Affordable Health Care Insurance Illinois - Medicaid is an important part of health insurance enrollment and coverage across Illinois, with Medicaid and CHIP covering about 30% of the state's 12.8 million residents. Illinois will have 3.9 million people on Medicaid by early 2023, up from 2.6 million in 2013 and 2.9 million before the COVID pandemic. As detailed below, Medicaid enrollment increased during the pandemic, but is expected to decline over the 12-month period beginning in July 2023.
With the expansion of state Medicaid under the Affordable Care Act (ACA), about a quarter of eligibles are eligible for Medicaid. The Illinois Department of Health and Family Services maintains ongoing updates of total enrollment numbers. As of September 2022, more than 914,000 Illinois residents are covered by expanded Medicaid.
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Total Medicaid enrollment includes those eligible for the ACA's low-income Medicaid extension and those already in a traditional Medicaid group (low-income, pregnant, children, parents of minors). children, elderly, visually impaired and disabled residents). Most Illinois Medicaid beneficiaries belong to one of these traditional entitlement groups. Illinois was also the first state to extend postpartum Medicaid coverage to 12 months, and the mother's coverage no longer ends 60 days after birth. (Most of the rest of the states have extended postpartum Medicaid coverage to 12 months.)
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Illinois' uninsured rate fell from 12.7% in 2013 to 7.4% in 2019 (it was even lower at 6.5% in 2016, but has been rising since then), and Medicaid is a key part of that. played a role. Medicaid prevented people from becoming uninsured amid mass unemployment in 2020 and also served as an important safety net during the pandemic.
During the COVID pandemic, states were barred from enrolling people from Medicaid even if they didn't meet eligibility guidelines. This rule was used for three years from March 2020 to March 2023. However, from April 2023, states may resume periodic requalification and deregistration.
States have some flexibility on when to return to normalcy, and Illinois chose to delay it as long as possible. , will begin sending update notifications in late April. And the first round of registrations will be canceled on July 1, three months after the first federal approval date.
Illinois uses regular renewal dates that registrants can find at abe.illinois.gov. Renewal will be available from that website one month prior to expiry. Registrants can renew online as updates become available The State will automatically renew benefits if there is sufficient information to do so (we expect that approximately one third of our customers will be able to automatically renew). paper form. The state encourages the use of online updates whenever possible.
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Enrollment in Illinois Medicaid increased by nearly a million during the pandemic, from 2.9 million to 3.9 million. The state expects about 32,000 people to lose coverage each month during the 12-month "rollback" period, and about 384,000 people to lose coverage once all eligibility is processed.
Most of these people are eligible for employer-sponsored health insurance or subsidized plans through the Illinois Exchange/Marketplace (getcoveredillinois.gov using the HealthCare.gov registration platform). Enrollment periods for employer-sponsored coverage are time-limited. HealthCare.gov also offers an extended enrollment period of 16 months for those who lose Medicaid during the "rollback" period, but to avoid gaps in coverage, it's still important to sign up well in advance of the Medicaid end date. If you are eligible for Medicare, there is also a special enrollment window that allows you to transfer from Medicaid to Medicare without late enrollment penalties.
In September 2016, Illinois officials directed the federal government to use existing Medicaid funding (without making any changes to eligibility or funding) for Medicaid participants' mental health and substance abuse treatment needs. Asked for permission to test different methods of treatment. The state planned to implement the change in July 2017, but CMS did not approve the proposed waiver until May 2018.
The idea is to focus on preventive care, supportive housing services and community-based care rather than institutional care. The state notes that 25% of Illinois Medicaid participants have a mental health and/or substance abuse diagnosis, while their treatment accounts for 56% of the Medicaid program's total costs.
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Under the terms of the approved waiver, Illinois will allow short-term inpatient substance abuse treatment, services to help manage withdrawal symptoms during substance abuse recovery, and home health care previously covered by Medicaid. We are conducting 10 pilot projects that provide visiting, job coaching and transportation services for previously unavailable newborns and children born to opioid-addicted mothers designed to help people find and retain employment.
A drug that could cure hepatitis C burst onto the medical scene a few years ago and was heralded as a miracle. But the initial cost of the pill can exceed $1,000 per day and the course of treatment lasts 12 weeks, so it can also strain your budget. Medicaid programs across the country are working on ways to address the situation, and in September 2016, the state of Illinois announced it was relaxing guidelines for when hepatitis C drugs are eligible.
Instead of limiting coverage to only seriously ill patients, Illinois Medicaid began offering hepatitis C drugs to people with stage 3 and 4 liver scarring, but not stage 4. Chronic hepatitis C patients who have not progressed to stage 3 liver scarring have urged states to look into the matter.
By 2018, the cost of the hepatitis C drug had dropped, and a generic version was expected to hit the market in early 2019. was available). And in October 2018, Illinois lifted restrictions on access to hepatitis C drugs, allowing thousands of Illinoisans to get hepatitis C through Medicaid, regardless of disease stage, without the need to prove sobriety. I have access to medicine.
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Federal law designates mandatory and optional insurance groups for Medicaid. States must cover mandatory groups to receive federal Medicaid funding, and are eligible for additional funding if they cover optional groups.
The federal government specifies minimum eligibility thresholds for various groups, and states can set their requirements above the minimum threshold. Illinois has set requirements close to the national average.
Please note that all these limits include a built-in 5% income disregard. It is part of the MAGI-based eligibility rules used to determine Medicaid expansion, pregnant and infant Medicaid eligibility.
Many Medicare beneficiaries also receive help through Medicaid. These include Medicare premiums, cost sharing, prescription drug costs, and assistance with services not covered by Medicare (such as long-term care costs).
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The Illinois Guide to Financial Resources for Medicare Beneficiaries describes these programs, including the Medicare Savings Program, Medicaid Long Term Care Benefits and eligibility guidelines.
Medicaid-eligible individuals in Illinois can choose between a paid service plan or a managed care plan. The Illinois DHS site explains these options.
Illinois takes longer to transition beneficiaries into managed care plans than many other states. However, in 2011 the state passed a law requiring managed care to be expanded to at least half of the state's Medicaid beneficiaries by January 1, 2015.
In June 2014, then-Governor Pat Quinn signed the Medicaid reform bill. The law restores dental and podiatry services to adults, aligns Illinois law with federal law to provide Medicaid coverage for children without private insurance for three months, and provides access to hospitals and nursing homes. We are streamlining refunds for this
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Illinois elected to expand Medicaid eligibility in July 2013 with an effective date of January 1, 2014, as the ACA permits. Making Medicaid available to low-income non-seniors is an important part of the Affordable Care Act's strategy to reduce the nation's uninsured rate. However, the Supreme Court ruling made Medicaid expansion optional, and there were still 12 states that did not expand Medicaid until 2023 (South Dakota will expand Medicaid in mid-2023; at 11).
The federal government paid 100% of the cost of the Medicaid expansion through 2016. After that, the federal government's share gradually declines, reaching 90% by 2020, with the remaining 10% provided by the state of Illinois (and will remain at that level for the foreseeable future). .
When the Medicaid expansion was approved, Illinois officials estimated that 342,000 Illinoisans would qualify. However, according to the Chicago Tribune, about 350,000 new registrants were approved in the first few months through June 2014.
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