Connecting Navigators to Jobs so They Can Continue Connecting Consumers to Coverage

Navigators are key to health care outreach and enrollment across the country, but in Cook County the number of working Navigators is on the decline as grant funding slows. This is not only bad for individual Navigators unable to find work, but compromises the success of future enrollment cycles. In-person assisters of all stripes — including Navigators, Certified Application Counselors, agents, and brokers — play a crucial role in helping people apply for coverage. An Enroll America study found that people who got in-person help were nearly 60 percent likelier to enroll. To help keep assisters in the community, through the Health Insurance Workforce Pipeline Initiative, Health & Disability Advocates and the Chicago Cook County Workforce Partnership are connecting unemployed Navigators with jobs in the health insurance field — specifically as brokers.

Health & Disability Advocates is leveraging its connections in the health insurance community to bring employees and employers to the table. Meanwhile the Chicago Cook Workforce Partnership contributes Workforce Investment Opportunity Act (WIOA) dollars that pay for job-readiness training, workshops, and on-the-job training that new hires may need once they start their jobs as brokers. Since its formation in early May 2015, the Health Insurance Workforce Pipeline Initiative has hosted Rapid Response Workshops that describe the resources available for unemployed or soon-to-be unemployed enrollment assisters. HDA and CCWP also organized an exclusive job fair where Navigators could meet and interview with employers looking to hire.

Former Navigators are already transitioning into new jobs thanks to this initiative. A group of eight new hires who had previously collaborated as enrollment assisters to connect 51,000 people with Medicaid and marketplace coverage will now be working together as brokers, drawing on their experiences as Navigators. According to Tearalla, a new hire, “As a broker, my Navigator skills are transferable and aligned with my current responsibilities. I will continue to provide outreach, education, and enrollment assistance to newly enrolled consumers and consumers seeking to re-enroll in the Marketplace.”

These transitioning Navigators will be doing outreach and drawing on their strong connections — including with Navigators — in the communities where they worked for the first two enrollment cycles where they already have strong connections. Said Tearalla, “Networking with existing community stakeholders is ongoing.”

Everyone wins — employers and Navigators alike — when these Navigators transition into new roles as brokers. According to one hiring manager, they were able to hire more former Navigators because money spent for training was covered by WIOA dollars. The hiring manager was also excited that the new hires have great working relationships with groups and community leaders.

New hires are eager to continue enrollment work. They are already reaching out to previous community contacts to spread the word about their new role and the ongoing opportunity to get health insurance. Said one former enrollment assister, Olivia, “I’m excited about the opportunity to continue to enroll folks in the ACA.” It’s a wonderful opportunity for the overall enrollment push in Illinois, too. Having seasoned pros with strong community connections on the front lines of Affordable Care Act outreach like Olivia and Tearalla can help set up a strong foundation for the upcoming enrollment cycle and get even more people connected to health insurance.

This post originally appeared on Enroll America's blog.

Bryce Marable
Health Policy Analyst
Health & Disability Advocates

An Observation on the “Observation Status” Law: It Doesn’t Work

The law, called the NOTICE Act, requires hospitals to notify patients hospitalized for more than 24 hours if they are on observation status. The law won’t go into effect until next August, which is great, because it could be better.

The way the law is written right now, it’s almost like asking a patient under anesthesia to sign a consent form. Within the first 24 hours of being admitted to the hospital for a medical event, many people—especially older people—aren’t able to focus on complicated issues of their status and its consequences.

Being on observation status has significant financial consequences. Observation status is considered outpatient service by Medicare. All care, supplies and procedures are covered under Part B, not Part A, and therefore are subject to Part B's higher deductible and co-pays. On top of that, most hospital pharmacies do not contract for Part D drug payments. Patients who have to take their normal medicines while under observation status will have to submit reimbursement requests to Medicare.

If a patient requires skilled nursing care after being discharged, Medicare will only pay for it following three days of inpatient hospitalization. Being on observation status—an outpatient—doesn't count toward the three-day requirement.

One Woman’s $3,900 Surprise

Jean Arnau, an 84-year-old who spent five days in the hospital with a fractured spine is a perfect example of how observation status poses consequences after discharge. She was in a hospital bed, wore a hospital gown and ID bracelet, ate hospital food and received regular nursing care.

When she was discharged and needed to transfer to a skilled nursing facility for rehabilitation, her family learned that she had never been formally admitted as an inpatient to the hospital at all. Instead, she'd been classified as an outpatient under observation and the nursing facility would charge almost $4000.

What To Do Until There’s a Real Fix

It’s great that the NOTICE Act requires patients receive “accurate, real-time information with respect to their classification, the services and benefits available to them, and the respective cost-sharing requirements they are subject to." It’s just that doing it within 24 hours of admission is too often not fair.

Talk to your clients, and their loved ones, before the need arises. The Center for Medicare Advocacy has put together a thorough packet explaining what your clients can do to protect themselves.

You can help by discussing these things with them:

• Urge them to ask about their status each day they are in the hospital. It can change from day to day.
• Tell them to ask the hospital doctor to reconsider your case or refer it to the hospital committee that decides status.
• Tell them to ask their primary care physician to state whether observation status is justified. If not, ask him or her to call the hospital to explain the medical reasons why you should be admitted as an inpatient.
• If they need rehab or other continuing care but learn that Medicare won't cover a a skilled nursing facility, tell them to ask their doctor if they qualify for similar care at home through Medicare's home health care benefit, or for Medicare-covered care in a rehabilitation hospital.
• After the fact, let them know they can appeal a Medicare decision of non-coverage. All the avenues for appeal are spelled out in the Center for Medicare Advocacy’s packet.

Preparing loved-ones before they are hospitalized isn't a fix to law, but it will empower future patients with a plan and knowledge of their rights. After having these conversations, patients will be more enabled to fight for their rights while Washington hopefully gets around to making much needed improvements to the law.

Phillip Lanier
Health Policy Intern
Health & Disability Advocates

Halloween Marks a Scary Time for Health Care in Illinois

If things don’t change soon, health care could be in for major setbacks in Illinois. The State budget battle is approaching its fifth month and counting.  So far, Medicaid payments continue per court order, but other services are beginning to run out of money:

• State payments to 911 call centers throughout the Illinois have been suspended, putting emergency services in jeopardy. 
• Illinois has stopped paying medical and dental claims for 150,000 state employees. The long-term cost of delayed care for a group of this size could be far greater than the cost of paying for care and preventative care today. 
• The state’s Psychiatric Leadership Capacity Grant, which was $27 million in the State’s FY2015 budget, is no longer being funded, affecting most of the 140 community health centers in Illinois and thousands of people who rely on them for psychiatric care. 

The longer the State budget impasse continues, the more services will be cut. These include services that indirectly have an impact on Illinois health care, such as after-school programs to keep kids out of trouble and supplemental nutrition programs, especially for the older adults.

It’s Not Too Late to Raise Your Voice!  

Contact your State legislators to let them know how concerned you are about the future of health care in Illinois. Tell them that Illinois seniors and children are especially vulnerable. We can’t let cuts affect them.Many program cuts will result in greater costs to the State in the not-so-long run. For example:

• Home care services and home delivered meals to seniors citizens cost a fraction of the $75,000 annual cost of nursing home care. Cuts to these programs will mean more seniors ending up in nursing homes, paid for by Medicaid. 
• Cut backs to after-school programs and Department of Children and Family Services support for older children will mean more kids and young adults intersecting with the justice system. Even short-term incarceration can pay for a full year of after-school activities for a child.
• Cut backs to mental health services will only cause an increase in city and country jail populations where the State will not only have to provide mental health services, but food, clothing and shelter. 

