Tag Archives: Medicaid Reform

Illinois begins audits and cuts to Medicaid. Rationing of care begins.

On July 7, 2012 the Illinois Tea Party broke down the ‘good’ and ‘bad’ parts of SB2840 and it’s amendments as well as HB5007. Together, these two pieces of legislation comprise what Governor Quinn refers to as ‘Medicaid Reform’. Whilst there was and still is genuine concern over the fiscal impact of Illinois expanding Medicaid nearly 2 years before the rest of the country. There was some good in HB5007. Specifically, the implementation of what most other state Medicaid programs already had in place for years. Namely, a TPA – Third Party Administrator.

The role of this TPA is to audit Illinois’ Medicaid program by verifying each year if current Illinois Medicaid recipients are still:

1.) Living in Illinois.
2.) Still living (not dead)
3.) Making the same income they were when they first qualified. If their income levels have increased rendering them no longer eligible, they are to be purged from our Medicaid rolls.

This is a very good thing since a pharmacist from another state recently stated during testimony that “some of our best customers are on the Illinois Medicaid program.”

The results of the first audit of Illinois’ Medicaid rolls are shocking indeed. According to the Chicago Tribune: Of the first 20,500 recipients screened by an outside contractor, the auditors recommend that 13,709 be removed from the rolls. Yes, that’s two-thirds of the first group screened, flagged as ineligible to receive their current Medicaid benefits. How so? In some cases, the recipients make too much money to qualify. In other cases, they don’t live in Illinois.”

Later in the same article the Tribune states: “Full stop. You may ask, as we do: Why didn’t state officials pluck this low-hanging fruit long ago?If Illinois officials knew, or suspected, that thousands of people were improperly receiving Medicaid coverage, why didn’t they act years ago to save hundreds of millions of taxpayer dollars?”

Since Julie Hamos – Illinois Department of Healthcare and Family Services chief – is quoted in the article as ‘doesn’t yet know‘. The Illinois Tea Party would like to clear up this mystery for her.

During Democrat Governor Rod Blagojevich’s Governorship, our Illinois Medicaid program was expanded illegally without legislative approval. Adding to the rapid bankruptcy of our Illinois Medicaid program was the fact that under Blago’s Governorship, legal residency status was not required on the Illinois’ “All Kids Covered” Medicaid application. Understand that when we use the term legal residency we are referring to U.S. citizenship. It took an investigation conducted by former Chicago Tribune reporter Dennis Byrne to determine just how many illegal immigrants were enrolled on our “All Kids Covered” program. The shocking answer was 75%.

Whilst the Illinois legislature is to be commended for finally implementing a TPA. They are still ignoring one of the largest drains on our Illinois Medicaid program. One that is a clear violation of Federal law. Namely, the 77,000 illegal immigrants who are still enrolled on our Medicaid program. None of which will be removed under Quinn’s ‘Medicaid Reform’ bill or any other legislation proposed.

According to Kaiser Health News the cost to cover just emergency treatment – much of it related to delivering babies – for more than 100,000 illegal immigrants is a $2 billion drain on the federal Medicaid program annually.  This being the case, one must ask. Why is there not a number 4 question added to the above TPA discovery process which asks: Are you a U.S. citizen?

By allowing thousands of illegal immigrants to stay on Illinois Medicaid program, lawmakers are disenfranchising Illinois residents who are not only legal U.S. citizens but are also medically fragile children. Part of Governor Quinn’s aforementioned ‘Medicaid Reform’ bill was $1.6 billion of top down, authoritative, across the board Medicaid cuts. $15 million of which pertain to medically fragile and technology-dependent children.

Equally disruptive and cold-hearted is the fact that Senate Bill 2840 eliminated Illinois’ Cares Rx program, which provides prescription drug coverage for 180,000 fixed and low income Illinois seniors. Seniors on fixed incomes of less than $16,000 have now lost their drug coverage. Community care and in-home care programs also faced severe cuts, resulting in the loss of services for thousands of seniors across the state. There is a word that properly defines this type of top down, authoritative, across the board cuts – rationing. And it’s about to get much, much worse.

Since 2000, Illinois Medicaid rolls have doubled, from fewer than 1.4 million people to nearly 2.8 million, or more than 1 in 5 Illinoisans. Starting in 2014, the President’s health care law is about to exacerbate this problem exponentially. According to various estimates, from 500,000 to more than 900,000 more Illinois residents will qualify for Medicaid when the PPACA (Obamacare) Medicaid expansion takes effect in 2014. This is because the PPACA expands Medicaid to childless adults for the first time ever. There are more than 15.1 million childless adults in the U.S. who will now be eligible for Medicaid. The PPACA also mandates that another 9 million Americans who already qualify for Medicaid but never enrolled do so beginning in 2014.

The ‘silver lining’ in Chief Justice John Roberts historic ruling on the PPACA last year was that states were now given the option to expand Medicaid. Since then many states have run the numbers and decided against expanding Medicaid. In contrast, Governor Quinn is moving ‘forward’ with Medicaid expansion with Senate Bill 26 which will voluntarily expand Illinois’ Medicaid program to nearly 350,000 additional individuals, who are between the ages of 19 and 64 with incomes under 138% of the Federal Poverty Level. The Dept. of Healthcare and Family Services (HFS) states the cumulative cost of this expansion could exceed $2.9 billion by 2020. The Kaiser Commission on Medicaid and the Uninsured estimates a similar number of $2.4 billion by 2020.

