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What health reform means for the people of Illinois

A blog by IllinoisHealthMatters.org

Thursday, July 25, 2013

Consumers Need Protection from Health Insurance Company Plan Year Manipulation


It was disappointing—infuriating actually—to learn that some of the nation’s health insurance companies are trying to take advantage of their current customers by manipulating plan years. They are doing so to avoid having to pass on to these customers the benefits of national health reform.

These insurers are reaching out to current customers, taking advantage of their uncertainties, and luring them to switch to health plan years that begin in 2013. By substituting 2013 plans for their current plans that run through early 2014, customers will lose important Affordable Care Act (ACA) protections that must apply to plans issued on or after January 1, 2014. For example, plans issued in 2014 must offer a comprehensive range of benefits and have rates based only on the customer’s age, geographic location, number in family, and tobacco usage. Discrimination based on gender or pre-existing conditions is banned by federal law in 2014 plans. Health insurance insider turned critic, Wendell Potter, recently wrote in detail about this outrage in the Huffington Post.

So insurers are trying to have the best of both worlds. They want all the goodies the ACA offers them, including hundreds of millions of new customers (many of whom will only be able to afford coverage because they qualify for the federal financial help in the form of advance premium tax credits and cost sharing subsidies available under the ACA), but they also want to deprive their existing customers of the benefit of ACA reforms.

Fortunately, insurance regulators can and are protecting customers from such manipulation. Illinois Department of Insurance Director Andrew Boron issued Bulletin 2013-07 on April 29, 2013, telling Illinois health insurers that they won’t get away with such manipulation. “The Department will not approve…filings for such arrangements,” the bulletin says. That should bring these threatened manipulations to an end in Illinois, and we hope regulators in other states take similar actions.

Health insurance has been baffling to most individuals and small businesses. The federal government, many states, and many non-profit organizations are working hard to inform citizens of the reforms, benefits, and opportunities the Affordable Care Act has already brought and the major improvements coming in 2014. Actions like these plan date manipulations simply have no place in the picture. Thank goodness regulators can and are stepping it to ensure a happy ending.

Margaret Stapleton

Monday, July 22, 2013

Governor Quinn Enacts Largest Increase in Health Care Coverage in State History


Governor Pat Quinn today signed legislation that enacts a critical part of President Obama’s Affordable Care Act (ACA) by making Medicaid coverage available to all low-income adults in Illinois. Today’s action delivers on a major priority announced by Governor Quinn in his 2013 State of the State address and is part of his agenda to improve the health of the people of Illinois and increase access to quality health care.

“In the home state of President Obama, we believe access to quality health care is a fundamental right and we proudly embrace the Affordable Care Act,” Governor Quinn said. “This legislation will greatly improve the health of hundreds of thousands of people across Illinois, strengthen our health care system and create thousands of good jobs in the health care field. Thanks to this law and our shared commitment to increasing access to health care coverage in Illinois, the people of Illinois will be healthier and have a higher quality of life.”

Sponsored by State Senator Heather Steans (D-Chicago) and State Representative Sara Feigenholtz (D-Chicago), Senate Bill 26 will make Medicaid coverage available to adults with annual income below 138 percent of the federal poverty line, which is $15,860 for individuals and $21,408 for couples. The measure is expected to enroll 342,000 people by 2017. Currently, Medicaid is only available to children, their parents or guardians, adults with disabilities or seniors. Enrollment for the newly eligible population will begin Oct. 1 with coverage starting on Jan. 1.

Under the ACA, for the first three years, coverage of newly eligible adults will be 100 percent federally funded. The reimbursement rate will phase down to 90 percent by 2020. State officials estimate this will bring more than $12 billion in new federal funding to support the state’s health care system from 2014 to 2020.

“The Affordable Care Act gives Illinois the resources to provide critical health care services to a population that desperately needs it,” Illinois Department of Healthcare and Family Services Director Julie Hamos said. “Under Governor Quinn’s leadership, we are reforming our health care system so that it focuses on delivering coordinated care and keeping people healthy through better preventive care, not just paying the bills when they become sick.”

Under Governor Quinn's leadership, Illinois is also increasing access to health coverage through the Illinois Health Insurance Marketplace, another major feature of the ACA. The Marketplace, which also launches enrollment Oct. 1 with coverage starting Jan. 1, will be accessed through a user-friendly website where individuals, families and small businesses will be able to compare health care policies and premiums and purchase comprehensive health coverage. Those with income between 138 percent and 400 percent of the federal poverty level will receive subsidies on a sliding scale if they obtain coverage through the marketplace.

