Welcome to the Illinois Health Matters Blog

What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Friday, May 31, 2013

Medicaid Expansion Passes Both Houses of the Illinois General Assembly

Earlier this week, the Illinois Legislature passed a bill (SB 26) to implement the Medicaid expansion option for adults without minor children on January 1, 2014. This expansion is a cornerstone of the Affordable Care Act and has the potential to cover over 600,000 low income adults in Illinois under the Medicaid program. The bill has overcome many hurdles along the way and now will be sent to the Governor's desk for his signature.

A year ago, the Supreme Court made the Medicaid expansion to adults an option that states did not have to take. However, the expansion is financially advantageous for states because the federal government pays all of the costs of the new Medicaid adult group for the first three years and thereafter, the state pays no more than 10% of the costs - making this the most lucrative Medicaid program in history for state governments. This coverage program will bring needed revenue to Illinois including to local entities such as Cook County and the City of Chicago as well as to hospitals and other safety net providers.

Illinois will begin accepting Medicaid applications for this new adult group on October 1, 2013, and coverage will begin on January 1, 2014.  For residents of Cook County, they can enroll right now and begin getting coverage into the CountyCare program which is an early implementation of the Medicaid expansion. The passage of SB 26 ensures that CountyCare enrollees will be able to continue to be covered under Medicaid along with the rest of the state in 2014.

In addition, SB 26 makes other changes to the Medicaid program including "fixing" some of the SMART Act Medicaid cuts by partially restoring dental care to pregnant women. Some mental health advocates were opposed to an amendment added onto the bill, that allowed a new category of mental health facilities for short term crises. For any questions, you can contact me at saltman@hdadvocates.org.
 
Stephanie Altman
Programs & Policy Director
Health & Disability Advocates

Saturday, May 25, 2013

ObamaCare Is Here – But Is It Working for People with HIV?

Read AFC's CountyCare report and press release. 
On January 1, 2014, national health care reform will kick into high gear, providing new health insurance options for millions of people across the country. And thanks to visionary leadership from Cook County Board President Toni Preckwinkle, Cook County Health and Hospitals System Board CEO Dr. Ram Raju, and the Obama administration, the Affordable Care Act (ACA) is already being implemented in Cook County in the form of CountyCare.
This new program implements a provision of national health care reform that allows states to expand Medicaid programs to cover most low-income adults. The federal Center for Medicare and Medicaid Services (CMS) granted Cook County permission to implement the program in October 2012. Previously, as many as 250,000 Cook County residents were excluded from Medicaid because they did not meet the program’s restrictive eligibility requirements, such as being totally disabled. The AIDS Foundation of Chicago (AFC) estimates that 1,800 or more Cook County residents with HIV could benefit from CountyCare.
While CountyCare is a sign of great things to come, it also provides some critical lessons that can be applied later this year when health care reform rolls out statewide. AFC recently released a new report, CountyCare & the Ryan White Program: Working Together to Optimize Health Outcomes for People with HIV, that details the importance of CountyCare and the role it can play in improving access to health care for HIV-affected individuals. It also contains a number of policy recommendations for the city and state departments of public health, Cook County, and the federal government that aim to improve the program for people with HIV and avoid problems in the future.
The most significant issue with CountyCare for people with HIV is that nine HIV clinics  in Chicago are excluded from the primary care network. As a result, 500 or more patients with HIV could be forced to switch doctors to receive care at a clinic that’s already enrolled.
Many low-income people with HIV have connections to the health care system that are tenuous at best. They are facing not just HIV and its paralyzing stigmas, but also homelessness, mental illness, substance use, and chronic physical health conditions, such as diabetes and heart disease. Large numbers live in violence-plagued communities in Chicago, where a trip to the corner store can mean getting caught in turf-war crossfire. In such contexts, HIV care is the last thing on a person’s mind, and something as simple as having to find a new doctor can cause them to drop out of medical care entirely.
Delayed or disrupted health care harms people with HIV and also worsens the health of our communities.  People who are not taking HIV medications face a far greater risk of transmitting HIV to their partners. In fact,research shows that people whose HIV is controlled with medications have a 96 percent lower risk of transmitting HIV to their partners.
If those nine clinics are unable to join the CountyCare network, their HIV-positive clients will be forced to switch to new health care providers. The federal Ryan White Program, which subsidizes medical care for low-income uninsured patients with HIV, is mandated by law to be the payer of last resort, tapped only when people have exhausted all other sources of coverage. In fact, federal law prohibits clinics from serving patients with Ryan White dollars if their insurance could be used. Thus, people with HIV are caught in a bind: They are required to apply for all insurance for which they are eligible, but if they enroll, they might be forced to leave their current health care provider of choice.
The Ryan White Program’s payer-of-last-resort provision is a double-edged sword. Despite being a resource for people without coverage, it has the potential to disrupt existing doctor/patient relationships, something all of us – and especially people with chronic, complex health conditions like HIV and other co-occurring diagnoses – want to avoid.
Such potential disruptions occur because different federal government entities routinely drop the ball in coordinating and communicating their strategies. One of the lessons we have learned as we prepare to implement health care reform nationwide is to closely monitor the interactions and implications of various programs.  We cannot rely on the federal government to communicate across or even within agencies. Sustained advocacy and vigilance will be needed as health reform kicks off.
So what are other lessons we are learning from the CountyCare rollout, and what can we do to avoid situations like this in the future?
It’s clear that the transition to new health care reform programs will be slower than we want. Case managers and other staff at community clinics are already overwhelmed by the flood of clients they see every day; it will be challenging to help thousands more people apply for new ACA programs, connect them important resources, and ensure they’re receiving optimal HIV care. New federal funding for ACA enrollment staff will hopefully help with this task.
Moreover, the HIV community needs to better prepare itself for health reform programs. Most importantly, clinics should aggressively reach out to new Medicaid and private insurance programs to make sure they are part of these new programs, and the insurance companies must do their part and enroll HIV clinics in their networks.  Clients can’t be stripped of medical options because their doctor doesn’t accept their insurance.
Establishing the right enrollment and service systems under CountyCare is paramount for people living with HIV. We have a unique opportunity to improve health care access and services for individuals with this disease. Getting this right is imperative, so we can learn from this rollout and help tens of thousands of other Illinoisans affected by HIV, who will have new insurance options in 2014 when the ACA goes into full swing.
The new report from AFC also details recommendations for service organizations, case managers, government officials, and people with HIV, so that all can take full advantage of CountyCare. It’s available at www.aidschicago.org/countycare.

