Health Insurance Coverage In Illinois - Medicaid is an important component of general health insurance and coverage in Illinois, with Medicaid and CHIP covering approximately 20% of the state's 12.5 million residents. Approximately 20% of insured individuals are eligible for Medicaid due to the expansion of Medicaid under the Affordable Care Act (ACA). The Illinois Department of Health and Family Services has updated total enrollment. until August 2021; 789,974 Illinois residents are covered by the expanded Medicaid program.
Total Medicaid enrollment includes those eligible for the ACA expansion of low-income adult Medicaid, as well as those already in traditional Medicaid groups (low-income pregnant women, children, parents of minors). Children the elderly blind or disabled). The majority of Illinois Medicaid enrollees have declined enrollment in these groups, while enrollment in the Expanded Medicaid program has increased. Being in one of the traditionally eligible groups. until June 2021; Illinois has more than 3.3 million total Medicaid enrollees, up from 2.62 million in 2013.
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During the COVID pandemic, Medicaid enrollment has increased dramatically due to widespread job and income loss. Under the Families First Coronavirus Response Act, passed early in the pandemic, states will receive additional federal Medicaid funding, but on the condition that no one be excluded from their Medicaid programs (unless that person leaves the state or applies for exclusion from the program). ) so since the beginning of 2020, Medicaid enrollment has mostly only increased, without the fluctuations typically seen when people transition to Medicaid.
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Illinois' uninsured rate dropped from 12.7% in 2013 to 7.4% in 2019 (it was even lower at 6.5% in 2016, but has increased since then).
In September 2016, Illinois officials have requested permission from the federal government to use existing Medicaid funds (regardless of eligibility or funding) to test different treatment options for Medicaid members who need mental health and/or addiction treatment. The state planned to make the change in July 2017, but CMS did not approve the waiver proposal until May 2018.
Counseling is about preventive care; To focus more on community care than supportive housing services and inpatient care. The state notes that 25% of Illinois Medicaid enrollees have mental health and/or substance abuse symptoms, but their treatment represents 56% of total Medicaid costs.
Under approved exemption rules; Illinois state short-term inpatient treatment; Ten pilot projects are being implemented for services previously not covered by Medicaid, including services to help people withdraw during drug addiction recovery. Health care.. Visits for infants and children born to opioid-dependent mothers and employment and transportation services to help people find and keep jobs.
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Over the past few years, drugs that can treat hepatitis C have been hailed as a miracle and have exploded in the medical world. But since the pills cost upwards of $1,000 a day initially and the course of treatment lasts 12 weeks, it can be a strain on the budget. Medicaid programs across the country are struggling to deal with the situation, and Illinois announced in September 2016 that it would relax its rules on when it would cover hepatitis C drugs.
Instead of limiting coverage to only the sickest patients; Illinois Medicaid began providing hepatitis C drugs for people with stage 3 and 4 hepatitis C infection, not just stage 4 cirrhosis. The State is urged to continue to review this issue with people with chronic hepatitis C who have not yet progressed to stage 3 hepatitis C.
Prices for hepatitis C drugs dropped in 2018, reaching $24,000 for a full course of treatment (compared to earlier years when the drug was available) on the market in early 2019. In October 2018, the state lifted restrictions on access to hepatitis C drugs, allowing thousands of Illinois residents to receive hepatitis C drugs through Medicaid regardless of disease stage without requiring proof of fitness.
Federal law defines mandatory and optional coverage groups for Medicaid. States must cover mandatory groups in order to receive federal Medicaid funding, and are eligible for additional funding if they cover optional groups.
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The federal government sets minimum levels for participation in various groups, and states can set their own requirements at or above the minimum level. Illinois is close to the national average requirements.
All of these restrictions include Medicaid expansion; Part of the MAGI-based eligibility rules used to determine Medicaid eligibility for pregnant women and children includes a built-in 5% income disregard.
Many Medicare recipients also get help through Medicaid. This includes Medicare premiums; cost sharing; Includes services not covered by Medicare, such as prescription drug costs and long-term care costs.
Medicare Savings Programs in our Illinois Medicare Financial Resource Guide; These programs are described, including guidelines for Medicaid Long Term Care benefits and eligibility.
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People with Medicaid in Illinois can choose between a fee-for-service plan or a managed care plan. These options are listed on the Illinois DHS website.
Illinois transitions beneficiaries to managed care plans more slowly than many other states. However, In 2011, the state passed a law requiring at least half of the state's Medicaid recipients to provide managed care by January 1, 2015. until 2021; More than 80% of Illinois Medicaid enrollees are covered by Medicaid managed care plans.
In June 2014, Governor Pat Quinn signed the Medicaid reform bill into law. The Act restores adult dental services; Illinois law aligns with federal law to provide Medicaid coverage for children without private insurance for three months. The law made it easier to reimburse hospitals and nursing homes, among other things.
Illinois decided to extend the Medicaid eligibility mandated by the ACA in July 2013 to the effective date of January 1, 2014. Making Medicaid available to low-income seniors is a key part of the Affordable Care Act to reduce the share of the uninsured. However, the country The Supreme Court's ruling made Medicaid expansion optional, and there are still 12 states that have yet to expand Medicaid until 2022.
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The federal government paid 100% of the cost of the Medicaid population expansion until 2016. After that, The federal government's share will reach 90% by 2020, with Illinois accounting for the remaining 10% (and it will remain at this level in the future), and the federal government's share will gradually decrease.
At the time Medicaid expansion was approved; Illinois officials estimated that 342,000 Illinois residents would be eligible. However, during the first few months, About 350,000 new members were approved in June 2014, according to the Chicago Tribune. After more than a year, In August 2016, total enrollment in the state Medicaid program exceeded 646,000. However, as of July 2018, enrollment had fallen to 606,670 and remained at (607,404) as of April 2020. That's still much higher than the state originally planned, but lower than a few years ago. However, The COVID pandemic has led to higher Medicaid enrollment (including Medicaid expansion enrollment). By August 2021, nearly 790,000 people were enrolled in the expanded Medicaid program in Illinois.
In May 2021, Medicaid and CHIP enrollment in Illinois totaled more than 3.3 million, a 27% increase from the end of 2013. 2014, Those who were eligible but not enrolled at the time, and those who became eligible as a result of the Medicaid ACA expansion.
Louise Norris is a private health insurance broker who has been writing about health insurance and health care reform since 2006. Her health news is regularly cited by coverage of health care reform and other health insurance experts.
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Apply online or complete the application and return it by mail or fax. You can also apply in person at your nearest Family Community Resource Center.
Eligibility: Children ages 0-18 with family income up to 142% FPL. Pregnant women with family income up to 208% FPL. Adults with family income up to 138% FPL. This map shows the 13 rated areas in Illinois. These locations determine the rates and options available.
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