Governor Quinn has long championed access to decent health care for all people. In August 2001, he joined his then 78-year-old Doctor, Dr. Quentin Young, to walk 167 miles across Illinois to advocate for health care for all.

For more information about Illinois' implementation of the ACA, go to HealthCareReform.illinois.gov.

Related Documents
Senate Bill 26 and the Affordable Care Act (PDF)

(This post was taken directly from the Illinois Government News Network press release)

Friday, July 19, 2013

Accountable Care Entities (ACEs): A New Coordinated Care Model in Illinois

SB 26 to be signed by the Governor into law on July 22, 2013, will expand Medicaid to over 600,000 new potential enrollees but it will also usher in a new form of coordinated care in Illinois for these new Medicaid enrollees as well as existing families on Medicaid - the Accountable Care Entity.

An Accountable Care Entity (ACE) will be a new Illinois model of an integrated delivery system. This will be the fourth model providing “care coordination services” for Medicaid clients, which now includes Managed Care Organization (MCO), Managed Care Community Network (MCCN) and Care Coordination Entity (CCE). This infographic provides a great overview of the system so far.



The ACE will have these elements:
  • Will be a provider-organized network of care -- providers working together collaboratively
  • Will be large enough to have impact for a population: initially children and their family members in Illinois Medicaid, at least 40,000 in Cook County, 20,000 in collar counties, 10,000 downstate
  • Will have at a minimum the following types of providers: primary care, specialty care, hospitals, and behavioral healthcare; will have a governance structure that includes each type of provider and works to create a shared culture of collaboration/transformation
  • Will build an infrastructure to support care management functions among the providers in the network, such as health information technology, risk assessment tools, transparent data and data analytics, communication with Medicaid members, etc.
  • Will work toward a new payment structure different from the current fee-for-service: shared savings within first 18 months, partial risk after 18 months and full risk after 3 years, which means capitated payments with financial incentives for the providers within the network
This is an opportunity for the hospital community and other providers to develop integrated delivery systems in Illinois that will manage Medicaid populations but are not traditional MCOs. Under SB 26, HFS will post a solicitation by August 1, and give 5 months to new entities to organize and apply.

The initial population assigned to ACEs will be children and family members (and likely newly eligible Medicaid clients under the Affordable Care Act.)

For more information check out the HFS Care Coordination Site

Stephanie Altman
Health & Disability Advocates

Thursday, July 11, 2013

Illinois to Be Awarded Over $90 Million in Medicaid Funds for Home- and Community-Based Care

The Affordable Care Act (ACA) section 10202 establishes the Balancing Incentive Payments Program or BIP. BIP offers State Medicaid programs a financial incentive to offer home- and community-based services (HCBS) as an alternative to institutional care in nursing homes. In exchange for an increased federal matching rate (Medicaid is a State-Federal jointly paid program), States must implement 3 structural changes to their long-term services and supports (LTSS) system:

1. A No Wrong Door–Single Entry Point system (NWD/SEP)

2. Conflict-free case management services

3. A core standardized assessment instrument

In March, 2013, Illinois’ State Medicaid Agency, the Department of Healthcare and Family Services, submitted a proposal to the Centers for Medicare and Medicaid Services (CMS) to participate in BIP. On June 12, 2013, CMS announced their approval of Illinois’ BIP application, which will bring in $90.3 million of Federal matching funds into the State for Illinois projected HCBS expenditures over the next 2 years.

What Does Illinois’ Proposal Look Like?

Illinois’ BIP proposal is the most comprehensive overview of the State’s various LTSS programs: from aging, to development disabilities, to physical disabilities, to mental health, to substance abuse—Illinois’ BIP proposal covers it all. For anyone who wants a crash course on what Illinois is doing in the area of LTSS balancing—the development of a LTSS system that is more home- and community-focused than institutional focused—the BIP application is a great place to start.