David Ernesto Munar
AIDS Foundation of Chicago 
(This post was originally published on the AIDS Foundation of Chicago blog). 

Friday, May 24, 2013

Illinois Senate Moves Towards Passing State Based Health Insurance Marketplace




In passing HB3227 (formerly SB34) today, the Illinois Senate took a major step in establishing a state based health insurance marketplace that helps small businesses and individuals in Illinois.

State Senator David Koehler (D-46 Peoria), chief sponsor of SB34 (now contained in HB3227) commented after the vote, "I am pleased that a super majority of my colleagues in the Senate voted for Illinois to establish its own state health insurance marketplace. Expanding help and providing a voice for small businesses and individuals who will be utilizing the new Illinois Health Insurance Marketplace is the intention of the Affordable Care Act, and I am proud that the Illinois Senate has made that commitment."

Brigid Leahy, Director of Legislation at Planned Parenthood of Illinois, said, "If we're running things at the state level, we can fix things, we can make them better, we have better control over making sure that it works for consumers. If it’s in the hands of the feds, we don’t have that power."

HB3227 establishes a pro-consumer and pro-small business health insurance marketplace in Illinois. The health insurance marketplace will be the one-stop insurance shop for more than a million Illinoisans.

Speaking on behalf of the Illinois Public Health Association, Tom Hughes said, "The diversity of this board will best represent the population of Illinois and protect consumers in the new marketplace."

HB3227 ensures that the marketplace is governed by a diverse board that represents women, small businesses, communities of color, labor, public health, people with disabilities, and consumers, and provides for accountability of the insurance industry selling plans on the new marketplace.

Jim Duffett, Executive Director of the Campaign for Better Health Care, said, "This historic vote by the Illinois Senate today shows the Senate's commitment to Illinois small businesses and individuals who will be eligible for the new Illinois health insurance marketplace. When fully implemented nearly 1.2 Illinoisans will be utilizing this marketplace. HB3227 will provide small businesses and consumers a direct voice in developing and implementation a State Based Marketplace that meets the needs of Illinoisans. Now it is up to the Illinois House to show their commitment and support to small businesses and individuals, and to President Obama's Affordable Care Act."

