Illinois turns to coordinated care in Medicaid program

President Barack Obama's home state of Illinois, and the same state that elected a Democratic governor in 2010 who promised to raise taxes to fix the budget, sent a moderate message to the Republican Party with a strong win by Mitt Romney in the March 20 GOP primary.

Romney and the other GOP candidates have battled each other over their conservative credentials, including repealing the healthcare law, but not how to improve healthcare delivery for Americans. They focus on the fringe culture war issues, such as contraception and the place of religious-based large hospitals and other businesses.

In Illinois, Gov. Pat Quinn and the state legislature have actively been planning and establishing aspects of the contested law, including a health insurance exchange and Medicaid expansion and care coordination.

About 13 percent of Illinois' population, or 1.6 million individuals, lack health insurance and will be able to obtain it through the state health insurance exchange when the major reform program takes effect in 2014.

Those who will be likely helped the most are the working poor. That would be more than 600,000 individuals who live at or below 138 percent of the federal poverty level, or $32,000 for a family of four, but do not currently qualify for Medicaid "and can scarcely afford to obtain health care," said Barbara Otto, CEO of Health and Disability Advocates in Chicago. The organization promotes smarter systems of health, education, disability employment and income supports for vulnerable people.

The organization launched March 20 an interactive map for Visualizing Health Care Reform that enables users to see at the state, regional and community levels, the numbers of Illinois residents who are uninsured now and who will be able to obtain coverage in 2014. The group made the interactive map available in conjunction with Illinois Health Matters, a statewide digital hub that offers information about how health reform will affect Illinois residents.

"It is crucial that we know who is uninsured and where they live," Otto said, adding that it will help to design programs and make decisions where resources are most needed.

In addition to the 610,821 individuals who will be eligible for Medicaid, 776,040 will be eligible to purchase health insurance with a subsidy, and 260,600 without a subsidy, she said.

While the largest percentage of residents eligible for coverage under the Patient Protection and Affordable Care Act are in largely urban and suburban Cook County, other Illinois counties also have "surprisingly" high levels of uninsured residents, she said.

"Health care reform will have a profound effect on middle-class families who have never been able to afford insurance for themselves or their children," Otto said.

The state's Department of Healthcare and Family Services also has put out a call for healthcare providers to submit proposals by the end of May to participate in a care coordination innovations project. Illinois will begin to shift at least half of its clients into coordinated care programs by 2015, part of the state's bipartisan Medicaid reform legislation.

"We are working collaboratively with healthcare providers across the state to harness technology to do a better of keeping residents healthy, and a better job of treating them when they do become sick," Quinn said in information about the coordinated care project.

Providers will demonstrate that they can build their own networks with care coordination services, achieve better health outcomes and cost savings than under the current system and without involving limiting health maintenance organizations as many other states have done. In addition, the state is looking for models that coordinate social services beyond those covered by the Medicaid program.

[Political Malpractice: They all chant 'ACA repeal' but what could a GOP president actually do?]

However, the Illinois Policy Institute, which advocates free market solutions, would restructure Medicaid to help fix the state's budget.

"We would empower the poor to make healthy and cost-conscious decisions, help them buy private insurance and phase out this help gradually so that they aren't trapped into a system of government dependency," said Jonathan Ingram, health policy analyst at the institute, in a blog.

The institute has recommended in its annual budget solutions report changing the state's Medicaid program into a sliding scale premium assistance programs, paired with health savings accounts for the most vulnerable population.

Over the last decade, Illinois Medicaid enrollees have increased by 80 percent to 2.8 million in 2010 because of eligibility gradually rising above the federal poverty level. At the same time, provider reimbursements are substantially below the national rate. As a result, adults and children on Medicaid find it difficult to schedule an appointment or even access health care.

Under the institute's reforms, "Medicaid patients will look like any other patients with private insurance," the report said.

For more of our primaries coverage, visit Political Malpractice: Healthcare in the 2012 Election.