In reading through the BIP proposal, you will see that Illinois is planning to integrate LTSS through collaboration across governmental department silos. The BIP operating agency will be the State Medicaid Agency: the Illinois Department of Healthcare and Family Services (HFS). HFS is already working in partnership with its sister agencies on implementing BIP:


Further, Illinois’ BIP goals will build off the existing work that Illinois is doing to balance LTSS in favor of HCBS. Existing LTSS balancing projects in Illinois include:


The work described in the BIP application details how Illinois will implement the 3 structural requirements of BIP: a no wrong door–single entry point system (NWD/SEP), conflict-free case management services, and core standardized assessment instrument. These 3 areas are described below briefly. It is important to note that currently Illinois has separate systems for each sub-population served in its LTSS programs: aging, physical disability, mental health, substance abuse, development disability. BIP provides Illinois with the opportunity to coordinate across the population groups from the community and consumer level, all the way up to the State government level.

1. Illinois’ No Wrong Door–Single Entry Point system (NWD/SEP)
Entry points for LTSS are not currently coordinated across aging and disability populations. Current access points include: DHS local offices, Aging and Disability Resource Centers (ADRCs), Area Agencies on Aging (AAAs), Division of Rehabilitation Services local offices, Pre-Admission Screening agencies that serve persons with intellectual/developmental disabilities, community mental health centers and regional mental health points of contact, and State agency websites.

The ADRC network offers a starting place to coordinate across all of these different access points. Under the leadership of Illinois Department on Aging, the vision for the ADRC system is “a highly visible and trusted resource for all persons regardless of age, income and disability, to access a coordinated point of entry to public long-term support programs and benefits, and to obtain information on the full range of long-term support options”. [See page 31 of the BIP proposal].

Illinois’ ADRC system is already in development with 7 ADRCs up-and-running across the state—through AAAs in collaboration with disability organizations. It is anticipated that by September 2016, all of Illinois’ 13 Planning-and-Service-Areas (PSAs) will have designated ADRCs through leadership from Illinois’ AAAs. ADRC entities also currently include Care Coordination Units, Community Care Program providers, Centers for Independent Living, and DoA’s Senior Help Line (a State-wide toll-free phone number).

The NWD/SEP system will allow for individuals to receive a level 1 screen to determine which LTSS an individual should be assessed for. Access to this level 1 screen will be available online through a coordinated network of ADRC partners.

2. Illinois’ Conflict-Free Case Management Services
Illinois has different case management systems for each population group served. To ensure conflict-free case management, per Federal guidance, Illinois will work to separate the determination of eligibility process from case management, and from the direct delivery of services.

In the BIP proposal, Illinois describes the current developmental disability and physical disability processes to be conflict-free. However, more work needs to be done in the area of mental health/substance abuse and aging to ensure conflict-free case management [see pages 23-24 of the BIP proposal].

The expansion of managed care models in Illinois will help to promote conflict-free case management. With the help of BIP funds, Illinois will also continue to work with CMS to identify potential conflicts of interest and to develop the proper firewalls between eligibility determination, case management and service delivery.

3. Illinois’ Core Standardized Assessment Instrument
Over the past year, Illinois human service agencies have collaborated with Navigant consulting to review Illinois’ current assessment tools and methodology (each population currently has their own assessment tool). With Navigant, Illinois will develop a uniform assessment tool (UAT) for access to LTSS. Recently, HFS released a Request for Information related to the development of the UAT as the State seeks out vendors who can integrate and coordinate across populations and State departments.

A UAT will allow Illinois’ to develop a more consumer-centered LTSS system. Many individuals with LTSS needs require complex care and fall into more than one category across the current Medicaid HCBS waiver system. This means that consumers with mental health needs who are also 60 years or older must access two separate programs to have their needs meet: one in mental health and the other in aging. This makes it very challenging for consumers, and cumbersome and redundant for State agencies. BIP is intended to fix this, to ease access to LTSS in a more timely and appropriate way.

Further, Illinois is also replacing the 30-year old COBOL-based system that is currently in use to determine eligibility for: Medicaid, the Supplemental Nutrition Assistance Program (SNAP, formerly ‘food stamps’), Temporary Assistance for Needy Families program (TANF), and the new Health Benefits Exchange, or Marketplace, required by the ACA. The new Integrated Eligibility System (IES) is branded as Application for Benefits Eligibility, or ABE.

What all of this means for professionals and consumers is that Illinois is moving towards a system that will significantly streamline the determination of eligibility process for a variety of different programs, including LTSS. Part of this systemic upgrade includes ensuring better Information Technology (IT) integration and easier access to data about these publicly funded programs across population types.