And remind them that, as the State’s infrastructure crumbles and the State’s bond ratings tumble, it will only get more and more expensive to catch up.

Phillip Lanier
Health Policy Intern
Health & Disability Advocates

Chicago needs a plan to sign up its uninsured; here's what to do

Health care coverage has an impact on the economic well-being of lower- and moderate-income people; therefore enrolling the uninsured should be considered a key economic strategy for Chicago and all of Illinois. Unfortunately, this isn't the case.

Sixty-three percent of Illinois' working population eligible for a private path to health coverage under the Affordable Care Act is still uninsured, with large swaths residing in Chicago (see a breakdown of the numbers across Illinois here).

Given those statistics, Mayor Rahm Emanuel needs all hands on deck—from business leaders to health insurance brokers, from community institutions like public libraries to religious leaders—to encourage people to sign up.

Open enrollment for 2016 health insurance coverage starts Nov. 1, so the city is in serious need of a plan. We propose a Commission for Healthy Chicago, similar to the mayor's effort on violence prevention, comprising city staff and community, business, faith and health care leaders to build a cross-sector strategy for outreach and enrollment. Emanuel can improve the economic security of working-poor Chicagoans simply by putting the clout of his office behind such a strategy.

Chicago shouldn't expect the state to lead. In the midst of the state's fiscal disarray, Get Covered Illinois has lost most of its staff and has stated it will rely more heavily on “partners” such as providers, brokers and nonprofits for enrollment support. GCI's limited capacity can't get the job done; nor should the city and state expect nonprofits and health care providers to fill the gap in funding or leadership.

The Task Ahead

With only 37 percent of the estimated 942,000 marketplace-eligible residents having enrolled, Illinois ranks 20th out of the 37 states that operate their marketplaces using the federal HealthCare.gov website.  

Here's another way to look at it: Two years into ACA's health insurance efforts, almost two-thirds of Illinois' marketplace population—the lower- to moderate-income people for whom the ACA was created—remain uninsured. Almost half of them are eligible for a tax credit or subsidy to make their plan more affordable.

Overall, about 73 percent of the nearly 600,000 people who are eligible but still uninsured live and work in the Chicago metro area. Within these areas there are significant proportions of the population who do not speak English as their primary language. In nearly half the metro area, at least one-third of the population speaks Spanish or another non-English language. In several of these areas, primarily in Chicago and suburban Cook County, more than 50 percent do not speak English as their first language. Notably, the areas with the highest proportion of non-English speakers are the same areas with the lowest share of eligible population enrolled.

 Other states have successfully enrolled low- to moderate-income people in the ACA health insurance marketplace. They have done this through:
• Use of data to target communities with large, underserved marketplace-eligible populations.
• Exploiting numerous local avenues to provide extensive education and outreach, including through events and local media, to directly connect the uninsured with help to enroll in coverage.
• Meaningful collaboration with brokers and the small-business community.

A healthy Chicago economy goes hand in hand with a healthy population that is ready to learn, work and is not burdened by health care costs. Let's not let Chicago and Illinois fall behind when it comes to covering working families.

This article originally appeared in Crain's Chicago Business.

Barbara Otto
CEO
Health & Disability Advocates

Stay the Course with SHIP

State budget cuts are not the only threat to seniors and people with disabilities. Federal reductions may be coming as well.

The US Senate is considering a 42% reduction in funding to the State Health Insurance Assistance Program, which counsels seniors and people with disabilities on their Medicare health plan options. SHIP funding would drop to a mere $20 million, diminishing the numbers and quality of the SHIP workforce.

SHIP is Necessary Now More than Ever

Every day, 10,000 Americans become eligible for a Medicare system that is increasingly more complex. Medicare beneficiaries pay the price for the confusion:

• 700,000 Medicare are paying the Part B Late Enrollment Penalty because they missed the deadline to sign up,
• Medicare Part D beneficiaries in Low-Income Subsidy are often unaware of lower priced options,

SHIP counselors are trained to sort through the mess of enrollment rules and multitude of health plan options. The Illinois program includes 600 SHIP counselors located across the State. These counselors provide free, unbiased counseling on Medicare, Medicare supplemental policies, Medicare managed care and long-term care insurance. Seniors can turn to SHIP counselors for assistance with fraud and abuse issues, billing problems and filing appeals. Annually, the Illinois SHIP creates a comparison guide for all Medicare supplemental policies, a vital resource to figure out the alphabet soup of options.

Poorer Trained, Less Helpful

The federal cuts would compromise SHIP's ability to adequately serve everyone who needs help. One and a half million fewer people would receive assistance. Moreover, most of the SHIP counselors are volunteers who donate almost two million hours of help. Cuts could also result in reduced or compromised volunteer training, which increases the risk of erroneous advice and reduces the quality of services beneficiaries receive.

No Substitute

Those in favor of the cuts claim there are less costly alternatives to SHIP. This is untrue. The materials suggested as substitutes, 1-800 Medicare, Medicare.gov and the Medicare Enrollment Handbook, all list SHIP as a resource for people to use with additional questions. A brochure is no substitute for one-on-one, expert advice.

What You Can Do

Tell your Senator to fight cuts to the SHIP program, that your family, friends, even you personally, benefit from the free services that SHIP counselors provide. It's easy:

• Send our Senators this model letter drafted by the National Council on Aging. Just copy and paste the text into their contact forms:  Sen. Kirk's form  Sen. Durbin's form (remember to sign your name!)
• Tweet your advocacy with this graphic we created – and tag @SenatorKirk @SenatorDurbin
• Feel free to personalize with your story, or the story of loved ones. Personal stories make a difference!

Go ahead, spread the word, fight the cuts. And as you do, share your efforts with Illinois Health Matters!


Bryce Marable MSW
Health Policy Analyst
Health & Disability Advocates

Patchwork of Short-Sighted Solutions Leave the State's Most Vulnerable at Risk

The following letter to the editor originally appeared in the Chicago Tribune.

The expectation that Medicaid-funded long-term care providers will continue to provide care to low-income and vulnerable citizens without payment for those services is short-sighted and doesn’t fully consider the strains that it places on them - and the direct care staff who provide the hands-on care to elders and people with disabilities.

For providers that can keep their doors open without Medicaid funding, it may mean cutting costs by laying-off staff, leaving the remaining nursing assistants to work longer shifts at the nursing home. Or, it may result in a consumer getting care from a new home care aide when her regular aide – who knew her schedule and needs – had to quit after losing her day care subsidy – another casualty of Gov. Rauner’s and the legislature’s inability to act and pass a budget.

For those providers that cannot keep their doors open without Medicaid payment, where are the people who relied on them for housing, for a meal, for a bath, or transportation to a medical appointment supposed to turn for care?  In many instances the home care aide is the professional who checks in to make sure that her client is well, taking her medication, and isn’t at risk for injury.  And for those receiving care in a nursing home, there is often not another option for them to receive 24-hour care.

These are realities that lawmakers are not taking into consideration as the budget impasse lingers on without a solution in sight. While ensuring that Medicaid providers in Cook County who serve children continue getting paid was a great solution, none seems to be in sight for the thousands statewide who rely on Medicaid services for care in nursing homes or to live safely and with dignity in their communities.

