1. COOK COUNTY HEALTH & HOSPITALS SYSTEM Impact of Health Care Reform on Children and Adults with Special Needs Presentation to The Arc of Illinois October 20, 2015

2. Overview About CCHHS Overview of Illinois Medicaid Understanding “New” Medicaid – Authorizing legislation – Eligibility criteria – Benefits – Who are the newly eligible? – How to apply? Redetermination Medicaid Managed Care Questions The Arc of Illinois Oct 2015 2

3. CCHHS Mission To deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; To foster partnerships with other health providers and communities to enhance the health of the public; And to advocate for policies which promote and protect the physical, mental, and social well-being of the people of Cook County. The Arc of Illinois Oct 2015 3

4. CCHHS Overview CCHHS at a glance: 2 hospitals 16 community health centers Correctional health services Specialty care center for persons with infectious disease Nationally-certified public health department CountyCare - largest Medicaid health plan serving residents of Cook County; current membership includes over 170,000 members The Arc of Illinois Oct 2015 4

5. Overview of Illinois Medicaid FY2014 total Medicaid enrollment in Illinois – 3,142,849 – In Cook County – 1,532,964 An estimated 618,923 adults in Illinois are eligible for adult Medicaid expansion – 341,063 reside in Cook County Total ACA enrollment statewide: 616,604 (August 2015) ACA Adult Enrollment in Cook County – 319,467 (August 2015) – Chicago – 208,639 – Suburban Cook County – 110,828 The Arc of Illinois Oct 2015 5

6. Understanding “New” Medicaid Affordable Care Act, signed March 2010 made Medicaid expansion mandatory by 2014; Supreme Court made it permissive with their ruling June 2012 As a result states needed to affirm their participation in Medicaid expansion To date, 31 states have expanded, 1 has an open debate, and 19 states are not moving forward at this time Illinois Public Act 98-0104 expanded Medicaid in Illinois, effective January 1, 2014 The Arc of Illinois Oct 2015 6

7. Understanding “New” Medicaid (cont’d) Age: 19 through 64 years Income: less than 138% FPL (~$16,104 for a single person; $21,707 for a couple) – Uses Modified Adjusted Gross Income (MAGI) methodology – No asset or disability test Citizenship: US Citizen or qualified non-US citizen Statewide enrollment began October 1, 2013 with coverage effective January 1, 2014 – Waiver approved October 2012; CountyCare became operational February 2013 The Arc of Illinois Oct 2015 7

8. Covered Services ACA Essential Health Benefits – Ambulatory patient services – Emergency services – Hospitalizations – Maternity and newborn care – Mental health and substance use disorder services, including behavioral health treatment – Laboratory services – Preventive and wellness services, as well as chronic disease management – Prescription drugs – Rehabilitative and habilitative services and devices – Pediatric services, including oral and vision care Same benefits as “traditional” Medicaid, also access to Long Term Supports and Services based on medical necessity (see http://www.hfs.illinois.gov/html/082114n.html) http://www.hfs.illinois.gov/html/082114n.html The Arc of Illinois Oct 2015 8

9. Who are the newly eligible? Newly eligible includes, but is not limited to: – Children previously eligible for All Kids, but turned 19 years – Parents on FamilyCare, but whose youngest child turned 18 years – Justice-involved individuals – Adults who are unemployed or are working in a low- wage or part-time job – Youth/adult with a disability but who does not receive SSI Also those in SSI waiting period – Former foster care children up to age 26 (all income is exempt The Arc of Illinois Oct 2015 9

10. How to apply? www.getcoveredillinois.gov – screening tool and find help with the application process www.getcoveredillinois.gov Medicaid – Application for Benefits Eligibility (ABE) – www.abe.illinois.gov – Medicaid and other income support programs - streamlined application for multiple programs www.abe.illinois.gov – Apply ANYTIME – CCHHS offers in-person and phone assistance via hotline at: 312-864-8200 Those ineligible for Medicaid may be referred to Marketplace OR CCHHS financial assistance program Marketplace for those ineligible for Medicaid – www.healthcare.gov www.healthcare.gov – Open enrollment period: Nov 1, 2015 – January 31, 2016 The Arc of Illinois Oct 2015 10

11. Medicaid Redetermination ALL Medicaid beneficiaries MUST complete an annual redetermination (i.e. renewal) to be assessed for ongoing eligibility Medicaid only cases and those who experience a Medicaid “category change” will be contacted by Illinois Medicaid Redetermination Project (IMRP) ACA adults are experiencing the redetermination process for the first time and may need extra help Most cases are being cancelled for non-response to redetermination notice The Arc of Illinois Oct 2015 11

12. Medicaid Redetermination (cont’d) Illinois Medicaid Redetermination Project – 1-855-HLTHYIL (1-855-458-4945) – TTY: 1-855-694-5458 – FAX: 1-866-661-7025 www.hfs.illinois.gov – Illinois Medicaid Redetermination Project www.hfs.illinois.gov – Frequently Asked Questions – Sample client notices – Link to upload redetermination documents The Arc of Illinois Oct 2015 12

13. Medicaid Managed Care State legislation enacted 2011 requires 50% of Medicaid enrollees be in “care coordination or managed care” by 2015 Nearly all Medicaid beneficiaries in Cook and the Collar Counties will be required to choose a Medicaid Managed Care Plan and Primary Care Provider OR be auto-assigned Illinois Client Enrollment Services is managing mailings and enrollment – 1-877-912-8880 The Arc of Illinois Oct 2015 13

14. Medicaid Managed Care (cont’d) The Arc of Illinois Oct 2015 14 Beneficiary receives enrollment packet Beneficiary has 60 days to choose a plan Beneficiary chooses OR is auto-assigned to a plan Beneficiary has 90 days to switch to another plan Beneficiary is locked into plan until the next Medicaid open enrollment period (about one year later)

15. Contact Information Kathy Chan Director of Policy 312-864-1152 kchan5@cookcountyhhs.org The Arc of Illinois Oct 2015 15