1. HOW ACA WILL AFFECT THE ILLINOIS MEDICAID PROGRAM
Town Hall Meeting
September 27, 2012

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

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
Parents and other caretakers of dependent children (called “FamilyCare”)
Pregnant women (called “Moms and Babies”)

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

5. Our Medicaid Clients, cont’d.

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

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

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%

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

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