A patchwork of short-sighted solutions will only leave the state’s most vulnerable at risk.  It is time to pass a budget with sufficient revenue to fund the services that seniors and people with disabilities rely on and to stabilize the long-term care employers and workers who provide the services.

Tameshia Bridges Mansfield
Midwest Director
Paraprofessional Healthcare Institute

Illinois Must Continue to Provide Vital Benefits, Regardless of Failure to Pass State Budget

The following originally appeared on The Shriver Brief from the Sargent Shriver National Center on Poverty Law.

As Illinois’s budget impasse continues, the failure of Governor Rauner and the state legislature to pass a fair, adequate, and fully funded budget is beginning to have an impact. Late last week, Illinois Attorney General Lisa Madigan filed a lawsuit seeking to clarify what payments the state can and cannot make in the absence of a state budget. At issue, among other things, is the state comptroller’s authority to continue to pay state workers.

Importantly, the state also has an obligation to millions of low-income Illinoisans who are recipients of public benefits or beneficiaries of health care coverage. Earlier in June, the Shriver Center formally reminded state officials of their obligations under existing consent decrees to continue to provide these important services. The agreed order entered yesterday by the court in People v. Munger authorizes and requires the comptroller to continue to provide cash assistance through the Temporary Assistance for Needy Families and Aid to the Aged, Blind and Disabled programs, medical assistance, and child care assistance regardless of the lack of a state budget.

Millions of Illinois residents who would suffer needlessly by losing their income and health care coverage due to the lack of an operational state budget can feel secure tonight that their benefits will continue uninterrupted. Now it’s time for the governor and the state legislature to work together toward a budget that serves all of Illinois and includes the sustainable revenue needed to fund the programs that families need.

Dan Lesser
Director, Economic Justice
Sargent Shriver National Center on Poverty Law

Medicaid: The Long-Term Costs of Short-Term Savings

The Rauner Administration’s decision to cut $1.5 billion in Medicaid spending to balance the state budget is like the proverbial cutting off the nose to spite the face. Central to the Rauner “plan” is to tighten eligibility for people with disabilities and older adults to access long-term care services and supports (LTSS). The Administration is proposing to increase the minimum eligible level of something called the “Determination of Need” score. The DON eligibility process determines how many hours of assistance an older adult or person with a disability can get in order to stay in their own home.

While the Administration views this as an appropriate cost-cutting measure, in reality such a move will ultimately reduce needed community-based services for people with significant disabilities, and will spread those costs to other parts of the healthcare delivery system.

Where the costs go

What happens to those costs? They get passed on to hospitals and urgent care providers, taxpayers (in the form of other social programs), and family members who are either under-employed or unemployed in order to help a loved one.

Persons who are aging or living with a disability require access to long-term care to live independently, and do not have other options to find support for their medical needs. Reducing access to home and community-based services means individuals who are at risk of living in more costly nursing facilities become desperate to find any help with activities of daily living, through friends or family members who may be able to assist with financial or personal healthcare needs.

This is easier said than done, however, as family members or friends who can volunteer to assist are often being forced to choose between their own employment and assisting their family member or a loved one. Creating a further burden is Rauner’s proposed elimination of funding for developmental disabilities respite care, a program that provides assistance for people who care for persons with disabilities,

Medicaid is not only the payer of last resort, but the program of last resort, for persons with significant medical needs – paying for as much as 49% of the country’s long-term care services.

How to save the state money

Keeping people out of emergency rooms and nursing homes ultimately saves the state money. Progress Center for Independent Living released data showing that home services remove pressure from Medicaid spending on nursing homes, saving the state more than $17,500 per person, per year in the Home Services Program for people with disabilities.

The cost savings for seniors in the Community Care Program are even greater, at more than $24,150 per person, per year. Consider the fact that the Home Services Program serves 30,000 people with disabilities, and the Community Care Program serves more than 80,000 people year round (based on the FY 2014 Public Accounting Report for both HSP and CCP from the Illinois Office of the Comptroller), and you have staggering numbers for cost savings. According to the Service Employees International Union, more than a third of people with disabilities now in the Home Service Program – some 10,000 people – will lose access to care in their homes, thereby creating a dependence on hospitals and institutions to address their long-term care needs. The Community Care Program will be losing more than 38,700 seniors.

Debate surrounding the state budget should be aimed at taking concrete strategic actions, rather than cutting low-cost and money-saving programs. Governor Rauner appears bent on forging ahead despite opposition from the Illinois house and senate.

The facts are clear. The cuts to the Medicaid budget are not cost-effective, and they isolate vulnerable populations. The notion that diminishing social safety nets is a good way to control state budget deficit is at best misguided, and we need to move on from this policy.

Related reading:

• Community-Based Long-Term Services & Supports at Medicaid.gov
• Gov. Rauner's Health Benefits for Workers with Disabilities site
• Kansas to break new ground in demeaning the poor? column by Michael Hiltzik in the LA Times
• ACA, Medicaid and Unintended Consequences for People with Disabilities post at the IHM blog
• Disability Rights Advocates Deliver Coffin To Rauner, Decry 'Deadly' Human Services Cuts in Progress Illinois

Same-Sex Couples Celebrate New Marriage and Healthcare Rights

The Supreme Court of the United States has been awfully busy lately—after last week’s landmark
rulings to uphold the Affordable Care Act and legalizing same-sex marriage, SCOTUS is certainly living up to its name. And while these decisions have massive implications in completely different realms of the American social and political landscape, they both improve the future of healthcare for same-sex couples. After facing decades of coverage ineligibility and discriminatory practices, achieving marriage equality means that same-sex couples will finally receive equitable treatment in a number of different areas of the healthcare arena.

New Options for Enrollment and Coverage

Because same-sex marriage is now recognized under federal law, LGBT couples are entitled to utilize insurance enrollment and coverage options designated for married spouses. One such opportunity now available to same-sex couples is the special enrollment period. Newly married same-sex spouses previously needed to wait to apply for coverage until the open enrollment period but these couples are now eligible to apply for coverage within 60 days of their union. These special enrollment periods are available to applicants who have recently experienced a major life event, a category which now incorporates same-sex marriages in light of the Supreme Court ruling.

Same-sex partners across the nation are now eligible to receive coverage under their spouse’s employer. A recent study by the Kaiser Family Foundation showed that less than half of employers offer insurance to non-married same-sex couples. Now that same-sex marriages are recognized under federal law, married same-sex couples across the nation will be able to access the same coverage benefits as heterosexual couples.  Although coverage for same-sex spouses was previously available through many insurance providers, same-sex couples will now have equal opportunity to access these benefits.

Spousal Rights

Friday’s Supreme Court decision also marks a huge step towards equal rights for same-sex spouses in healthcare settings. Couples who were previously denied basic spousal rights such as default power of attorney will be entitled to the same privileges as heterosexual couples in healthcare settings.

Although this may seem like a small victory to couples that have faced this type of discrimination, this decision marks a giant leap forward in the fight for equality. Take the story of LGBT rights activist Janice Langbehn: while vacationing with their family in Florida in 2009, Janice’s partner of 18 years Lisa Marie Pond suddenly collapsed and was rushed to a local trauma center. Because they were not Lisa’s blood relatives, Janice and their three adopted children were not allowed to see Lisa and were in the waiting room while she received treatment. Although Janice had power of attorney and the documentation was faxed to the hospital within an hour of Lisa’s arrival, it was too late: Lisa had suffered a brain aneurysm and slipped into a coma, and died without her partner or her children by her side.

