health improvement.
East Central Illinois Area Agency on Aging, Inc. released a report on the impact of the State budget crisis on Illinois seniors and community programs.
- 100% of Adult Protective Services dollars are not being paid.
- 80% of Long Term Care Ombudsman dollars for Nursing Home Resident protection are not being paid.
- 50% of Home and Community Based Service funds are not available.
- 100% of Senior Health Assistance Program Services are not available.
(The above percentages may vary by region)
November 2017- HFS launches new Medicaid Managed Care Program called “HealthChoice Illinois”. More details included above.
November 2016- The White House released state fact sheets showing the impact of repealing the Affordable Care Act. View the Illinois fact sheet here.
March 2016 – The Henry J. Kaiser Family Foundation published “Profile of Medicare Beneficiaries by Race and Ethnicity: A Chartpack”. This chartpack draws on data and analysis from a variety of sources to profile the Medicare population through the lens of race and ethnicity, describing life expectancy, demographic characteristics, income and savings, health status and chronic conditions, supplemental coverage, selected measures of access to care, and service utilization.
January 2016 – The College for Behavioral Health Leadership recently conducted a national survey to analyze compensation for peer-support specialists. Their report reveals some striking differences among the current national structures for PPS wages.
October 2015 – The Henry J. Kaiser Family Foundation published a brief that analyzes long-term services and supports (LTSS) among seniors living in the community.
July 2015 – Medicaid Payments to Those Caring For Children Throughout State Will Continue During Budget Impasse – Click Here to read more!
April 2015 – The Illinois Department of Healthcare and Family Services has released its Annual report for FY2014.
March 2015 – The Illinois Department of Healthcare and Family Services has released guidance on billing procedures for medical providers based on clients’ Care Coordination health plans.
December 2014 – The Centers for Medicare & Medicaid Services (CMS) has announced Illinois as a Model Design Award recipient in its second round of the State Innovation Models Initiative. This award money will help to improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries.
November 2014 – “The Dismantling of Medicaid” How managed care has changed the nature of Medicaid – Click Here
October 2014- The Governor’s Office of Health Innovation and Transformation, the Illinois Department of Public Health, and the Illinois State Health Improvement Plan (SHIP) Implementation Coordination Council will host a series of forums across the state to explain changes with the healthcare system in Illinois. They will also serve as an opportunity for stakeholders to provide feedback to the state. The healthcare summit flyer has more information about registration.
September 2014- There are a lot of moving parts to healthcare reform in Illinois. The Health and Medicine Policy Research Group (HMPRG) put together a report explaining the many facets of healthcare reform, and how these pieces fit together (Note: this report is still a draft and is subject to change).
September 2014 – The Children’s Services GOHIT (The Governors Office of Health Innovation and Transformation) Subcommittee has prepared a concise sheet explaining the differences between the various Managed Care Entities (MCE’s) Click Here
August 2014 – “Inmates signing up for Obamacare: Dart” Cook County Sheriff Tom Dart discusses the impact of the Affordable Care Act on mental health care for the incarcerated. Click here to read more
August 2014 – “Nearly 1 in 6 Blue Cross patients in Illinois to be assigned to new managed care groups” Click Here to Read More
July 2014 – Effective July 1, 2014, behavioral health providers providing services to individuals covered by a Managed Care Organization (MCO) may no longer bill the state directly for reimbursement, and must instead bill the MCO directly. HFS encourages providers to contract with MCOs in their area in order to continue to provide services to their patients and ensure timely payment. Click here to view the notice from HFS.
July 2014 – Effective July 1, 2014, Adult Dental Benefits will be restored to the 2011 levels by the Illinois Department of Healthcare and Family Services (HFS) Click Here to learn more.
June 2014 – The State of Illinois intends to submit a Model Test proposal to the Center for Medicare and Medicaid Innovation under the State Innovation Model Cooperative Agreement Funding Opportunity (CMS-1G1-14-001): Click Here to Read
June – 2014 – The Department of Healthcare and Family Services put together three documents to help with enrolling in a health plan:
- FAQ’s Information Brochure – Click Here to Learn More
- For a step by step help to enroll online guide – Click Here for Help
- Read More Here After choosing your health plan review your Initial Enrollment Letter
May 2014 – The Department of Healthcare and Family Services put together this summary of changes:Click Here to Read
Additionally, they have shared updated demographic data through April 2014 of the enrolled Medicaid expansion population: Click Here to Read
A meeting schedule for discussions regarding the 1115 Waiver can be found on the Illinois Department of Health and Family Services website. For full information regarding the Waiver, please visit their website.
October 2016: Illinois officially submitted the 1115 Waiver to the federal government. The final submission can be found here.
On September 2nd 2016, the Illinois Department of Healthcare and Family Services (DHFS) released the 1115 Research and Demonstration Draft Waiver for public comment. In partnership with 11 other State agencies and the Governor’s office, DHFS is seeking a five year Medicaid Section 1115 Research and Demonstration waiver for its Behavioral Health Transformation. The demonstration waiver is designed to transform the behavioral health system, integrate behavioral and physical health and optimize outcomes for Illinoisans.
Click here to read the Notice of Public Information and brief summary of the 1115 waiver.
Click here to read the full 1115 waiver released in September 2016.
Click here to review slides released prior to the Joint Public Hearing on the 1115 Waiver.
Click here for an up-to-date two page overview of the 1115 waiver.
Click Here for 1115 waiver FAQ’s.
Click Here to read the 1115 Waiver Proposal released in June 2014.
Care coordination implementation is a complex issue facing Illinois. Care Coordination requires that 50% of Medicaid clients be enrolled in care coordination programs by 2015 under one of a variety of managed care entities. Click here for a short summary of each type of managed care entity.
Click Here for the latest informational update from the Department of Health and Family Services
Click Here for a diagram illustrating components of Coordinated Care.
Click Here for a map of Care Coordination Expansion in Illinois.
“Medicare Medicaid Alignment Initiative (MMAI) plans synthesize Medicare and Medicaid benefits into one health insurance plan for dual-eligible beneficiaries. This brief is intended for health providers and benefits counselors to assist consumers in using and navigating this new health insurance option. There are six Chicago-area health insurance plan options and the two Central Illinois health insurance plan options. Commonly asked questions and details regarding these plans are addressed within this text.”Click Here to read more.
Click Here to learn more about what “Pay for Success” is.
Long Term Care Services
Illinois is undergoing a shift from funding nursing facilities to home and community based settings.
Click Here to learn more
Affordable Care Act (ACA) Implementation: Expanding Coverage in Illinois
The Supreme Court, in its decision on the Affordable Care Act, asserted the full implementation of Medicaid provisions was an option, not a mandate, for states. Illinois must officially opt-in to full Affordable Care Act implementation to ensure Medicaid coverage for newly eligible legal residents and receive full funding from the federal government for the first three years.
If Illinois defers implementation or chooses to opt-out, many poor Illinoisans will go without health coverage; unable to enroll in Medicaid or access federal subsidies for those with higher incomes.
Click Here to read a report regarding Small Businesses and the Affordable Care Act.
Medicaid expansion is a sound investment for Illinois, take a look at this!
3 million people benefit from Medicaid in Illinois. In messaging to your network, please feel free to use this info sheet explaining the importance of investing in Medicaid, and find out how many people are enrolled in Medicaid in each Senate District and House District.