Post on 18-Jan-2016
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)
The Arc of Illinois Oct 201515
Contact Information
Kathy ChanDirector of Policy312-864-1152kchan5@cookcountyhhs.org