Unfortunately, Lisa and Janice’s story is not unique—hundreds of same-sex couples have similar heart-wrenching stories of being denied basic spousal rights in hospitals and other healthcare systems. This landmark ruling will hopefully put an end to these discriminatory practices and allow same-sex couples the same fundamental rights to which all married couples are entitled.

An End to Discrimination

The recent ruling will hopefully mark an end to the prejudicial practices often employed by hospitals and healthcare facilities in serving same-sex couples and their families. As illustrated by Lisa and Janice’s story, unequal treatment of same-sex couples has been an unfortunate part of our nation’s healthcare history. These practices will hopefully be left in the past with this monumental decision.

Although Illinois was ahead of the curve in officially recognizing same-sex marriage, our statewide healthcare institutions have not all been sensitive to the specific care needs of LGBT patients. In an effort to hold healthcare organization accountable for their policies and practices for serving LGBT communities, the Human Rights Campaign launched their Healthcare Equality Index (HEI), which evaluates the equitable treatment of LGBT patients in healthcare settings based on the presence of four criteria: providing staff training in LGBT patient-centered care, equal visitation rights for LGBT patients and their visitors and written patient and employment non-discrimination policies. Although 16 Illinois hospitals and healthcare systems ranked among the 427 national leaders in LGBT healthcare equality, 12 of the 50 Illinois facilities surveyed in 2014 failed to meet the majority of equality criteria.

Despite this, equitable healthcare treatment for the LGBT community on a national scale is closer now than ever before. The 2014 HEI survey found that 84% of the hospitals met all four criteria for LGBT patient-centered care. This is a 101% increase in the number of healthcare systems designated as national leaders in promoting LGBT equality in 2013.

The Supreme Court's legalization of same-sex marriage symbolizes a new era of equality, while the upholding of the Affordable Care Act marks a huge stride towards equal healthcare for same-sex couples nationwide. Now that the federal government has done its part in recognizing same-sex marriage, it’s up to healthcare systems across the nation to follow suit and ensure that their practices promote equitable treatment for LGBT patients and their families.

Dena Balk
Policy Intern
Health & Disability Advocates

Small Employers: Take Another Look at Wellness Programs

Small employers want a healthy workforce but wonder how and if they should promote healthy
behaviors among their employees.  Trends show that larger employers, who typically self-fund their health insurance programs, find a direct link between the benefits of wellness programs and their health insurance bottom line.  This provides clear motivation for internal programming and incentives to keep employees fit, eating healthy and smoke-free.  For small employers who traditionally provide fully insured health insurance programs, the direct return on investment from implementing a wellness program may be less obvious.

The Return on Investment

Research has consistently shown that unhealthy employees are less productive and take more sick days. In 2010, The Harvard Business Review made a compelling argument in favor of worksite wellness programs. In the programs they highlighted, they found improved health status, fewer sick days and workers' compensation premiums declining by as much as 50%.  Even though small employers are faced with a highly regulated premium environment because of the Affordable Care Act (ACA), wellness programs might allow small businesses a solution for lowering workers' compensation costs.

Healthy Employees, Happy Employees

The Centers for Disease Control and Prevention (CDC) identifies several ways that both employers and employees can benefit from work-based health programs.  At the top of their list for employees: increased well-being, self-image and self esteem.   This kind of indirect impact on the employee psyche can boost morale, reduce turnover and ultimately improve productivity. Calculating the cost of employee turnover can be tricky for a small business, but some estimate it to be between 150 – 175% of the annual salary depending on the job level.

The question for small employers comes down to the bottom line.  The actual cost of employer wellness programs can vary greatly. Questions to consider as you begin exploring the feasibility include:

• Will the program be run in house or using an external vendor?
• How extensive will the health interventions be?
• Will you include health screenings?
• What type of employee incentives will be provided?

In addition, small businesses may not be aware that the ACA has created new tax-based incentives for qualified employer wellness programs.   There are rules to comply with, as plans must be reasonably designed to “promote health or prevent disease.”  Additionally they must be made available to all “similarly situated” employees.  For more details see this Department of Labor Fact Sheet.

Small Scale Ideas Make a Big Difference

Still unsure about incorporating a more comprehensive wellness initiative into your business model? Some small scale initiatives can make a big difference.  Even something as simple as extending lunch hours can give employees time to make lunchtime fitness practical and possible.   Rather than allowing employees 30 minutes to grab a burger and fries, 90 minute lunch slots offer employees time to hit the gym. Small changes like this can give a boost to employees and the small business as a whole.

Worth the Time to Investigate

Small employers have a lot to consider when it comes to how to allocate their health related workforce dollars.  Finding a little room in the budget now as well as spending some time re-thinking a few basic workplace rules could ultimately pay off.   Proven reductions in workers' compensation premiums, employee turnover rates and new ACA tax incentives make it the perfect time for small employers to give worksite wellness programs a closer look.

Michele Thornton MBA
Insurance and Benefits Consultant

Illinois Dodges Disaster on Supreme Court's Obamacare Ruling

The following originally appeared on Crain's Chicago Business.

Illinois just dodged a bullet with the outcome of King v. Burwell. If the Supreme Court had ruled against subsidies being challenged in the case, working people and families in the state collectively would have lost more than $49 million a month to help purchase health insurance.

In its decision, the court affirmed the legality of the provision of premium tax credits under the Patient Protection and Affordable Care Act in all states, whether they established their own health insurance marketplace or used the federal marketplace. On average, working poor and middle-class Illinoisans are getting $211 monthly to help pay their health insurance premiums. A different decision would have meant a 169 percent increase in out-of-pocket expense on the average premium.

Recent data by the Kaiser Family Foundation show nearly 73 percent of the remaining uninsured in Illinois eligible for Get Covered Illinois, the state's health insurance marketplace—roughly 597,473 people—live and work in metropolitan Chicago. In the Chicago area, more than 100,000 of the remaining uninsured reside in areas where English is not the predominant spoken language. While concise data are not available of how many of the uninsured are working, American Community Survey data indicate that as many as 62 percent of the uninsured in Illinois are working at least part time and more than likely work for small businesses.

The most recent year for which U.S. Census data on businesses are available, 2012, show 314,199 business establishments in Illinois. However, 94 percent of these companies employ fewer than 50 employees and thus are not required to provide health insurance via the ACA. Cook County alone accounts for 41 percent of the state's total small businesses.

NOW WHAT?

Now that the King v. Burwell decision has put the legality of subsidies to rest, Illinois needs to get busy enrolling the remaining 597,473 uninsured individuals eligible for a path to coverage in the Get Covered Illinois marketplace. Of these uninsured, 283,629 are eligible for a tax credit or subsidy.

It's a matter of economic security for our residents and for Illinois' economic environment. The math tells us that the business community—especially small businesses—needs to be at the heart of efforts to enroll the remaining uninsured. Crain's and Health & Disability Advocates surveyed small businesses last fall and learned that Chicago-area companies still face increasing health care costs; are confused by the requirements of the ACA; and are unlikely to enroll themselves and their employees online. In fact, more than 80 percent of those surveyed said they shop for health insurance for themselves and their employees using health insurance brokers and agents.

