Updates on health care reform in Illinois

Chicago tax bill protest
December 2017

So much has happened over the past month that any attempt to provide updates could risk being made irrelevant by the time we hit the "Send" button. The much-discussed tax bill is making its unceasing progression towards passage. 

Some caveats are in order: Yes, the House and Senate have to come together to craft a final version. And yes, that final version may look different than what exists now. But the core issue remains: Whatever form the tax bill takes, once signed it will surely negatively impact the nation's budget and create ever-increasing pressure to cut back spending for public programs to make up for the trillions in lost tax revenue.This bill represents nothing else but a clear strategy of creating a crisis in order to justify undercutting the critical safety net programs millions rely on.

Meanwhile, events continue to unfold that are impacting Illinois' healthcare landscape.

 HCBS rule under continued threat
The home and community based services settings rule was first promulgated in January 2014 under sections 1915(c), (i) and (k) of the Medicaid statute. The rule lays out clearly the next step in the continued process to address the imbalances between institutional and community-based settings in Medicaid spending. Originally, states had five years, until March 2019, to submit plans to CMS outlining how their Medicaid agency would evaluate a setting's compliance. Actions by CMS, under the guise of giving states more time to address challenges, have pushed back enforcement of this rule for three years, to March 2022.  

Unfortunately, large-scale institutions, especially those serving people with developmental disabilities, have seen this pushback as an opportunity to further erode enforcement. These operators have consistently provided services in size, scale, and scope that demonstrate noncompliance with the rule. Instead of working to scale back their institutions to facilitate compliance, they have used legislative pressure -  in the form of letters to CMS and proposed budget amendments - seeking to undermine the rule and allow their institutions to be considered community-based settings. Expect further action by these groups, as well as reaction from the disability advocacy, community going forward.

 Medicaid managed care roll-out
January 1 is right around the corner - and perhaps no one is feeling it more keenly than the seven managed care organizations in the state that will be expected to begin serving Medicaid enrollees in Illinois.  

Illinois' Department of Healthcare and Family Services is in final preparations for its Medicaid managed care program, re-branded as HealthChoice Illinois, to go-live January 1. Medicaid enrollees already in managed care are being transitioned to one of the seven plans that won state contracts earlier this year. This transition applies to enrollees living in one of the 30 counties (shaded) that adopted managed care beginning in 2011.

The state anticipates an April 1 go-live for Medicaid enrollees living in counties new to managed care. The final go-live, for those in the DCFS Youth program, is expected in July 2018.  HFS posts all HealthChoice Illinois member and transition notices on its
Care Coordination page.

 ACA enrollment
Marketplace enrollment took off with a bang in Illinois. During the first four weeks of this open enrollment period, 95,000 Illinois residents selected plans on the exchange - a 40% increase over the same time period last year. Other states have seen similar increases. Since the Thanksgiving holiday, however, the pace of enrollment has slowed.  

To make up for the Trump Administration's attempts to limit sign-ups, the state's Department of Insurance beefed up its outreach efforts, taking a van tour to every county in the state, and community organizations doubled down on enrollment assistance. A final reckoning of the results won't fully be known until after the enrollment period ends on December 15.

 Mental health parity in Illinois
Next year will mark the 10th anniversary of the landmark federal Mental Health Parity and Addiction Equity Act. The goal of the act is to push for non-discriminatory access to mental health and substance use disorder treatment. That is, access free from enhanced prior authorization processes, dollar or service limits, or lack of sufficient provider networks.

Illinois was selected as one of five states to participate in the November launch the Parity@10 Compliance Campaign. Parity@10 is a three-year campaign to establish effective models for robust Parity Act enforcement. The campaign is intended to ensure that insurance carriers and state medicaid programs offer fully parity-compliant susbstance use and mental health benefits, and that regulators end complaint-driven enforcement models that put the onus on consumers to fight for the health care to which the law entitles them.

The Illinois House Mental Health Committee held a subject matter hearing yesterday (Monday, December 4). It examined the barriers people with mental health conditions continue to face in seeking treatment, and the steps health plans and the state agencies are taking to ensure compliance with federal and state laws meant to address past inequities in service delivery.

This issue brief from the Kennedy Forum, one of the five advocacy organizations spearheading the campaign, provides good background.

 CHIP still waiting

Remarkable as it may seem, Congress has still not managed to reauthorize the Children's Health Insurance Program, which provides health care coverage for children whose families make too much to qualify for Medicaid but too little to pay for private insurance. Some 9 million children depend on CHIP, about 131,000 of them in Illinois. This unprecedented failure to move quickly to reauthorized a popular program that has enjoyed bipartisan support is a depressing sign of the kind of wrangling and inattention we nowcan expect from our government on an annual basis.

John Jansa
Health & Disability Advocates

Please forward this newsletter to friends or colleagues who are interested in how the ACA and other developments are impacting health care in Illinois with. If you have questions or suggestions, email us at info@illinoishealthmatters.org .
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