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

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

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”)

Our Medicaid Clients, cont’d. 2.7 million adults and children are currently enrolled Children under 19 1,656,209 Adults with disabilities 258,672 Seniors 166,104 Other adults 623,807

Our Medicaid Clients, cont’d.

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

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

“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%

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

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