ADDENDUM
HB3227 Fact Sheet

Media Contacts:

Jim Duffett, CBHC Executive Director
217.352.5600 office / 217.840.5850 cell

Kathleen Duffy, CBHC Communications Director
312.913.9449 office / 773.934.4754 cell

Monday, May 13, 2013

Immigrant Health Care Access & The Affordable Care Act

A recently released report entitled “Affordable Care Act Implementation in Illinois: Overcoming Barriers to Immigrant Health Care Access” demonstrates the need for a culturally competent market place and navigator program that will cater to the complex needs of the immigrant population of Illinois. Luvia Quiñones of the Illinois Family Resource Program and Abdelnasser Rashid of the Illinois Immigrant Integration Institute collaborated on the report. They address the following questions:   

Who are the uninsured immigrants in Illinois?
  • Illinois is home to 1,754,808 immigrants. 45% are naturalized U.S. citizens and 55% are either Legal Permanent Residents, (LPR’s), or undocumented. Of the immigrant population:
    • 77% are Latino 
    • 16% are White
    • 11% are Asian
  • 30% of the total uninsured population in Illinois is comprised of immigrants. 
  How will the uninsured immigrant population benefit from the ACA?
  •  48% of the immigrant population will be eligible for coverage in the state of Illinois.
What are the current and future barriers immigrant families face while trying to access health and human services?
  1. Language, literacy and cultural barriers, (Illinois has the 5th largest limited English proficiency population in the country).
  2. Complexity of application process and of eligibility rules
  3. Logistical and Public Education Challenges  
  4. Administrative burdens, (many cases are left open as agencies wait to determine the legal status of a client).
  5. Limited computer proficiency
  6. Climates of fear and mistrust (particularly common among mixed status families, which comprise around 25% of all immigrant families in the U.S). 
How can IL best serve and enroll the maximum number of uninsured immigrants through the marketplace?

The report highlights the strategies already employed by the Immigrant Family Resource Program, (IFRP). IFRP subcontracts with 37 community organizations that work with immigrant populations, and over the past 13 years has worked to improve the lives of over 425,000 immigrants and refugees by:
  • Ensuring that a diverse population of immigrants are able to connect to services through the capacity to communicate in 45 languages,
  • Collaborating with community members and state staff to clarify what documents are required for assistance and insurance program applications, AND 
  • Engaging trusted community organizations already frequented by immigrant populations and educating them on pertinent issues.
Incorporating these strategies into the Illinois health insurance marketplace will be instrumental in reaching the immigrant population in Illinois.

Click here for coverage of the report in last week’s Tribune!

Friday, May 10, 2013

Visualize It!



For the second consecutive year, Health & Disability Advocates (HDA) has released its Visualizing Health Care Reform tool, a unique, interactive map that allows users to see a geographic and demographic breakdown of uninsured state residents who will be eligible for healthcare coverage when the Affordable Care Act (ACA) is fully implemented beginning in 2014.

The visualization is an especially practical tool for groups in the public, private and non-profit sectors, who are planning how they will meet the demand for information and for assistance to connect individuals with the new health care options. The interactive map allows users to pinpoint data for 87 Illinois communities, or roll up to larger regions around the state. The latest release of the tool provides geographic and demographic breakdowns of those who will become eligible for coverage in Illinois, as well as the undocumented non-citizens who do not have a new path to coverage.

The AP covered the tool yesterday and focused in on the over 40,000 uninsured veterans in Illinois - 32% (13,000) of whom will be newly eligible for Medicaid in Illinois, as long as the Medicaid expansion passes the legislature.

HDA CEO, Barbara Otto, was featured on WGN News illustrating how to use the tool.

With Visualizing Health Care Reform, we hope to help build an on-ramp to affordable health care for eligible individuals and families while also helping those on the implementation side to plan for a smooth and effective transition.

Please share the tool with your networks and email us if you have questions!

Thursday, May 9, 2013

Illinois Senate Takes First Major Step To Passing A State Based Health Insurance Marketplace

Springfield - The State Senate Insurance Committee passed HB3227, formerly SB34, today, a major step in establishing a health insurance marketplace that helps small businesses and individuals in Illinois.

State Senator David Koehler (D-46 Peoria), chief sponsor of SB34 which was folded into HB3227, said, "To live up to the intention of the Affordable Care Act, we need to expand our help and support for the small businesses and consumers who will be using the new Illinois Health Insurance Marketplace. My bill does this, and I am pleased that my colleagues on the Insurance Committee were able to pass it."

Mark Burris of Springfield, the owner of MCCE Investments and owner of seven Subway Sandwich franchises, said, "Small businesses need a level playing field and there must be checks and balances with the insurance companies."

Burris continued, "In this bill, financing of the health insurance exchange under is through assessments of the insurers, as it should be. The insurance industry will benefit from the tax dollars used to create the infrastructure of the how the exchange is set up. It is only appropriate that they finance the day to day operations of the insurance health marketplace when an estimated one million new insurance customers will be purchasing private health insurance."

