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Presentation on theme: "HOW ACA WILL AFFECT THE ILLINOIS MEDICAID PROGRAM Town Hall Meeting September 27, 2012."— Presentation transcript:


2 Key Things to Know About Medicaid Medicaid is not Medicare, which is mostly for seniors, of any income – it’s 100% federally funded Medicaid is healthcare for low-income adults and children – a mix of people with needs not otherwise covered by traditional insurance or Medicare Medicaid is a state program, jointly funded by federal and state government – 50%/50% in Illinois (varies by federal formula) Medicaid must comply with many federal laws as well as state laws 2

3 Our Medicaid Clients Today Under current law, Medicaid clients must fit into a certain category to qualify, no matter how poor they are: – Children under 19 (called “AllKids”) – Persons with disabilities who meet the Social Security definition – Seniors aged 65 and older – Other adults o Parents and other caretakers of dependent children (called “FamilyCare”) o Pregnant women (called “Moms and Babies”) 3

4 Our Medicaid Clients, cont’d. 2.7 million adults and children are currently enrolled – Children under 19 1,656,209 – Adults with disabilities 258,672 – Seniors 166,104 – Other adults 623,807 4

5 Our Medicaid Clients, cont’d. 5

6 But Small % of Medicaid Clients Incur Majority of Medicaid Costs 16% of clients who are Seniors and Persons with Disabilities (SPD) cost 55% of Medicaid budget (all agencies) – they have most complex health/behavioral health needs 6

7 Current Income Limits Under Medicaid Medicaid is for low-income people – It is a “means-tested“ program, based on income – Includes asset tests for some groups (e.g., disabled) – But a person also has to fit into a category Today, income limits are different for different groups – 300% federal poverty level for children – 133% federal poverty level for parents/caretakers – 200% federal poverty level for pregnant women – 100% federal poverty level for seniors and disabled, with an asset test 7

8 “New” Medicaid Under ACA Under ACA, “new Medicaid” clients will qualify on basis of income, with a consistent national standard, not the current categories –Income level = 133% of federal poverty level (in 2012 about $25,390 per year or $2,116 per month for a family of 3) In Illinois, additional 500,000 are expected to enroll in Medicaid –2/3 could be “new Medicaid” clients who will qualify based on income –1/3 could be currently eligible but are not yet enrolled (“old Medicaid”) Federal government will pay 100% for “new Medicaid” through 2017; phase to 90% by 2022 –“Old Medicaid” will still be reimbursed at 50/50% 8

9 ACA Challenges for Medicaid Need law setting out eligibility standards for “new Medicaid” clients – Need General Assembly action during 2012 veto session or by early 2013, at latest Need healthcare providers willing to serve 500,000 more Medicaid clients – Alternative healthcare professionals to expand pool of doctors – More outpatient clinics in all neighborhoods, reflecting diverse cultures, languages, etc. Need “new Medicaid” clients to fit into redesigned Medicaid service delivery system – In process of moving at least 50% of clients into care coordination/managed care by 2015 9

10 ACA Challenges for Medicaid, cont’d. Need to manage continuity of care for clients moving from Medicaid to Exchange, and back, from one year to next (“churn”) – Don’t know medical history of “new Medicaid” clients – mostly single adults Need to be ready to enroll “new Medicaid” clients as well as applicants to the Exchange, by Oct., 2013 – New Integrated Eligibility System (IES) will handle seamless application process – New system will include modern database matching to prevent fraud – Deloitte just won bid, and work is starting 10

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