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March 2015

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MEDICAID CUTS ONE THING REDETERMINATIONS ANOTHER
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In his 2016 budget proposal,Governor Bruce Rauner requested $1.47 billion in Medicaid cuts, while directing an additional $53 million toredeterminations as a cost-saving investment.Redeterminations certify theeligibility of people receiving healthcare and other benefits and was intendedto reduce the number of individualsinappropriately getting state aid. In his budget address Rauner said, "by...prioritizing our redeterminationefforts, we will save hundreds of millions of dollars."

Critics ofredetermination question whether the program will reduce spending. They suggest that the state only saves money bytemporarily cancellingbenefits for people who are still eligible but never responded to the notice. The critics point to datareleased by the Illinois Redetermination Project, which found that80% of cancellations were due to no response. They anticipatemedical spending will increaseaspeople abruptly lose their link to medical care and prescriptions and visit the emergency room for more costly procedures.

Aside from seeking to rollback redeterminations, lawmakershave introduced legislation requiring the statepublish monthly metrics on the program.The data points would include the number cancelled for non-response and the number reinstated after one, two, and three months, among others.The legislation, referred to as the Medicaid Managed Care Transparency bill, has been introduced in the state House and Senate. Illinois Health Matters will be following progress for this bill and the Governor's budget proposal, so check back for updates.


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From Getting Insurance To Actually Using It

After the 2015 Open Enrollment Period 347,300 Illinoisans purchased plans through the marketplace, and 541,000 people have enrolled in Medicaid since its expansion in 2014. While connecting individuals to coverage is good news, the newly insured are often overwhelmed by having to navigate the overly complex healthcare system and understand the related insurance and medical jargon. This confusion and lack of experience counteracts one of the healthcare reform law’s major goals: to reduce medical costs by increasing access to primary care. Obtaining coverage will not offset a lifetime of avoiding the doctor’s office and visiting the emergency room for primary care. The newly insured must learn how to find a doctor, fill a prescription, and read a prescription label. Without that, they are subject to poor health outcomes and high costs. The newly insured must gain health literacy which can only happen through the combined efforts of consumers, communities, providers and governing bodies. Read more...

In case you missed it

Governor Bruce Rauner calls for $1.47 billion in cuts toMedicaid, requesting the reinstatement of many SMART Act cuts and slashing additional healthcare services.

Nursing home quality measures revised by the Centers for Medicare & Medicaid Services to raise facility standards and assist consumers in finding suitable care. The new measuresaddress staffing quality and antipsychotic drug use.

The Supreme Court began hearingoral arguments for King v. Burwell on March 4, and policy analysts are making projections on the potential impact of a ruling against the Affordable Care Act.

Senators call for apregnancy special enrollment period, arguing women will forgo prenatal care or face high out-of-pocket expenses without insurance.

Recent resources

An issue brieffromHealth & Disability Advocates that explainshow people with disabilities can experience gaps in coverage because of ACA reforms.
ACA's Consequences for People with Disabilities

This chart from state refor(um)outlines the new forms tax-filers must fill out because of the ACA.
Different Tax Docs

The Wall Street Journal lays out the steps consumers can take when insurers won't pay.
Appealing a Denied Insurance Claim

The Georgetown University Centers For Children and Families and Health Insurance Reformscreated alistof common questionsfrom the second open enrollment period.
Round Up of OE2 Q's



Events

Find enrollment events in your area at the Get Covered Illinois Events page.

Find volunteer and community engagement opportunities at Get Covered America Events page.

Download a presentation and/or watch a recording from the EverThrive Illinois Webinar series.

Learn what the ACA means for a small business owner from the Small Business Majority's Thursday talks.



From our social media

On Twitter
@ILHealthMatters: study found 25% higher risk of death among uninsured compared with privately insured adults http://bit.ly/1Ngpbaa #KingvBurwell

On Twitter
@ILHealthMatters:SPECIAL ENROLLMENT PERIOD Mar 15-April 30 if you didn't have 2014 insurance and didn't know about the penalty #ACA word of the week #ACAwow

On Facebook
?#?ACA? word of the week: PREMIUM - the amount you pay for insurance each month http://1.usa.gov/1aHh7xa ?



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