May 2, 2019

Rate Review – What a Difference!

Logo of Illinois Depart of Insurance with Department of Prior Approval labelOn April 11, the Freedom from Aggressive Insurance Increases Review Act passed the Illinois House on a bipartisan 73-41 vote. The bill ( HB 471 ), known as the FAIIR Act, would give the Department of Insurance the authority to approve or deny unreasonable health insurance rates. This kind of meaningful rate review is practiced in 37 states and has been shown to curb outrageous rate hikes.

In terms of health insurance, Illinois is what is known as a “file and use” state, which means that insurance companies must file their intended premium rates, which then go into effect without having to be approved by the Department of Insurance. In “prior approval” states, the insurance commissioner can approve, reject, or reduce rates, often actively negotiating with the insurer. Continue reading “Rate Review – What a Difference!”

April 9, 2019

Rules May Complicate Pritzker Plan to Tax MCOs

Cover of Illinois FY 2020 budget proposal, with photo looking up into capitol doneGov. Pritzker’s budget proposal delivered last month calls for new taxes on cigarettes and insurance companies to fund Medicaid. Here is some context on where it came from and the challenges it faces.

The Department of Healthcare and Family Services operating budget of $25.1 billion is about $900 million more than for the current year. The vast majority of it is earmarked for Medicaid. The program, which covers 1 in 4 Illinois residents, accounts for close to a third of total state spending. Continue reading “Rules May Complicate Pritzker Plan to Tax MCOs”

March 13, 2019

Will Benefits Updates Follow Wage Increase?

For every dollar the boss had and didn't work for, one of us worked for a dollar and didn't get it - Women's March signThe long fought-for $15 minimum wage bill was signed into law by Governor Pritzker on February 19. It raises the state’s minimum hourly wage from $8.25 to $9.25 next year, and then phases it in to $15 by 2025.

Although the federal minimum wage is still $7.25, much of the country has moved on. More than 60% of the working age population is estimated to live in areas with a higher-than-federal minimum. Chicago and Cook County have raised theirs, currently at $12 and $11, respectively. California, Massachusetts, and New Jersey will beat us to $15. As of January 2017, 29 states and a couple dozen cities had set their own minimum wage, and a dozen states automatically raise it every year to keep pace with inflation. Continue reading “Will Benefits Updates Follow Wage Increase?”

February 13, 2019

Imagine Medicaid with Informed Consumer Choice

Patient getting in-person assistanceDo you remember when the ACA Marketplace opened in 2013, and the whole thing was so complicated that special roles like “navigators” and in-person counselors, aka IPCs, had to be created to help people enroll? Even though few assisters remain due to significant funding cuts from the federal government, people still need help with healthcare choices, especially in our Medicaid program.

Most people have access to expert help figuring out their healthcare choices. With an employer, you have an HR person or representative to help you sort through your healthcare choices. On the private market, you have brokers and agents. In Medicare, you have Senior Health Insurance Program counselors and brokers. Granted, all those systems have their shortfalls, but the common thread is that there is a person you can reach for help.

Not so for Medicaid recipients – the people likely to need it the most. Continue reading “Imagine Medicaid with Informed Consumer Choice”

January 16, 2019

Medicare In-home Services: Learn from Medicaid

A senior holds her glasses and handbag. New services may help more seniors stay at home.

As people age, they typically need more help doing everyday things, whether it’s getting the groceries or taking a shower or remembering to take their meds. In many cases, even limited assistance can allow a senior to remain in their home for many years, even decades.

The logical program to provide in-home services is Medicare, which pays for most of seniors’ medical care. But Medicare does not cover them. Medicare does cover skilled medical services like physical therapy or nursing care when you’re ill or recovering from an illness or surgery, but you must be certified by a doctor as homebound, and even then it will not cover non-medical home services such as help bathing or dressing or preventive aids such as grab bars. The result is that many seniors end up spending down their resources to be eligible for Medicaid to get the non-medical care they need in order to live at home. Our system makes middle class people become poor to get the care they need – and, ultimately, states pick up the tab. Medicaid has been covering a growing portion of long-term care in the U.S. – 53% in 2018.

