Tag: Medicaid

Illinois Extends Medicaid to Low-Income Adults–a Very Big Deal

Girl at the doctorIllinois took a big step on the road toward all Illinoisans having quality, affordable health care this past week. On July 22, 2013, Illinois Governor Pat Quinn signed into law Senate Bill 26, as Public Act 98-0104. The new law extends Medicaid eligibility to nearly all low-income Illinois residents effective January 1, 2014. Until now, low-income adults, ages 19 through 65, the great majority of whom are working at lower wage/no benefits jobs, have not been eligible for Medicaid. These people qualified only if they were totally disabled or caring for minor children. The federal Affordable Care Act allows states to cover this long left-out group in their Medicaid programs and receive 100% federal funding for the costs. With Public Act 98-0104, Illinois wisely is doing so.   

With the other ACA reforms also set to go into effect January 1, 2014, nearly all uninsured Illinois residents now will have access to public or private health coverage and health care. Those under 138% of the Federal Poverty Level (FPL) ($15,415 for an individual) will be eligible for public coverage in Medicaid. (The income limits are higher for children in Illinois’s All Kids program.) Those over 138% of the FPL will be able to purchase health insurance on the Illinois Health Insurance Marketplace. Illinoisans finally will have peace of mind knowing that:

  • they can get comprehensive, affordable private insurance if their income is over Medicaid’s limits;
  • they can get Medicaid if their income is lower;
  • they can move from public to private health coverage and vice-versa as their income changes; and
  • both the private insurance plans and Medicaid will cover comprehensive, quality care. 

The insurance sold on the Marketplace starting October 1, 2013, will be better in coverage and cost than the individually purchased health insurance now being sold. ACA reforms eliminate insurance companies’ ability to deny or price coverage based on one’s preexisting medical condition or gender. Instead, health insurance policies will be priced on the basis of the customer’s age, geography, number in family, and tobacco usage. Additionally, policies must cover a broad range of needed health services and not charge any copayments or deductibles for preventive care.

Medicaid, too, will offer comprehensive, quality coverage. Skeptics (and there are a lot of them) who disparage Medicaid coverage should take another look. The Illinois Medicaid program has been reforming itself for several years now. It was ahead of the curve on requiring Medicaid patients to have a “medical home,” that is, a primary care doctor who manages their care and refers them for specialty care as needed. It also is testing a variety of “care coordination” models that take the medical home concepts farther and, through provider payment methods aimed at improving quality and decreasing costs, encourage preventive care, discourage unnecessary emergency room use, and support patient follow up and follow through on treatment.

With the enactment of Public Act 98-0104, Illinois is a lot closer to coverage for all. On January 1, 2014 (with enrollment starting October 1, 2013), Illinois residents at all income levels will have access to quality, affordable health insurance coverage. Of course, neither Medicaid coverage nor insurance coverage will drop from the sky. People need to apply. They can do that starting October 1. Between now and then the Illinois government, the federal government, and hundreds of Illinois community groups will be offering information about public and private coverage and the application process. And after October 1, they’ll be there to help us apply and walk us through the enrollment process.  

Supreme Court Rules Affordable Care Act is Constitutional

By John M. LeBlanc and Natalie J. Ferrall
In a 5-4 decision, the United States Supreme Court ruled that the Patient Protection and Affordable Care Act (“ACA”) is constitutional. The majority opinion, authored by Chief Justice Roberts, uphel…

Supreme Court Rules Affordable Care Act is Constitutional

By John M. LeBlanc and Natalie J. Ferrall
In a 5-4 decision, the United States Supreme Court ruled that the Patient Protection and Affordable Care Act (“ACA”) is constitutional. The majority opinion, authored by Chief Justice Roberts, uphel…