cook county health & hospitals system impact of health care reform on children and adults with...
TRANSCRIPT
COOK COUNTY HEALTH & HOSPITALS SYSTEM
Impact of Health Care Reform on Children and Adults with Special Needs
Presentation to The Arc of IllinoisOctober 20, 2015
The Arc of Illinois Oct 20152
Overview
• About CCHHS • Overview of Illinois Medicaid• Understanding “New” Medicaid– Authorizing legislation– Eligibility criteria– Benefits– Who are the newly eligible?– How to apply?
• Redetermination • Medicaid Managed Care • Questions
The Arc of Illinois Oct 20153
CCHHS Mission
To deliver integrated health services with dignity and respect regardless of a patient’s ability to pay;
To foster partnerships with other health providers and communities to enhance the health of the
public;
And to advocate for policies which promote and protect the physical, mental, and social well-being of
the people of Cook County.
The Arc of Illinois Oct 20154
CCHHS OverviewCCHHS at a glance:• 2 hospitals• 16 community health centers• Correctional health services• Specialty care center for persons with infectious
disease• Nationally-certified public health department• CountyCare - largest Medicaid health plan serving
residents of Cook County; current membership includes over 170,000 members
The Arc of Illinois Oct 20155
Overview of Illinois Medicaid• FY2014 total Medicaid enrollment in Illinois – 3,142,849– In Cook County – 1,532,964
• An estimated 618,923 adults in Illinois are eligible for adult Medicaid expansion– 341,063 reside in Cook County
• Total ACA enrollment statewide: 616,604 (August 2015)• ACA Adult Enrollment in Cook County – 319,467 (August
2015)– Chicago – 208,639– Suburban Cook County – 110,828
The Arc of Illinois Oct 20156
Understanding “New” Medicaid
• Affordable Care Act, signed March 2010 made Medicaid expansion mandatory by 2014; Supreme Court made it permissive with their ruling June 2012
• As a result states needed to affirm their participation in Medicaid expansion• To date, 31 states have expanded, 1 has an open debate,
and 19 states are not moving forward at this time• Illinois Public Act 98-0104 expanded Medicaid in
Illinois, effective January 1, 2014
The Arc of Illinois Oct 20157
Understanding “New” Medicaid (cont’d)
• Age: 19 through 64 years • Income: less than 138% FPL (~$16,104 for a single person;
$21,707 for a couple)– Uses Modified Adjusted Gross Income (MAGI)
methodology– No asset or disability test
• Citizenship: US Citizen or qualified non-US citizen• Statewide enrollment began October 1, 2013 with coverage
effective January 1, 2014– Waiver approved October 2012; CountyCare became
operational February 2013
The Arc of Illinois Oct 20158
Covered Services• ACA Essential Health Benefits
– Ambulatory patient services– Emergency services– Hospitalizations– Maternity and newborn care– Mental health and substance use disorder services, including
behavioral health treatment– Laboratory services – Preventive and wellness services, as well as chronic disease
management– Prescription drugs– Rehabilitative and habilitative services and devices– Pediatric services, including oral and vision care
• Same benefits as “traditional” Medicaid, also access to Long Term Supports and Services based on medical necessity (see http://www.hfs.illinois.gov/html/082114n.html)
The Arc of Illinois Oct 20159
Who are the newly eligible? • Newly eligible includes, but is not limited to: – Children previously eligible for All Kids, but turned 19
years– Parents on FamilyCare, but whose youngest child
turned 18 years – Justice-involved individuals– Adults who are unemployed or are working in a low-
wage or part-time job– Youth/adult with a disability but who does not receive
SSI• Also those in SSI waiting period
– Former foster care children up to age 26 (all income is exempt
The Arc of Illinois Oct 201510
How to apply? • www.getcoveredillinois.gov – screening tool and find help
with the application process• Medicaid– Application for Benefits Eligibility (ABE) –
www.abe.illinois.gov – Medicaid and other income support programs - streamlined application for multiple programs
– Apply ANYTIME– CCHHS offers in-person and phone assistance via hotline
at: 312-864-8200• Those ineligible for Medicaid may be referred to
Marketplace OR CCHHS financial assistance program • Marketplace for those ineligible for Medicaid– www.healthcare.gov – Open enrollment period: Nov 1, 2015 – January 31, 2016
The Arc of Illinois Oct 201511
Medicaid Redetermination• ALL Medicaid beneficiaries MUST complete an
annual redetermination (i.e. renewal) to be assessed for ongoing eligibility
• Medicaid only cases and those who experience a Medicaid “category change” will be contacted by Illinois Medicaid Redetermination Project (IMRP)
• ACA adults are experiencing the redetermination process for the first time and may need extra help
• Most cases are being cancelled for non-response to redetermination notice
The Arc of Illinois Oct 201512
Medicaid Redetermination (cont’d)• Illinois Medicaid Redetermination Project – 1-855-HLTHYIL (1-855-458-4945) – TTY: 1-855-694-5458 – FAX: 1-866-661-7025
• www.hfs.illinois.gov – Illinois Medicaid Redetermination Project– Frequently Asked Questions – Sample client notices– Link to upload redetermination documents
The Arc of Illinois Oct 201513
Medicaid Managed Care • State legislation enacted 2011 requires 50% of
Medicaid enrollees be in “care coordination or managed care” by 2015
• Nearly all Medicaid beneficiaries in Cook and the Collar Counties will be required to choose a Medicaid Managed Care Plan and Primary Care Provider OR be auto-assigned
• Illinois Client Enrollment Services is managing mailings and enrollment – 1-877-912-8880
The Arc of Illinois Oct 201514
Medicaid Managed Care (cont’d)
Beneficiary receives
enrollment packet
Beneficiary has 60 days to
choose a plan
Beneficiary chooses OR is auto-assigned
to a plan
Beneficiary has 90 days to switch to
another plan
Beneficiary is locked into plan until the
next Medicaid open enrollment period
(about one year later)