Now that federal funding for ACA assisters and navigators is ending, a public-private partnership for enrollment in Get Covered Illinois is critical. We need to double down on engaging health insurance brokers and agents. While the state did an amazing job in enrolling 633,757 adults in Medicaid as part of ACA, Illinois ranked well behind others in marketplace enrollment, coming in 20th out of 37 states that operate marketplaces using HealthCare.gov.

Get Covered Illinois is key to helping Illinois businesses thrive, enabling them to better attract and retain talent. The marketplace also encourages entrepreneurship by ending the reliance of individuals on larger employer-sponsored coverage.

A strong ACA marketplace is a win-win for the business community and the state. We urge Springfield, City Hall and county governments to make enrollment of the remaining uninsured a top priority and engage the business community, health insurance brokers and agents in the process.

Barbara Otto                                          
CEO                                                        
Health & Disability Advocates           

Erica Salem
Director of Strategic Health Initiatives
Health & Disability Advocates

What Really Happens After Enrolling in Medicaid Managed Care?

Health & Disability Advocates (HDA) is monitoring the rollout of the Medicare-Medicaid Alignment Initiative (MMAI) and has heard from frustrated case managers working with consumers who are confused about the enrollment process and their rights. In response, HDA developed an enrollment timeline that explains what new enrollees can expect from Managed Care Organizations (MCOs) and plan representatives upon enrollment. To produce the timeline, HDA researched the MMAI demonstration contract developed by the State of Illinois and approved by the Center for Medicare and Medicaid Services (CMS)  HDA also solicited input from health plans on whether their on-the-ground practices were accurately reflected in the timeline.

The finished product outlines important points for case managers and their clients to consider.

One Day Changes Everything

Consumers who are enrolled in a managed care plan after the 12th day of the month will not see their coverage start until the month after next. This is relevant for consumers choosing a specific managed care plan in order to see a particular provider or specialist in that plan’s network. Submitting paperwork after the cut-off date means consumers would have to wait longer than expected for necessary treatment. Helping consumers submit required documents in a timely manner can guarantee they are connected to the medical treatment they need, which promotes continuity of care.

Stratification Sets Up Future Contact Standards

Once enrolled in a plan, all enrollees can expect to complete a Health Risk Screening within 60 days. The screen collects information on the enrollee’s physical and mental health conditions and identifies their current medical providers. This is what IlliniCare’s Health Screen looks like. Health plans use the screen to establish intensity of services and frequency of contact with Care Coordinators by stratifying the enrollee as low, moderate or high risk.

Enrollees stratified as low risk will receive annual follow-ups from their Care Coordinators while those stratified as moderate or high risk will have quarterly follow-ups. Moderate and high risk enrollees will also complete a Health Risk Assessment and create an Individualized Care Plan within 90 days. These enrollees will help form their own Interdisciplinary Care Team of healthcare providers that meets quarterly to review the Individualized Care Plan.

The Care Coordinators’ Role

Care Coordinators focus on enrollees’ healthcare needs by connecting them to necessary tests, doctors and treatment. They also facilitate information sharing among providers by leading the Interdisciplinary Care Team. Addressing enrollees’ medical needs is their priority. Care Coordinators direct less attention to linking enrollees to social supports, like housing and public benefits.

It’s also important for case managers to know that Care Coordinators must manage a substantial caseload of up to 600 enrollees. Caseloads include a blend of low, moderate and high risk enrollees, with each risk level weighted differently.

Understanding what a care coordinator can—and cannot—be expected to do is advantageous to case managers. When roles are clearly recognized, case managers know how care coordinators can be used as a resource. And in what instances an alternative referral would be more appropriate. This establishes a stronger professional relationship between case managers and care coordinators, which ultimately benefits the enrollee.

Case managers and Care Coordinators are on the front lines of healthcare reform and fostering solid working relationships between these two players will be a critical component of the success or failure of these efforts. Knowing what case managers and their clients can expect from managed care plans can lay the foundation for a strong relationship that supports the health of individuals while also furthering the goals of healthcare reform.

Bryce Marable MSW
Health Policy Analyst
Health & Disability Advocates

People With Disabilities Who Opt Out of ‘Voluntary’ Wellness Programs Will Pay the Price, and the EEOC’s Okay With That.

The following originally appeared on the American Civil Liberties Union's Speak Freely Blog.

Voluntary wellness programs at work can provide benefits to employees, but employers are increasingly adopting “voluntary” wellness programs that unfairly burden workers with disabilities the most of all. Worse, the Equal Employment Opportunity Commission seems to think that’s okay, undermining core antidiscrimination protections it used to defend.

Here’s why.

Imagine a woman living with rheumatoid arthritis and severe depression who, under doctor’s care, has finally returned to work. Her medications — a corticosteroid and an antidepressant — have triggered weight gain. Now imagine this woman facing her employer’s “wellness activities:” She is instructed to fill out a detailed questionnaire about her medical conditions; she is weighed and pronounced overweight; she is told to lose weight. Oh, and the program is voluntary — but if she doesn’t comply, she will have to pay hundreds of dollars more in annual health care premiums. 

This imaginary example is all too real: Persons with disabilities risk discrimination and stigma if their employers gain access to their private medical information. And disabled workers are far more likely to have a condition targeted by wellness programs, such as high blood pressure, high blood glucose, or being overweight. 

Historically, the Americans with Disabilities Act has provided employees with disabilities some protections against overly intrusive and punitive wellness programs. The EEOC has maintained, sensibly, that voluntary medical examinations and inquiries cannot impose penalties on employees who decline to participate. 

Until now.

The EEOC has recently proposed new regulations and guidance language on wellness programs that would allow employers to implement wellness programs that add up to 30 percent of the cost of the employee’s health insurance to an employee’s health care bill. Based on the average annual premium, this translates to an extra cost for disabled employees of about $1,800 per year, either because they don’t want to answer questions that could expose their disability to their employer or because they cannot meet the health goal

The EEOC describes these programs as “voluntary,” but workers with disabilities are the least likely to be able to afford additional health care premiums. According to the U.S. Census Bureau, median household income for people with disabilities is less than half of household income for people without disabilities: $25,974 compared to $61,103. At the same time, there is little evidence that these programs are effective. 

If the EEOC is going to allow employers to charge workers hundreds more each year, it needs to be sure important privacy and disability protections are in place.

Three safeguards matter the most. First, the EEOC needs to provide guidance language that workers with disabilities have the right to request a reasonable accommodation waiver from a wellness program, so that their medical status can be taken into account in their ability to comply. The guidelines should also protect disabled workers’ privacy, so that their decision to join or not join the wellness program doesn’t broadcast the details of — or even the existence of — their medical condition to their employer. Finally, disabled workers should rest assured that the guidelines protect them from disability-based discrimination in the workplace, such as harassment of employees who cannot comply with “normal” health standards. 

Comments on the proposed regulations are due this Friday, June 19, 2015. Tell the EEOC not to permit employers to subject their disabled workers to a Hobson’s choice: Submit to the prescribed wellness activities, or pay hundreds more each year. The EEOC should instead insure that workers with disabilities can opt out of these programs without penalty. 

