Updates on healthcare reform in Illinois

February 2018

At this time of year when the weight of all we bear seems reflected in dark grey skies and bleak landscapes, we may sometimes catch ourselves wishing darkness on those who are tormenting us, and tormenting those less fortunate. And yes, there are dark clouds full of  peril out there. But as Dr. King said, darkness cannot drive out darkness, only light can do that. And in this spirit, and in this month, we're here to shed a bit of light on some topics of the day - in hopes that the sun can be made to emerge again and shine some light on us all

 Association and short-term plans - the latest hell
The Administration continues to foist "solutions" to all the horror and misery that comes from increasing access to care. The latest comes in the form of "association" and "short-term" health plans.

These kinds of plans are not new, having existed in some form for over 20 years. They were specifically designed to provide health coverage with a limited scope: either for groups under the banner of an "association" or for a short time frame, usually 90 days. Because of this limited scope, these plans can circumvent some of the protections outlined in the Affordable Care Act, including the requirement to cover essential health benefits .

But their use is becoming more prevalent following an October executive order through which the administration sought to broaden people's ability to purchase these plans. The real question is how will states respond to this order, as each state has its own regulatory framework for what constitutes an association or short-term plan. Illinois does not, in fact, allow for the sale of short-term.

As for association plans, the federal Department of Labor has opened a public comment period on proposed rules to expand their use.

Will Illinois pursue similar a path? Stay tuned.

  How does HFS assign Medicaid members to plans?
The state's Department of Healthcare and Family Services has been saying that they're going to publish the algorithm they use to assign Medicaid members to health plans (members have 30 days after receiving their letter to make a selection; those who don't are auto-assigned). The agency has never made that formula public, but now they're saying they will. It's supposed to be posted on the Care Coordination page of the HFS website. As of yesterday, it's not there yet; but we will be keeping an eye out. It is worth noting, however, that the Care Coordination page is, even apart from that, a very interesting resource in that it contains a lot of links to plan notices, past documents, and other useful information. 

To recap the managed care roll-out: Members who were previously enrolled in managed care have already transitioned to their new "HealthChoice Illinois" plans; those in counties that had no managed care are receiving enrollment packets, with an anticipated go-live of April 1.  Children served under the Division of Specialized Care for Children (DSCC) and those in the foster care system have a tentative enrollment date of July 1 .

The latest available mailing schedules and go-live dates are posted at HFS. We will keep you advise on HealthChoice Illinois roll-out updates in future newsletters.

 Work requirements threaten access to care

Kentucky and Indiana have just had Medicaid waivers approved containing work requirements for beneficiaries following January's CMS guidance in support of such policies. We took a look at both waivers, as well as the eight pending work requirement waivers, to see what other changes they propose that might affect eligibility or affordability of coverage.  See fact sheet

 Money Follows the Person ready for reauthorization

Sen. Rob Portman (R-OH) introduced a bill in December to reauthorize the Medicaid-funded program Money Follows the Person program. This program provides states with funds to help seniors and people with disabilities move out of institutional care and back into the community. Our new fact sheet highlights the successes of the program and some of the challenges it faces.

And speaking of fact sheets, our series on Medicaid waivers and plan amendments remains highly pertinent, sadly for all the wrong reasons.

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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