Updates on healthcare reform in Illinois

May 2018

Having testified on an early version of Illinois' proposed 1115 behavioral health waiver in 2016, we celebrated its long-awaited approval earlier this month. The first pilot kicks off in just six weeks, and we will be watching to see how long the others take to move off the dime, and what kind of geographic restrictions and enrollment caps the state make seek to place on them.

 1115 behavioral waiver approved at last

As you may know, the Department of Healthcare and Family Services was notified on May 7 that its section 1115 Medicaid behavioral health waiver had finally been approved. The agency announced the program - called the Better Care Illinois Behavioral Health Initiative - the same day.

The waiver, in the works since early 2016, was designed to support Medicaid beneficiaries with substance use disorders (SUD) and mental health challenges while also reigning in the costs associated with their treatment. As proposal documents indicated, beneficiaries with behavioral needs account for almost 60% of the program's spending.

Of the 10 pilots in the waiver, only SUD residential and inpatient treatment will start on July 1. This pilot will be statewide, and the state cannot institute annual enrollment limits.
The other pilots are targeted to various beneficiary groups with or affected by opioid/substance use disorder (OUD/SUD), crisis intervention for individuals experiencing a psychiatric crisis and intensive in-home services to stabilize behaviors that may lead to crisis. Details and start dates for these nine pilots have not been announced.

Better Care Illinois Behavioral Health Initiative's 10 pilots:
● Residential and Inpatient Treatment for Individuals with SUD
● Clinically Managed Withdrawal Management Services
● SUD Case Management (diversion from the criminal justice system)
● Peer Recovery Support Services
● Crisis Intervention Services (ages 6-64 experiencing a psychiatric crisis)
● Evidence-based Home Visiting Services (mothers during 60 days postpartum whose newborn has withdrawal symptoms and children up to age 5 born with withdrawal symptoms)
● Assistance in Community Integration Services
● Supported Employment Services
● Intensive In-Home Services (ages 3-21)
● Respite Services (ages 3-21 whose families need relief

The program would "help Illinois become a leader in integrating physical and behavioral health services for some of our most vulnerable residents," said HFS Director Felicia Norwood. "We have an opportunity to transform lives and be better stewards of taxpayer resources."

SPW's September 2016 1115 waiver testimony

 Blue Cross oops in IL

A s of April 1, Blue Cross and Blue Shield of Illinois has had  enrollment halted  in for new Medicaid members. It does not show up as an option for beneficiaries selecting a HealthChoice Illinois plan, and is not receiving auto-assignment of new members who do not make a plan selection.

HFS took the action citing network inadequacy and also noted that the plan is also out of compliance with the state's grievance and appeals standards. The insurer is also to pay a $150,000 penalty to the state.
The department said the insurer had failed to develop an adequate provider network in the northwest, central and southern regions of the state.

HFS Director Felicia Norwood  told legislators on April 26 that she expects the insurer to achieve compliance and be able to restart enrollment soon.

 Springfield watch
With the May 31st end of the state session looming, legislators are scrambling. Here are two bills on our radar.  

** HB 4383, Ensuring Patient Continuity of Care - This bill (sponsors: Feigenholtz/Steans) gives Medicaid managed care patients the option to remain with their primary care provider if their care is disrupted due to a contract termination between the PCP and a health plan. Currently, if such a contract is terminated, the patient must choose a new PCP which in many instances can sever a longstanding relationship, and is disruptive to continuity of care. Track bill status

** SB 2388/SFA1, The Short-Term, Limited Duration Health Insurance Coverage Act - This bill (sponsor: Steans) was developed with help from Protect our Care Illinois in response to the Trump Administration's proposed regulations to expand short-term insurance terms from three months to a year, and make them renewable. These insurance plans are not bound by ACA consumer protections and can deny coverage for pre-existing conditions. Analysts and advocates have decried short-term plans because of their potential to  undermine health risk pools and cause Marketplace premiums to soar. SB 2388 would:
● Require short-term plans sold in Illinois to limit their coverage duration to 90 days and with no option to renew
● Prevent issuers of short-term plans from discriminating against people with pre-existing conditions
● Require the application, sales and marketing materials for short-term plans to include disclosures such as "WARNING! This plan may not cover all of the health care you need and may leave you with very high medical bills."

A g
rowing list of senators are co-sponsoring the measure, but a committee hearing set for last week was postponed as opponents worked on an amendment for the house version. Currently, a House and a Senate version are being crafted.  Learn more at Protect our Care Illinois * Take action

  Shame on HUD

T he federal government provides housing assistance to the lowest-income Americans. Those with incomes below 50% of an area's median income currently receive subsided housing at 30% of household gross income. As was recently reported, Housing and Urban Development Secretary Ben Carson now wants to raise that to 35% and add work requirements. An increase in the ceiling for 712,000 households in this group would triple their rents to $150. It is not known whether Sec. Carson, who often refers to the fact he grew up in poverty, ever had his landlord triple the rent when he was growing up.

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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