Claudia Center

Senior Staff Attorney

American Civil Liberties Union

Redoing Redes: Strengthening Communication Procedures in the Illinois Medicaid Redetermination Project

The Illinois Medicaid Redetermination Project (IMRP) is erroneously suspending vital medical care for people who remain eligible. Since the rollout of the IMRP in early 2013, the program has been plagued by inadequate communication from the state that leaves consumers confused and ultimately without healthcare. Consumers report that they are not receiving the required notices by mail and when they call with questions, frontline state staff cannot provide answers. Because of the state’s ineffective communication protocols and inadequate employee training, rightful Medicaid beneficiaries are in the precarious situation of being unable to fill their prescriptions, go to the doctor or receive treatment. The purpose of the IMRP is to save state dollars by trimming the Medicaid program of those who are no longer eligible, not cut people who still deserve services.

Letters Lost in the Mail

Medicaid beneficiaries are cut simply because they never received their redetermination notices in the mail. For example, Health & Disability Advocates worked with a mother whose child had been dropped from Medicaid because IMRP sent the notice to a non-existent address. The fact that IRMP sent the letter to an incorrect address on the same street where the family lived suggests that it was a clerical error. In this situation, a young adult dealing with serious mental illness could not access medication and treatment, because the state, not the individual made an error. Sudden lapses in care can pose serious consequences for people who rely on these supports for their physical and mental health.

This is not an isolated instance. A survey of case managers working with older adults and people with disabilities found that the IMRP fails to adequately notify people of their redetermination responsibilities and inform them when they are bounced from the program. Many get the bad news when they attempt to fill prescription or go to the doctor and are told that they are no longer covered. People deserve clear communication from the state telling them they are no longer covered and the steps to get reinstated.

Confused and Not Covered

Even in cases where Medicaid recipients do receive notices, many consumers find the letters are hard to understand and filled with jargon. Given that the intended audience has never before been required to submit to annual redeterminations and may also have lower literacy levels, the letters must be crystal clear. Reports from case managers suggest the letters are confusing.  One case manager surveyed noted “clients do not understand what documents they need to submit with the form and whether they need to submit anything.” With the potential for people to lose their health coverage, the consequences of this confusion are severe.

IMRP’s own data reveal their communication shortcomings. According to May’s Medicaid redetermination numbers, 81% of cancellations are due to a lack of response. Being cancelled doesn’t mean a person is ineligible. In fact, a substantial portion of these clients should still be receiving services.  Of those dropped, 1/3 were reinstated within three months.  In FY 2015 alone, this translates into 238,025 people being incorrectly cut from Medicaid, and this number could be even higher. People who are less frequent healthcare users may learn of their cancellation when they attempt to schedule a doctor’s appointment. With people who deserve Medicaid cut from the program, the IMRP is not achieving its main objective of reducing state expenditures by eliminating those who no longer qualify. Cutting eligible people will actually result in higher costs. Without access to primary medical treatment, people will resort to more costly emergency room care for conditions that could have been managed or even prevented.

Matters get worse when consumers call state workers for clarification, because frontline staff members are often not fully informed themselves. In the above-mentioned case of the mother fighting for her son’s coverage to be reinstated, her interaction with the IMRP hotline was unhelpful and hurtful. The representative said there was nothing more she could do and blamed the family. Stateline workers should be fully trained to provide answers; anything less only increases confusion and frustration.

The Path Forward

The state must develop plain-language notices that explain redeterminations and their importance while outlining the specific steps to keeping coverage. This would not be a new undertaking. State officials have previously brainstormed ways to create simple, more consumer friendly forms. Unfortunately, the furor around budget deficits and service cut threats has drowned out the push for clear communication standards. Even worse, continuing to deemphasize this issue will leave many rightful Medicaid recipients suddenly without coverage. Communication protocols and state staff should support individuals in maintaining their vital connection to healthcare, not create hurdles that effectively jeopardize emotional and physical health. State officials must restart the discussions on clear notices and broaden the conversation to include improved training for frontline staff. These reforms will go a long way towards supporting the IMRP’s original objective of eliminating wasteful spending while also keeping those who still deserve coverage connected to care.

Bryce Marable MSW

Health Policy Analyst

Health & Disability Advocates

The Missing Link: Putting Health into Your Hands

The Affordable Care Act brought about the expansion of Erie Family Health Center, the only health clinic in Evanston and Skokie. Long after its opening in Evanston, Erie Family Health Center was under capacity and wanted to reach more people. In contrast, the Evanston and Skokie Health Departments conducted community surveys in 2013 and found that one of the most prevalent health issues identified by the community was access to healthcare.

Something needed to change in the way that people accessed the healthcare system and the way they were connected to information and care. Inequalities in the healthcare system limit the types of care and information for people of different backgrounds. Many people do not know how to access quality health information or where to go for their health-related needs.

A Community Collaboration Promoting Health

Students at Northwestern University are partnering with public institutions, community organizations and university departments to create student-run health resource centers at the Evanston and Skokie libraries. Called the Health Information Resource Centers Utilizing Libraries in Evanston and Skokie (HIRCULES) Health Hub, the initiative will work to promote health literacy, preventative care, awareness of community resources and understanding of the existing healthcare system. The program is powerful and unique; it empowers people to take ownership through guidance, linkage and education.

The HIRCULES Health Hub will provide the Evanston and Skokie community with a trusted central resource where they can be connected to educational materials to improve health literacy. The HIRCULES Health Hub desks will be staffed by Northwestern students trained as medical librarians at Evanston and Skokie Public Libraries. Students will gather resources and search for materials for library patrons. HIRCULES will also include a website with relevant health resources and databases that contain searchable information including frequently asked questions, health services available in Evanston and Skokie and a calendar of health-related community events.

Identifying Challenges, Creating Solutions

The HIRCULES Health Hub will feature monthly themes with digestible and accessible information. Developing these monthly themes has taught staff a great deal about the community and led to new solutions. For example, last summer staff created a Back to School theme and wanted to inform parents where they could obtain school supplies if they could not afford to buy them from a store. The organization that had previously provided this service had recently closed, and with two months until the start of the new school year, no one else was planning to provide supplies to any Evanston school districts. HIRCULES staff reached out to community organizations, Parent Teacher Associations and school district boards to find a point person who ran a program to fill the need for school supplies for low-income students. Because of HIRCULES, real needs of the community were identified and addressed.

Improving Knowledge and Health

Normalizing routine, preventative care is another important aspect of the project. HIRCULES staff will promote preventative care through education of how to utilize Federally Qualified Health Centers and medical homes. Most people are not aware of the implications of the Affordable Care Act, which promotes preventative care. This reduces costs and improves health outcomes over time. Emphasis on preventative care education is imperative in empowering people to utilize pre-acute and ambulatory points of access to health systems. The partnership between HIRCULES and Erie Family Health Center helps establish a healthy lifestyle through regular, preventative primary care checkups and referrals for more complex health services.

Information Hub for the Community

The final objective of HIRCULES is to guide people to health-related resources, simplifying their search for health and wellness and improving services in the existing, complex healthcare system. All available, health-related resources in the community are being compiled into a virtual database accessible online and through visiting the HIRCULES Health Hub. For example, if an expecting mother wants to know where she can access prenatal and postnatal care, HIRCULES staff can direct them to Family Focus. If a parent needs assistance enrolling his or her family in health insurance, they will be connected with a local health insurance navigator and resources from Get Covered Illinois.

These major health issues will take time to address and overcome. Programs like HIRCULES are a vital contribution to making positive changes and improving the health of Evanston and Skokie citizens.