HB3227, formerly SB34, establishes a pro-consumer and pro-small business health insurance marketplace in Illinois. The health insurance marketplace will be the one-stop insurance shop for more than a million Illinoisans.

Jim Duffett, Executive Director of the Campaign for Better Health Care, said "This new marketplace will offer small businesses access to more affordable health insurance plans. Instead of paying 18% more than larger businesses, they will have a chance to compete for and retain good employees by providing affordable insurance. A win-win for small businesses and their employees because of the Affordable Care Act (ACA), commonly referred to as Obamacare."

HB3227, formerly SB34, ensures that the marketplace is governed by a diverse board that represents women, small businesses, communities of color, labor, public health, people with disabilities, and consumers, and provides for accountability of the insurance industry selling plans on the new marketplace.
 
Speaking on behalf of the National Association of Women Business Owners Chicago (NAWBO Chicago), Linda Forman said, "Who sits on the insurance exchange governing board is very important. We believe that a statewide governing board will be better able to understand the needs of women and the diversity of backgrounds and geography of small businesses throughout this state if the governing board is composed of the types of people who will be using the health insurance exchange marketplace."

"We can all agree that what we had has not worked very well, and to continue to do nothing is a bad mistake. We are excited to support HB3227, formerly SB34, and proud to be part of the Small Business Health Care Consortium. Our members are proud to see us take a step in the right direction on behalf of small business all across the state," said Larry Ivory, President of the Illinois Black Chamber of Commerce. "We congratulate the members of the Insurance Committee for taking that step for Illinois small businesses and individuals today."
ADDENDUM
HB3227 (containing SB34 language) Fact Sheet

Kathleen Duffy
Campaign for Better Health Care

Monday, May 6, 2013

The ACA is Coming – How Can I Help Enroll People?

The past few weeks have brought a flurry of activity from the federal and state government agencies who are reaching out to community-based entities to solicit their assistance in Affordable Care Act outreach, education and enrollment. In Illinois, it’s even more confusing because there are three possible “helper” groups: Navigators, In Person Counselors and Certified Application Counselors. 

This blog is intended to answer some of your frequently asked questions about these enrollment helpers and how you can get involved.

What’s a Navigator and How Can I Be One? 
“Navigator” is the term that has been given to people or organizations charged with providing guidance to individuals enrolling in the Health Insurance Marketplaces created by the Affordable Care Act. Many of you have been wondering how you can become one of these entities. Unfortunately, there are no actual “navigator positions” right now. This is because various entities have to apply for funding (grant application due June 7) to become navigators and receive training.

What do you mean by “entity”?

Many types of groups/entities can be Navigators. Self-employed persons and public or private organizations are eligible to apply for funding to operate as Navigators (see the FAQ here). In each Marketplace there must be at least two sub-sets of entities and at least one will be a community and consumer-focused nonprofit. There are some restrictions, however: navigators cannot have conflicts of interest. Therefore, navigators cannot be health insurers, have affiliations with health insurers, or accept any form of payment from insurers that is related to enrollment inside or outside of the marketplaces.

What if I don’t want to or am not eligible to apply for these Navigator grants?
If you don't think you or your organization would qualify for this funding alone, you could consider reaching out to another organization in your area that might be applying. Check out this consumer assistance matchmaking spreadsheet to meet up with other groups. Another option would be to wait until the grants have been decided upon and then reach out to see if the recipient organizations need any additional staff.

What is the In-Person Counselor (IPC) Program?
In-Person Counselors (IPCs) are the same as Navigators, in that they will educate people about the new system, help them understand their health plan choices, and facilitate their selection of the plan that is right for them. They are different than Navigators because funding for these entities comes from the state instead of the federal government and they will receive training directly from the state.

The IPC grant application just came out and applications are due May 30th. Entities in Illinois can apply for these funds and hire new personnel or use existing staff as In-Person Counselors in the community. Find more information and access to the application here. The Illinois Health Insurance Marketplace will be conducting a webinar for those interested in the IPC program on Thursday, May 9 at 10 am. You must register to participate. 

But how is a Navigator and In Person Counselor different from a Certified Application Counselor (CAC)?
CAC's have been defined as “trusted community-based organizations, providers, or other organizations with expertise in social service programs.” CACs allow organizations that would likely aid consumers anyway (such as hospitals or clinics) be involved more formally in the process of finding health coverage. Unlike Navigators and IPCs, CACs are not eligible for public funding but the Marketplace will be required to certify CACs to help people apply for Medicaid and plans sold through the exchange.

So what should I do now if I want to be one of these helpers?
Feel free to email us at info@illinoishealthmatters.org with any questions!