Stay Tuned as Illinois Continues to Balancing LTSS in Favor of HCBS


As Illinois implements BIP and its other LTSS balancing programs, the State’s goal is to develop a new HCBS infrastructure that is consumer driven and easy to access and navigate. We look forward to reporting back as consumers across the State find it easier to live and receive care in their homes and communities.

Please let me know if you have questions, comments or responses to this blog post. You can reach me at: 312.372.4292 or kpavle@hmprg.org.

Kristen Pavle
Associate Director, Center for Long-Term Care Reform
Health & Medicine Policy Research Group

Thursday, June 27, 2013

New Report Finds that the Affordable Care Act Will Spur Entrepreneurship

One benefit of the new health insurance options and reforms in the Affordable Care Act starting in 2014 will be the positive impact on the creation of small businesses and sole proprietorships. The new paths to health care coverage will allow more individuals to purchase their own coverage instead of having to be employed in order to receive health care insurance.

A recent report found that the Affordable Care Act is expected to produce a sharp increase in entrepreneurship next year, according to the analysis done by the Robert Wood Johnson Foundation, the Urban Institute and Georgetown University’s Health Policy Institute.

The number of self-employed people nationally is expected to rise by 1.5 million — a relative increase of more than 11 percent — as a direct result of the health care overhaul. One major barrier to entrepreneurship in the past in the United States has been the difficulty of getting health insurance on the individual market. A pre-existing condition or disability can make it very expensive and difficult – if not impossible – to purchase health insurance as an individual. Therefore, many people remain employed in a job that is not satisfying in order to maintain health care coverage – referred to as “job lock.” If health care is more portable, more employees will have the freedom to change jobs, retire and/or start their own businesses.

According to the report and this infographic, in Illinois, there are currently 475,000 people self-employed but there are expected to be 537,000 people self-employed after the ACA is implemented – an increase of 62,000 newly self-employed or 13.1%. This increase is due to the new options for health insurance outside of the traditional employer-employee relationship and the elimination of pre-existing condition exclusions in health insurance. The ACA will create insurance marketplaces in every state where individuals and small businesses can shop for insurance and compare insurance products as well as receive financial assistance if they are low income to defray the costs of premiums and cost-sharing.

In Illinois, health care reform implementation is proceeding with the creation of the new Federal State Partnership Marketplace to open enrollment on October 1, 2013 and to start providing coverage on January 1, 2014. Illinois also recently passed Senate Bill 26 to expand Medicaid under the ACA with the potential to cover hundreds of thousands of additional low income individuals. The bill is currently awaiting the Governor’s expected signature into law. Enrollment campaigns and education and outreach will begin in earnest in the summer. More information on the Illinois effort to implement the ACA can be found at: http://www2.illinois.gov/gov/healthcarereform/Pages/default.aspx and at www.illinoishealthmatters.org.

Stephanie Altman
Health & Disability Advocates

Federal Recognition of Same-Sex Marriage Could Mean Big Changes for Taxes and Health Care Reform

The Supreme Court issued two key rulings today on same-sex marriage, United States v. Windsor (regarding the federal Defense of Marriage Act or "DOMA") and Hollingsworth v. Perry (regarding California's Proposition 8). The Court struck down DOMA as unconstitutional and dismissed the appeal in the Proposition 8 case for lack of standing.

"These momentous decisions certainly have implications for taxes and the Affordable Care Act (ACA)," said Brian Haile, Senior Vice President for Health Care Policy, Jackson Hewitt Tax Service Inc. "Same-sex partners should understand some of the implications of marriage to their health insurance options under the ACA before they tie the knot. Simply put, getting hitched affects their health care."

Haile outlined the following:

1. Same-sex partners may now be able to file as "spouses." Under the federal income tax rules as currently written, taxfilers may be able to claim a same-sex partner as a dependent if they live together for the year, if the partner resides legally in the U.S., if the taxfiler provides at least 50 percent of the total support for the partner and the household, and if the partner has very limited income. This is a murky area – and the Court's decisions only partially clarify the law.

To the extent that the Court's rulings expand the federal definition of marriage, then many of these individuals in jurisdictions that recognize same-sex marriages may now be able to file as "spouses" rather than "dependents." Other same-sex individuals who did not meet the restrictive dependent test may now become part of the taxfiler's household as a spouse in those states that recognize same-sex marriage. (For reference, 12 states and the District of Columbia marry same sex couples.) However, the marital status vis-a-vis federal law of same-sex couples who live in states that do not recognize their marriage remains unclear.