Brittany Zelch & Emery Weinstein

Brittany and Emery are undergraduate students attending Northwestern University Weinberg College of Arts and Sciences who study global health. They helped found and remain involved in the HIRCULES Health Hub.

ACA, Medicaid and Unintended Consequences for People with Disabilities

People with disabilities who are eligible for healthcare through Medicaid may experience painful gaps in coverage during transitions. There are groups of people with disabilities that are particularly vulnerable: those who need long-term care services, those who apply but are not yet found eligible for SSI in 209b states with expanded Medicaid and youth transitioning to the adult system.

Long-term care services and supports, such as personal assistance services or durable medical equipment, are critically important to some people with disabilities. Medicaid packages for people with blindness and disabilities, or AABD or SSI Related Medicaid, offer comprehensive coverage, including long-term care supports and services. For those who need them, these services are a lifeline to independence, living in the community and employment.  Either not affordable or available through the private insurance market, Medicaid has been the sole access point for people with disabilities who need long-term care services. The Adult ACA Medicaid group, or expansion group, is a Medicaid program that may or may not provide an individual with long-term care services in any given state.

209(b) Expansion States Facing Challenges with Transitions 

One key difference across states is the option to automatically provide SSI Related Medicaid to recipients of the federally-administered state supplementary payments though the Supplemental Security Income (SSI) program. Ten states use at least one eligibility criterion that is more restrictive than the SSI program for Medicaid eligibility and are referred to as 209(b) states. This means that an individual in these states who applies and is found eligible for SSI must make a separate application for Medicaid coverage.

The following states are currently 209(b) states: Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma and Virginia. All but Missouri, Oklahoma and Virginia have expanded Medicaid eligibility through the ACA.

Limited Access to Long-Term Care and Providers in the ACA Adult Group

Because many SSI applications take longer to process than Medicaid applications, people with disabilities can frequently be found eligible for ACA Adult Medicaid while waiting for SSI eligibility to be approved. While this group of individuals who have been approved as ACA Adult Medicaid eligible has access to healthcare, they may not have access to long-term care services.

Once SSI eligibility is approved, however, the beneficiary is no longer eligible for the category of Medicaid (ACA Adult) they are currently receiving. When they are put into the correct category for coverage (SSI Related Medicaid), they are sometimes dropped from one health plan and put into another without their knowledge. The end result is a current Medicaid beneficiary who is denied or faces delayed access to long-term care services he or she should be receiving under SSI Related Medicaid, as well as potentially losing access to providers and being forced to reapply altogether.

In addition to the lack of access to needed long-term care services, people may also experience challenges related to accessing medical service providers. In some states, the integration of the ACA and managed care has vastly changed provider infrastructure, with managed care plans for SSI Related Medicaid offering different provider networks and services than ACA Adult Medicaid managed care plans.

Many individuals, especially those new to SSI Related Medicaid, will not be aware that they are in a different category until another action is taken, such applying for a Medicaid waiver service, attempting to contact their managed care plan or going to see their providers. Both of these issues can result from the timing of an individual’s Medicaid application and approval.

Youth with Disabilities Facing Challenges with Transitions

Youth with disabilities can also potentially face significant unintended consequences around access to appropriate healthcare coverage. Children with disabilities are found eligible for SSI due to a reduction in both Activities of Daily Living and Instrumental Activities of Daily Living. This means a youth can be eligible for SSI under a broader context of criteria, like an inability to socialize or play with others.

Adult disability determinations, by contrast, are made based on a disabling condition that impacts employment—not only current employment, any employment in the country that may be available to someone with such impairments. These are vastly different criteria.

As a result, many children are found eligible and begin receiving childhood SSI and SSI Related Medicaid. However, when they turn 18, they are required to meet the adult disability guidelines in order to remain eligible. Many children fail to meet those adult requirements and their benefits are terminated. Of those that are found ineligible when they turn 18, a number are later found to be eligible in further review or appeal processes. Because Medicaid waiver programs are available only to individuals who are current Medicaid recipients, a child may have waited years to be eligible for Medicaid waivers, be found eligible, only later to be denied eligibility for adult disability—which results in losing benefits under SSI Related Medicaid and SSI eligibility. If, upon later application, the individual is once again found eligible for both adult SSI and SSI Related Medicaid, he or she must now go to the back of the waiting list for the same waiver services previously lost under a youth determination. This can result in years without necessary, critical services and care.

Experiences in the States

Health & Disability Advocates conducted a short, informal survey of seven 209(b) states that have expanded Medicaid to learn more about how states identify people who are in the “wrong” eligibility category and the processes states have in place to prevent this from happening. With six of the seven states responding to the survey, HDA found that:

• Three of six respondents offer Medicaid provider packages that are different depending on whether you are in SSI Related Medicaid or ACA Related Medicaid.

• Three of the six responding states offer some variety of waivers to individuals even if they are placed in ACA Related Medicaid.

• None of the responding states have a formal process for coordinating information about individuals who transition eligibility from one service package to another.

• Four of six states are unaware of whether individuals have been improperly placed in the wrong Medicaid eligibility package; the remaining 33% have implemented trainings, but know that individuals continue to get placed into the wrong eligibility group.

• Five states (all but North Dakota) were not aware of specific alerts that notify the Medicaid beneficiary that their eligibility for one program has ended and another started.

Upon further contact, roughly half of the states were in the early stages of identifying the issue of individuals being inappropriately placed and noted a need to develop a process for re-engaging the beneficiary to get them connected to appropriate providers for maximized health.

Recommendations Going Forward

While states are currently uncertain about the scope and breadth of these issues, it is important to identify individuals who have fallen through the cracks and may experience a significant disruption in services and eligibility. At a minimum, requiring states to create an automated notification system for changes to eligibility would provide beneficiaries greater clarity and time to plan.  In North Dakota, for example, individuals receive a notice as they leave eligibility under one Medicaid group and become eligible for another. Notice of and clear information about the ramifications of the change is critical.

Another recommendation for states is to look at integration of its systems and data tracking of disability populations. Data exchanges between the state and federal systems, along with the differing eligibility criteria among various programs, should make tracking persons with disabilities a high priority for states. Minnesota, for example, is developing a new integrated system with the capacity to match data sets to a broader context of information, such as employment status. This will greatly enhance the ability of the state to make sure that people with serious health needs receive the proper services and have access to the supports they need for the greatest possible independence.

Joe Entwisle, MS, CLCP
Sr. Policy Analyst
Health & Disability Advocates

The Future of Enrollment in Illinois: Where We’ve Been and Where We’re Going

When Get Covered America came to Illinois before the first open enrollment period for the Affordable Care Act in 2013, there was a lot of work to be done. At that time 78% of the uninsured had not heard of the health insurance marketplace and were unaware of the new health coverage options or opportunities for financial help available to them for the first time. The initial awareness gap was daunting, but hundreds of thousands of Illinoisans stood to benefit from the marketplace and needed to know how the Affordable Care Act could help them.

Many Milestones Through Collaboration

Fortunately, there were a number of stakeholders like Health & Disability Advocates (HDA), the Campaign for Better Health Care (CBHC), Alivio Medical Center and the AIDS Foundation of Chicago, among others, eager and ready for the challenge ahead. This commitment helped achieve many of the goals laid out in the beginning. After two successful open enrollment periods, nearly 350,000 Illinoisans have enrolled in health insurance through the marketplace, and hundreds of thousands more have received coverage through expanded Medicaid and CHIP. Working together towards the same mission, Get Covered America and its partner organizations increased awareness and provided enrollment resources for consumers across the state.