Stephani Becker & Alexa Herzog
Illinois Health Matters

Saturday, May 4, 2013

Young People Get Covered in Big Numbers

Today, the Commonwealth Fund released the findings of its Biennial Health Insurance Survey, showing that a skyrocketing number of young people have gained insurance since the health care reform passed.

While it is clear that 2014 coverage options will be crucial – there are still high numbers of the population who were either uninsured, underinsured, or unprotected from high out-of-pocket costs – young people have already begun to see new reform benefits due to the earlier implementation of the dependent coverage provision.  Specifically, the report stated that:
  • Approximately 3.4 million young adults have gained coverage since the dependent coverage provision took effect.
  • About 79 percent of 19 to 25 year-olds were insured at the time of the survey, up from 69 percent in 2010.
  • The number of people saying they had trouble with medical bills or debt climbed in the past decade, yet stayed statistically the same from 2010 to 2012.  According to Commonwealth, this is likely due to the increased coverage of young adults, since other age cohorts saw either no improvement or deterioration in coverage.
In other words, the ACA’s dependent coverage provision has increased coverage and saved young people from medical bills and medical debt.

The better news? The best is yet to come.  Over half of the potential new Medicaid enrollees are under the age of 35, and millions more will have access to subsidies on new health care marketplaces.  This survey makes clear: when offered good options, young people enroll in insurance.  And the ACA has some really great options coming down the pike.

Jen Mishory
Young Invincibles

(This post was first published on the Young Invincibles Blog here)
http://younginvincibles.org/2013/04/young-people-get-covered-in-big-numbers/

Funding Opportunity Announced for Illinois In-Person Counselors


Beginning October 1, 2013, the Illinois Health Insurance Marketplace will open for enrollment. Pursuant to the Affordable Care Act, the Marketplace will be a website where those seeking insurance coverage can shop for health care and determine if they are eligible for financial assistance with premiums and health costs. In Illinois, we are estimating that more than half of our Health Insurance Marketplace customers will want help enrolling in the program.

In order to meet their needs, Governor Pat Quinn and the Illinois Health Insurance Marketplace established the In-Person Counselor program (IPC). IPCs will educate people about the new system, help them understand their health plan choices, and facilitate their selection of the plan that is right for them. IPCs will be instrumental in the Marketplace’s plan to create a statewide “Culture of Coverage” by engaging, educating, and enrolling the uninsured in Illinois in qualified health plans.

Today, the Illinois Health Insurance Marketplace is very excited to announce the release of the grant application for the In-Person Counselor program.

The Illinois Health Insurance Marketplace, in coordination with the Illinois Department of Public Health, will be accepting applications through the end of May 2013 from community groups and other qualified organizations who want to participate in the IPC program. The state has designated approximately $28 million in federal funds for grants to participating groups. Organizations that are selected through the online application process will participate in a training and certification process this summer.

For more information about the application process for the Illinois IPC Grant Program, go to: http://www2.illinois.gov/gov/healthcarereform/Pages/IPC.aspx.

Additionally, the Illinois Health Insurance Marketplace will also conduct an informational webinar on Thursday, May 9 at 10:00 AM. Interested groups can register for the webinar by going to https://www305.livemeeting.com/lrs/8002054163/Registration.aspx?PageName=hfhrvf978qb8w95p.

Thank you,

Brian Gorman

Director of Outreach and Consumer Education
Illinois Health Insurance Marketplace

Wednesday, May 1, 2013

A Simpler Way to Apply for Health Care

By Kathleen Sebelius, Secretary of Health and Human Services
Posted April 30, 2013

Today, we take one more step toward meeting the promise of helping millions of Americans access quality, affordable health coverage.

We have finalized the application you can complete later this year to learn what health insurance programs you are eligible for and the discounts to help pay for it. Starting in October, it will be the one application you can use to apply for the new Health Insurance Marketplace, Medicaid, the Children’s Health Insurance Program, and tax credits that will help pay for premiums.

I’m also pleased to say the application has been simplified and significantly shortened. The application for individuals is three pages, and the application for families is reduced by two-thirds, to seven pages. This is much shorter than industry standards for health insurance applications today.

Whether you choose to use this application to apply for coverage online, by phone, or on paper, the Health Insurance Marketplace will give you better options than they have today – with one destination to apply and many resources to get help. In-person counselors and a toll free phone line will be available to help you through every step of the process.

The online application that will go live on Healthcare.gov when the Health Insurance Marketplace opens for enrollment on October 1, can be found here: http://cciio.cms.gov/resources/other/index.html#hie

You can sign up to learn more and get ready to enroll at signup.healthcare.gov.

(This post was originally on the healthcare.gov blog here).