2. Same-sex partners with similar incomes may lose out. For example, same-sex partners who each have an income of $40,000 may be eligible for the premium assistance tax credits under the ACA – but only if they remain single. If they marry (in those states that allow same-sex marriage), then they would lose eligibility because their income would be over the threshold for a household of two.

3. Same-sex partners with different incomes may gain. For example, two persons in a same-sex relationship who had incomes of $30,000 and $80,000, respectively, would not qualify for the tax credits if they were married in states that recognize same-sex marriage (because their combined income is above the limit for a couple). However, the individual making $30,000 would qualify for the tax credits if he or she remains unmarried (as that individual's income is below the threshold for a household of one). Of course, the couple may end up paying a lower marginal tax rate if they marry and exercise a new right to file jointly – so part of the decision about whether and when to marry in states that recognize same-sex marriage may involve a complicated trade-off between minimizing taxes and accessing insurance.

4. Same-sex couples who currently access domestic partner benefits may gain. Under the current federal income tax rules, the value of the benefits that employers provide to opposite-sex spouses is largely excluded from income; however, the opposite is true from same-sex partners – and they have to pay taxes on the full value of the employer's contribution for same-sex partner health insurance, etc. These taxfilers may no longer have to treat the value of the health insurance as imputed income if they get married in states that allow them to do so – meaning that their taxes may go down. The same is true for employers: they may pay lower payroll taxes if the couple marries and no longer has to treat the value of the employer's contribution as imputed income.

5. Same-sex couples who do not have or do not access domestic partner benefits may lose out. If the couple marries (assuming that they live in a state that recognizes same sex marriage) and one employer offers spouse or dependent coverage, then the same-sex spouse may lose eligibility for the ACA tax credits. The ACA limits the tax credits to spouses and dependents who do not have access to coverage. Even if the employer does not subsidize spouse or dependent health coverage, the fact that a spouse has access may disqualify him or her from the tax credit program.

6. Married same-sex couples receiving ACA tax credit will have to file jointly. If a same sex couple were to get married in a state that allows them to do so and claim the new tax credits under the ACA, then the ACA rules require them to file a joint return for the respective tax year (as is the case with opposite-sex married couples).

Even with the Court's decisions, HHS still faces several related policy questions. The final rules about the new insurance marketplaces clarify that the marketplaces and insurers must "…[n]ot discriminate based on race, color, national origin, disability, age, sex, gender identity or sexual orientation."* Consequently, many observers had a number of questions about how HHS would interpret these requirements in the context of the small group marketplace even before the Court's rulings. For example, must the small group marketplace require insurance companies to provide same-sex domestic partner coverage to participating employers and employees?

"To my knowledge," Haile added, "the agency's only requirement in this regard is that insurers in the federal marketplace self-attest that they do not discriminate on this basis."**

Surprisingly, many same-sex couples (particularly lower-income same-sex couples) may be better off if HHS answers "no" to such questions. The reason is simple but not intuitive: the final rule on premium tax credit eligibility states that individuals who have access to "affordable" employer-sponsored coverage are ineligible for premium tax credits. However, "affordability" of employer-sponsored insurance is determined only with regard to the employer contribution to the employee-only coverage. Consequently, a same-sex partner (and for that matter, any dependent) may be ineligible for tax credits if the employer offers same-sex coverage – even if the employer makes no contribution to toward the associated premium. However, if partner or other dependent coverage is unavailable, then a same-sex partner or other dependent may have some hope of qualifying for a tax credit.

The Internal Revenue Service and other federal agencies may issue interpretive guidance later this year to clarify some of the outstanding questions, but the implications of the Court's rulings today certainly complicate both the tax code and health care reform.

* 45 CFR Section 155.120(c)(2); 45 CFR Section 156.200(e).
** Letter to Issuers, April 5, 2013, available at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2014_letter_to_issuers_04052013.pdf.

Brian Haile 
Senior Vice President for Health Care Policy
Jackson Hewitt Tax Service Inc. 

For more information about the Affordable Care Act and its impact on taxpayers, please visit Jackson Hewitt's public website or Brian Haile's Twitter channel.

