Updates on healthcare reform in Illinois

March 2018

I was standing in the security check-in line as I headed to a morning meeting. The attendee in front of me remarked that it didn't feel like two months had passed since our last meeting. So true! And yet, each day seems to bring new state and federal developments that add to our list of challenges. This month we focus on bills before the State legislature and federal guidances that force us into more screen time and less Springtime.

 Illinois bills we're following
Protecting ACA protections. The Do No Harm Healthcare Act (HB 4165)
would prohibit the State from applying for any federal waiver that would reduce or eliminate any protection or coverage in effect on January 1, 2017 that was required under the ACA. It was voted out of committee 10-6 along party lines on March 8, and moved to the full House for consideration. The Rauner Administration is on record as opposing the bill and will work to stop its passage. (Sponsor: Greg Harris)

Access to mental health treatment. HB 5464 amends Illinois Insurance Code to permit treatment for inpatient and outpatient mental health benefits along with substance abuse disorder treatment for the first 180 days per plan year when deemed medically necessary by the person's health care provider and without the need for prior authorization. The insurer or MCO must allow immediate access to mental health or substance use disorder treatment, including allowing the patient to seek treatment out of network within 24 hours, if no in-network provider is immediately available. It was voted out of committee lines on March 8. (Sponsor: Sara Feigenholtz)

Medicaid single drug formulary. In an attempt to standardize drug formularies used by Medicaid managed care organizations, HFS included language in their most recent managed care contract requiring all plans to adhere to a single formulary (or preferred drug list) authorized by HFS. The contract further states that MCOs shall not deviate from the PDL, even if they choose to offer more generous coverage options. This single PDL thus creates barriers to care for a large number of Medicaid recipients living with chronic illnesses like HIV/AIDS. HB 4096 amends the Public Aid Code to require that the State's preferred drug formulary would only serve as a minimum standard, not a restrictive list, thus allowing MCOs the ability to provide stronger drug coverage if they choose. The bill was voted out of committee on January 30, but appears to be languishing on the floor. (Sponsor: Greg Harris). 

 Advocacy and action for healthcare access
Medicaid backlog. Advocates report that the Department of Healthcare and Family Services is running months behind in processing Medicaid applications and redeterminations. The Shriver Center advises community partners helping clients troubleshoot medical-only redetermination case to have them try to set up a Manage My Case (MMC) at ABE.Illinois.gov. The applicant should not go in person to the Medical Management Unit, but can contact the MMU by email: DHS.MMU@illinois.gov

#ProtectOurCare's text to action. Join Protect Our Care IL's mobile network. Text POCIL to 40649 to receive advocacy alerts (no more than two per month). Be in the know when it is of the utmost importance and you need to take action immediately Sign up

Sign up for Get Covered Illinois alerts. The Illinois Department of Insurance is dealing with a rapidly changing landscape. Advocacy groups and workers are encouraged to sign up for communications for GCI to stay abreast of changes and eventshttp://eepurl.com/cLN_Tv

 Useful info at Smart Policy Works

Why work requirements won't work. The Trump Administration is using its administrative authority to align Medicaid with conservative thinking that employment is linked to better health outcomes and helps move people out of poverty. CMS has already approved this shift in three states, with seven other states having similar waivers pending. But most Medicaid recipients are already working. And the track record of Clinton-era "welfare reforms" suggests this is not an effective way to enhance economic stability for people, or for states. Read the post

Expirations loom for Medicaid managed care. Although most states now deliver Medicaid services through managed care, in many states these programs come about through Medicaid waivers. Among the most frequently used are 1915(b) waivers, which have a short 90-day approval time frame and can last from 2 to 5 years. SPW has compiled a list of 1915(b) waivers  expiring before July 2019  to help promote the stakeholder engagement that is a critical piece of the waiver renewal process. Illinois' Managed Long Term Services and Supports waiver will expire in May 2019.

John Jansa
Smart Policy Works

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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