But 2019 ushers in help at home services for Medicare – and the change may be the catalyst for a more dramatic transformation in healthcare delivery and effectiveness.

Continue reading “Medicare In-home Services: Learn from Medicaid”

December 14, 2018

Will 2019 Bring a Medicaid Buy-in to Illinois?

Map of states exploring Medicaid buy-in, updated from unitedstatesofcare.org
Click to enlarge
When Governor-elect JB Pritzker and incoming legislators take office a few days from now, we hope among the top-of-mind issues for them will be healthcare – and the possibility of creating a public option that would allow Illinois residents to purchase a premium to participate in the state’s Medicaid program. Candidate JB Pritzker talked about his vision for such an initiative, which he called “IllinoisCares,” and his platform included a public health insurance option that would be available to all residents.

IllinoisCares would allow Illinois residents to purchase health insurance from the state, rather than a commercial plan. Forty-two states – including Illinois – already have Medicaid buy-in programs, but they are limited to working people with disabilities who have not been able to purchase affordable health insurance coverage that meets their health needs in the private market. Continue reading “Will 2019 Bring a Medicaid Buy-in to Illinois?”

December 13, 2018

The Healthcare Bills of 2018

To do in November: Override SB 1737 veto - checked!The new year will bring with it Public Act 100-1118, which protects Illinois consumers by imposing strict limitations on so-called “short term health insurance plans.”

Enacted in a veto override last month, it was perhaps the most dramatic of several important legislative achievements the now-outgoing 100th Legislature.

The Short-Term, Limited-Duration Health Insurance Coverage Act – The bill was developed with help from Protect our Care Illinois, in response to the Trump Administration’s proposed regulations to extend short-term insurance terms and make them renewable.These plans, which are essentially a form of junk insurance, are not bound by ACA consumer protections and can deny coverage for pre-existing conditions; analysts warned that extending their duration would undermine risk pools and cause Marketplace premiums to soar. Continue reading “The Healthcare Bills of 2018”

October 29, 2018

Feds Will Subsidize Junk Health Coverage

Washington Post tweet about new guidance, featuring CMS Administrator Seema VermaRecent guidance from the Centers for Medicare and Medicaid Services encourages states to take new steps to circumvent the ACA. Specifically, it invites them to apply for Medicaid Section 1332 waivers in order to use ACA subsidies for short-term insurance and association health plans. These plans, originally intended only to tide people over between periods of more-permanent coverage, are little more than flimsy stop-gaps that scarcely merit the name of real health insurance. Continue reading “Feds Will Subsidize Junk Health Coverage”

September 6, 2018

A Strong, New Mental Health Parity Law

In Illinois, mental health and physcial health are equalBehavioral health coverage loopholes: Closed! SB 1707, a bipartisan mental health parity bill, is now the law of the state.

The bill, signed by Gov. Rauner on August 22, now Public Act 100-1023, strengthens the existing state parity law and arms the Department of Insurance with clear enforcement powers.

Calling it “the strongest mental health parity law in the nation,” the Kennedy Forum noted that introduction was spurred by a provider survey undertaken by the forum and its partners. Continue reading “A Strong, New Mental Health Parity Law”

March 13, 2018

Work Requirements Don’t Solve Problems

Construction worker carrying a big pipeSince efforts to repeal the ACA stalled out in Congress, the Trump Administration has used its administrative authority in an attempt to reshape Medicaid to be more in line with conservative arguments that employment is linked to better health outcomes and helps move people off Medicaid and out of poverty.

The Administration is giving the green light to states to condition Medicaid eligibility on meeting a work and/or community engagement requirement. Guidance from the Centers for Medicare & Medicaid Services has expressed a preference for following existing federal program work requirements found in programs like the Temporary Assistance for Needy Families (TANF), and the Supplemental Nutrition Assistance Program (SNAP). Continue reading “Work Requirements Don’t Solve Problems”

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