(This post originally appeared on PRNewswire here)

Wednesday, June 26, 2013

Provider-Plan-Payer Alliance for Health - Your Input is Needed

Illinois was recently awarded a Model Design grant from the Center for Medicare & Medicaid Innovations (CMMI) for the development of a State Health Care Innovation Plan. Through these grants, CMMI is encouraging states to develop multi-payer approaches that send a consistent signal to providers and consumers incentivizing healthy behaviors, safe environments, and appropriate community supports linked to high quality care through accountable and comprehensive delivery systems. Illinois will develop its models to test over three years in the next round of funding. The grant period officially began April 1, and we must submit the comprehensive plan to CMS by September 30.

Over these six months, Illinois will develop its State Health Care Innovation Plan, which will focus on models to improve overall population health through collaboration among public health, health care, and community development sectors. The Innovation Plan will incorporate new initiatives, as well as build upon the delivery and payment system reforms already underway in Medicaid and the private sector. The planning process will require collaboration among health plans, providers, and payers to reform payment and delivery systems and the active engagement of community development and public health communities to enhance quality, improve health status and reduce overall costs.

Michael Gelder, Senior Health Policy Advisor to Governor Quinn, will lead the development of the plan in conjunction with the directors of Healthcare and Family Services, Human Services, Aging, Insurance, Professional Regulation, and Public Health. Staff workgroups will focus on delivery system/payment reform, data, and policy changes needed.

Overall, this grant is essential to achieve Governor Quinn’s goal to transform Illinois’ health care system to emphasize health, wellness, and independence. A healthy population is critical to keep health care costs affordable for businesses and families, which in turn will help Illinois attract jobs and continue to expand our economy.

Resources
Steering Committee Members
Steering Committee Presentation
State of Illinois Provider-Plan-Payer Alliance for Health
Letter from CMS Center for Medicaid Innovation Awarding Illinois the Model Design Award
CMS State Innovation Model Fact Sheet
Value of an All Payer Claims Database Webinar
Alliance Town Hall Meeting Notes - June 6, 2013

Comments
We welcome your feedback throughout the next 6 months as we develop our State Health Care Innovation Plan. Please submit your comments here and use the Town Hall Questions as a guide. Your comment and name may be made public on this site unless you indicate otherwise, with an exception for personal information or inappropriate language.

NOTE: All submissions are subject to the Freedom Of Information Act (FOIA).

[This was originally posted on the State of Illinois' Health Care Reform Website]
Illinois was recently awarded a Model Design grant from the Center for Medicare & Medicaid Innovations (CMMI) for the development of a State Health Care Innovation Plan. Through these grants, CMMI is encouraging states to develop multi-payer approaches that send a consistent signal to providers and consumers incentivizing healthy behaviors, safe environments, and appropriate community supports linked to high quality care through accountable and comprehensive delivery systems. Illinois will develop its models to test over three years in the next round of funding. The grant period officially began April 1, and we must submit the comprehensive plan to CMS by September 30.

Over these six months, Illinois will develop its State Health Care Innovation Plan, which will focus on models to improve overall population health through collaboration among public health, health care, and community development sectors. The Innovation Plan will incorporate new initiatives, as well as build upon the delivery and payment system reforms already underway in Medicaid and the private sector. The planning process will require collaboration among health plans, providers, and payers to reform payment and delivery systems and the active engagement of community development and public health communities to enhance quality, improve health status and reduce overall costs.

Michael Gelder, Senior Health Policy Advisor to Governor Quinn, will lead the development of the plan in conjunction with the directors of Healthcare and Family Services, Human Services, Aging, Insurance, Professional Regulation, and Public Health. Staff workgroups will focus on delivery system/payment reform, data, and policy changes needed.

Overall, this grant is essential to achieve Governor Quinn’s goal to transform Illinois’ health care system to emphasize health, wellness, and independence. A healthy population is critical to keep health care costs affordable for businesses and families, which in turn will help Illinois attract jobs and continue to expand our economy.

Consumer & Community Feedback Needed!
We welcome your feedback throughout the next 6 months as we develop our State Health Care Innovation Plan. Please submit your comments here (scroll down to the bottom of the page) and use the Town Hall Questions as a guide.

Your comment and name may be made public on this site unless you indicate otherwise, with an exception for personal information or inappropriate language.

NOTE: All submissions are subject to the Freedom Of Information Act (FOIA).
- See more at: http://heartlandpolicy.blogspot.com/2013/06/provider-plan-payer-alliance-for-health.html#sthash.g0hxlRcD.dpuf