Worse yet, our Illinois Medicaid program already has unpaid bills piling up after lawmakers enacted a budget pushing $2.4 Billion of 2011’s bills into 2012. As they have been doing repeatedly for years now. In fact, on January 30, 2012, the Civic Federation released its “Budget Roadmap” for fiscal year 2012. In it, they highlight the fact that state officials now believe the Illinois Medicaid program will have between $21 and $23 billion in unpaid bills by 2017.

Purging illegal immigrants from our Illinois Medicaid rolls and implementing real reforms such as those proposed by the Illinois Policy Institute will save Illinois’ billions and insure that Illinois’ truly indigent and those with special needs are cared for. Until such reforms are implemented, Illinois Medicaid patients will continue to suffer from low reimbursement rates and long payment delays. Nursing homes and hospitals will continue to run out of money while they wait for reimbursement. And, doctors will continue to turn away poor patients and those with special needs.

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Illinois Tea Party review of Amendment to Illinois Senate Bill 2840 provides confirmation of immediate Obamacare exchange implementation.

The Illinois Tea Party has completed an initial review of the Amendment to Illinois Senate Bill 2840 issued on 5/21/2012. The following sections outline the immediate development of a state and federally subsidized “Obamacare health insurance exchange”.

Section 65 on page 68, line 18 states the following:

“Section 65. The Children’s Health Insurance Program Act is amended by changing Sections 25 and 40 as follows:

(215 ILCS 106/25)

Sec. 25. Health benefits for children.

(a) The Department shall, subject to appropriation, provide health benefits coverage to eligible children by:

(1) Subsidizing the cost of privately sponsored health insurance, including employer based health insurance, to assist families to take advantage of available privately sponsored health insurance for their eligible children; and(2) Purchasing or providing health care benefits for eligible children.”

Section 65 on page 69, line 19extends these tax subsidized health insurance exchange benefits to:

“(b) The subsidization provided pursuant to subdivision

(a)(1) shall be credited to the family of the eligible child.”

Page 73, line 4 established grants for “community based organizations to educate the public” about this new program.

Page 73, line 13 establishes a state run, web site based health insurance exchange:

“The Department shall annually publish electronically on a State website and in no less than 2 newspapers in the State the premiums or other cost sharing requirements of the Program.

Income requirements to qualify (well above the existing Federal poverty level) as well as the specific expansion of Medicaid are discussed throughout this Amendment beginning on pages 81 & 82. These income requirements and expansion clauses are very similar to the requirement outlined in the Obamacare legislation.

It is crucial to understand that what is being done here is the expansion of eligibility through increasing financial eligibility standards, or through increasing income disregards, or through the creation of new programs.

Such specific changes to our Medicaid system were prohibited by a ‘2 year moratorium” passed by the 96th General Assembly on January 25, 2011 which reads:

(215 ILCS 106/26) –

    Sec. 26. Moratorium on eligibility expansions. Beginning on the effective date of this amendatory Act of the 96th General Assembly, there shall be a 2-year moratorium on the expansion of eligibility through increasing financial eligibility standards, or through increasing income disregards, or through the creation of new programs that would add new categories of eligible individuals under the medical assistance program under the Illinois Public Aid Code in addition to those categories covered on January 1, 2011. This moratorium shall not apply to expansions required as a federal condition of State participation in the medical assistance program.
(Source: P.A. 96-1501, eff. 1-25-11.)

Illinois Senate Amendment #2 to HB5007 also includes language to implement Obamacare in Illinois 2 years early.

Amendment to Illinois Senate Bill 2840 and Amendment #2 to HB5007 provides for a federally subsidized and state subsidized health insurance exchange, as mandated in the federal Obamacare legislation (PPACA) passed on March 23, 2010. Establishing an Obamacare health insurance exchange under the guise of “Medicaid Reform” with a $700 million new price tag to the tax payers of Illinois and a projected cost of $10 billion by the year 2020 is grossly irresponsible.

Why our legislators would attempt to pass legislation now that will incur these extra costs to the Illinois tax payer when the Supreme Court of the United States will be ruling on the Constitutionality of the Obamacare legislation in 3 short weeks from today is incomprehensible and reprehensible.

Not one Republican voted for the Obamacare legislation and we expect the exact same no vote this time around from every Illinois Republican. Most especially our House Minority Leader Tom Cross.

What can you do to stop Governor Quinn, Illinois Democrats and those Republicans who support the implementation of Obamacare in our state nearly 2 years early? You can call your Illinois state representative and let them know that Illinois needs real Medicaid reform, not higher taxes and that you oppose Governor Quinn’s “Medicaid Reforms” and that you are against him establishing a state based Obamacare health insurance exchange via Executive order. Call the statehouse switchboard at (217) 782-2000 to be connected. Look up your legislator here. Again, they could vote as early as tomorrow or Tuesday.

Also call House Minority Leader Tom Cross. He seems to be ‘flip flopping’ and is ready to ‘cut a deal’. He needs to know that you value and expect principled leadership and rigorous policy reform. His statehouse number is (217) 782-1331. If the line is busy, call his district office at (815) 254-0000.

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