Stepping Back to Move Forward

Because of the great work that has happened on the ground in Illinois, Get Covered America will be stepping back with full confidence in capable partners like HDA, CBHC and many others—such as Family Guidance Centers and Ada S. McKinley—to continue this important work to make health care enrollment a permanent part of communities. It’s clear that the coalition of partners who have come together on this issue have made great strides over the past two years. As the insurance landscape changes and the number of uninsured Illinoisans continues to decrease, Get Covered America wants to make sure that resources are allocated in the smartest and most effective way.

While Get Covered America won’t have an active outreach presence on-the-ground in Illinois moving forward, the organization will continue to support partners in the state with cutting edge data, best practices, tools and resources. Get Covered America will refine and continue to offer digital tools like the Get Covered Connector while also introducing new programs, like  training and support for local partners and health insurance literacy resources for the newly insured.

The Enrollment Challenge Ahead

Just released by Get Covered America, the State of Enrollment Report takes a critical look at the lessons  learned and what still needs to be done to get Illinois covered. Using on-the-ground knowledge and data analysis, the report identified several key initiatives integral to maximizing the number of Illinoisans who enroll in coverage. This is a great resource for partners on the ground and the foundation for a sustainable coalition for years to come.

The Get Covered America team is thrilled at what has been accomplished in Illinois so far, but there’s still important work to be done. While more Illinoisans have health coverage than ever before, there are still too many who remain uninsured and need the facts about how the Affordable Care Act can help them and their families.  On-the-ground partners like CBHC, Family Guidance Centers and Alivio Medical Center will continue this work and make health care enrollment an institutional reality for years to come.  And Get Covered America  looks forward to supporting their efforts.

David Elin
National Fundraising Director
Enroll America

Rauner's Budget is Bad Medicine for State's Health Services

The following post originally appeared on Crain's Chicago Business.

The much-anticipated “turnaround budget” from Illinois Gov. Bruce Rauner feels more like a “look back,” parading out failed ideas from past years. Rauner says this budget "preserves services to the state's most vulnerable residents”—but a quick review suggests this is far from true. Instead, we see a budget that:

• Further decimates a fragile community mental health system
• Reduces access to lifesaving drugs for people living with HIV and prevention services for those at risk of HIV
• De-funds critical substance-abuse treatments
• Drastically reduces cost-effective breast and cervical cancer screening services
• Makes it harder, and in some cases impossible, for people with disabilities and seniors to get support to live at home
• Reduces funding for evidence-based tobacco prevention and cessation services
• Eliminates Medicaid benefits for preventive health services, including adult dental care
• Eliminates health insurance for workers with disabilities, coverage unavailable in the private marketplace
• Slashes funding for hospitals serving Medicaid populations
• Eliminates funding for care coordination, originally designed to contain costs
• Secures Illinois' position near the bottom of states for per-enrollee Medicaid funding

It's ironic the governor calls these cuts “tough medicine,” when the proposed budget would deny any medicine and critical health care services to so many. We've been down this road before, and here's what we learned:

• Cuts of $113 million to mental health and addiction treatment services in fiscal years 2009-11 increased state costs by more than $18 million due to increased emergency room visits, hospitalizations and nursing home placements.
• Elimination of Medicaid coverage for adult dental services in 2012 caused spikes in emergency department visits for dental problems. In-patient ER treatment for dental problems averaged $6,498, nearly 10 times the cost of preventive care delivered in a dentist's office.
• Disinvesting in HIV prevention will lead to new infections, for which the Centers for Disease Control estimates lifetime treatment costs of $379,668 per case.
• For every dollar Illinois spends on providing tobacco cessation treatments, it has on average saved $1.29. Cutting funding for smoking cessation services will increase costs by up to $32.3 million annually in health care expenditures and workplace productivity losses.

As proposed, the Rauner budget is not only bad for our health, but it's bad for businesses, too, likely resulting in decreased productivity, loss of jobs and economic activity, and greater health care costs for employers. Some examples:

• The proposed child care “intake freeze” and increase in parent co-pays will lead to increased absenteeism as employees will take time off to care for children. Such absenteeism already is costing American businesses nearly $3 billion annually.
• Planned cuts to Illinois hospitals are expected to result not only in the loss of more than 12,500 jobs but $1.7 billion in economic activity.
• Cuts in funding for health care services, such as cancer screening, most certainly will increase the health care costs of Illinois businesses. One study of major employers found that patients with cancer cost five times as much to insure as patients without cancer ($16,000 versus $3,000 annually).

We urge the governor to listen to the critics of this budget and learn from Illinois' past experiences. We stand prepared to support him on this learning curve.

Barbara A. Otto
CEO
Health & Disability Advocates

Illinois Cooperative Brings Competition, Lower Costs for Small Businesses

Taking Advantage of Land Of Lincoln Health

Consumer Operated and Oriented Plans, or CO-OPs

for short, are a new health insurance option for small business owners. Created by the Affordable Care Act, CO-OPs are consumer-directed and required to engage members in plan oversight. Only insured members can vote for and run for a seat on the CO-OP’s Board of Directors.

What is a CO-OP?

The federal CO-OP program offers low-interest loans to eligible nonprofit groups to help set up and maintain these issuers. CO-OP loans are only made to private, nonprofit entities that demonstrate a high probability of financial viability. All CO-OPs receiving loans were selected by the Centers for Medicare & Medicaid Services on a competitive basis based on external independent review by a multi-disciplinary team. As CO-OPs meet or exceed developmental milestones, funds are allowed to be incrementally drawn down.

Taking Advantage of a CO-OP'portunity

The Illinois small business community capitalized on the CO-OP option. Small businesses in Illinois had been confronting high health insurance costs that threatened their ability to offer employee coverage. Illinois was previously dominated by one major health insurance carrier, who in 2014 wrote over 90% of the public health insurance marketplace policies in state. This market dominance gave small business owners few options in terms of obtaining and providing their employees with affordable health insurance. With CO-OPs offering the promise of increasing competition and lower rates, small businesses and individuals formed a CO-OP owned by its members and operated by its advocates.

Small Business Have More Choice

CO-OPs are following through on that promise. The Illinois CO-OP has enrolled over 50,000 businesses in 2015. During the second open enrollment period, one of every four new enrollees to the 2015 public marketplace is choosing a CO-OP. This additional competition is fantastic news for small business owners and their employees.

And High-Quality Plans

The Illinois CO-OP has been able to roll out innovative and transparent plans that connect consumers with provider choices they know and trust, because of the CO-OP's close relationship with the medical community. A consumer’s commitment, as an individual or employee, to choose the provider on the front end and at the time of selecting insurance coverage motivates the provider to build a strong relationship with that consumer. As a consumer-focused company, The CO-OP's small business insurance offerings are also designed by individuals who are attuned to the unique needs of this community.

The Bottom Line

The majority of small business owners value and care about their employees. Moreover, healthy employees with access to quality medical care are happier, more motivated and productive. Stabilizing health insurance premiums for small businesses while at the same time enabling them to procure quality coverage for their employees is a true game-changer. Small businesses drive our economy. Providing them access to affordable health insurance will benefit not only the small business community, but the entire Illinois economy.


Elliot Richardson
Founder and CEO
Small Business Advocacy Council