EXPANDING COVERAGE IN CHALLENGING TIMES

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EXPANDING COVERAGE IN CHALLENGING TIMES Powered By Docstoc
					EXPANDING COVERAGE IN
  CHALLENGING TIMES
    Anne Marie Murphy, Ph.D.
        Medicaid Director
  Illinois Department of Public
               Aid
     FY2005 APPROPRIATIONS BY AREA
                All Funds                            Medical Programs


                    $11,998.8 Million                                     Hospital
                                                      $1080.0M 9.5%       Assessment
                                                                              Managed Care
                                    $181.9M(1.6%)
                                                                         Special Education Match
                                    $240.0M (2.1%)
                                                        $778.1M 6.9%     Remaining Medical

Energy Assistance                                                         Practitioners
                                                      $642.3M 5.7%
$312.4 M (3%)
P.A. Recoveries
$28.0M (.2%)
                                                      $2037.0.M 18%
                                                                            Drugs
Administration
$102.7M (1%)


Inspector General
$19.7M (.0%)                                          $1,765.8M 15.6%     Long Term Care
                               Medical Services
                               $11,330.5M (94.3%)
Child Support
$205.5M (2.%)


                                                       $2,154.5M 19%      Cook County &
                                                                          U of I




                                                       $2,450.9M 21.6%   Hospitals
   Where there is a will, there is
         usually a way!
In spite of tough budget times,
Governor Blagojevich has prioritized health care.

Illinois was the only state last year to do major
     coverage expansions
• without cutting provider rates,
• without cutting other eligibilities
• without increasing beneficiary out-of-pocket
     costs.
KidCare Now Covers Over 1 million Illinois Children


                            KidCare Children (In Thousands)
          1200
                                          862.2       944.1   959.6   1023.3
          1000
                    779.1   785.6
           800
           600
           400
           200
             0
                    FY 98   FY 99         FY 00       FY 01   FY 02   FY 03

                              Phase 2 of Kidcare
    Phase 1 of Kidcare        implemented 10-1-1998
    implemented 1-1-1998
                   Children 2002

                 Actual Enrollment
                         vs
           Census Population Survey (CPS)


According to CPS data, the uninsured rate
 for children in Illinois has decreased from
 14.6% in 1998 to 11.35% in 2002

Total Medicaid Enrollment – Actually Enrolled
                  959,600

    Total Medicaid Enrollment – CPS Data
                  637,288
Illinois Medicaid the largest provider
    of health insurance in the state:
       1.8 million Beneficiaries
(thousands)
  2,000



  1,500



  1,000



   500



     0
          FY'99      FY'00    FY'01    FY'02     FY'03      FY'04   FY'05

              Family/KidCare Assist   AABD     DCFS/Other     SeniorCare
      KidCare/FamilyCare
          Expansions
• July 03 – KidCare expansion from
  185% FPL to 200% of FPL
• July 04 – FamilyCare expansion from
  49% FPL to 90% FPL
• FY05 proposal – FamilyCare expansion
  from 90% FPL to 133% FPL
   KidCare Rebate for those with
  Employer-sponsored Health Care
• With private sector insurance
  rates increasing at close to
  14%, this is leading to increased
  costs for employees
• Originally funded at state
  expense.
• No wrap-around benefits
  requirements
• Benefit requirements –
  physician and hospital inpatient
• No employer contribution
  requirements
           SeniorCare
• Implemented 05/02 as an 1115
  pharmacy Waiver
• Comprehensive prescription benefits
  for seniors with income up to 200%
  of FPL
• Much more generous than Medicare
  drug bill
         SeniorCare vs. Medicare
Drugs bought           SeniorCare               Medicare
                       beneficiary              beneficiary
                       pays                     pays
$1,855                 $119 on average $1,045


$5,100                 $988 on average $4,020


Assumptions:
SeniorCare Beneficiary with income 150-200% FPL
SeniorCare Beneficiary with average cost prescription drugs
                                                              15
   Illinois Healthy Women
• Implemented 04/04
• Family planning waiver
• Yearly physicals, family planning
  services, mammograms/treatment for
  STD and HIV detected at family
  planning visit
• Currently, covering at state expense
  for multivitamins with folic acid
        Show Me The Money!

• In our HIFA waiver, we got federal match for
  programs that were previously state funded.
• In our “unborn” SCHIP amendment, we got
  federal match for births that the state was
  previously paying for.
• In our SeniorCare waiver we converted a state
  funded program to a federally matched program
• We appropriated new dollars.
Federal Matching Funds for
     Rebate Program
• Medicaid funding for Rebate (premium
  assistance program)

• Medicaid funding for insured children who
  choose direct coverage

• Insured children can move from premium
  assistance to direct coverage at any time
Federal Matching Funds for
   State Only Programs
• Illinois Comprehensive Health
  Insurance Program (ICHIP) - state
  program for uninsurable persons

• State Hemophilia Program – provides
  medical services to persons with
  hemophilia
    Not just a program on Paper -
    Really getting Children enrolled !
•   KidCare Application Agents (1100)
     $50 for an approved complete application
     90% approval rating for apps received
     $7 million paid in Technical Assistance Payments (TAP)
•   General Outreach
    Gives hundreds of presentations on the KidCare program
    Work with community groups, employers, schools, hospitals, etc.
    throughout Illinois
    Promote KidCare at many county fairs, the Illinois and DuQuoin
    State Fairs
•   Targeted Outreach
    Hotline number included on Child Support checks disbursed
    throughout the state
    Osco-Albertsons Pharmacies – displayed posters and handed out
    applications
    Worked with SEIU to distribute KidCare material to all its members
    Previous Simplifications
• Eliminated asset requirement

• No face-to-face interview required for
  application or redetermination

• Two page mail-in application

• 12 Months Continuous Eligibility
         “One Pay Stub”
          January 2004
• Reduced income verification to
  require proof of one payment

• Accept family’s statement regarding
  amount of child care paid

• Denial rate for failure to provide
  verifications reduced by over 10%
    Presumptive Eligibility
                   Began 05/04
Authorized by state eligibility staff when
  application for medical benefits is received if:

•   Declared family income equal to less than 200%
•   No PE within last 12 months
•   No evidence that immigration status not met
•   Continues until decision is made on application
•   Authorized PE to over 3,000 families in first
    10 days of program
           Future Plans
• Web-Based Application – December
  2004
• Processing all mail-in applications
  within two weeks of receipt – end of
  summer
• Looking at ways to streamline
  renewals
     Future Initiatives for
       Federal Funding
• Rebate for mandatory populations
• Coverage for immigrant children in
  U.S. less than 5 years
• Allow claiming for PE under Title XIX
• Allow enhanced match for enrollment
  of Medicaid children above the level
  enrolled prior to SCHIP

				
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