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The harsh Medicaid reality

Tuesday, Feb 14, 2012

* US Sen. Dick Durbin pointed out some sobering Medicaid statistics this past weekend

“One-third of all children in Illinois, their only health insurance is Medicaid,” Durbin said. “Over half of all births in Illinois are paid by Medicaid. And 60 percent of the Medicaid budget goes to the frail, elderly who are broke and living in nursing homes on Medicare, Medicaid and whatever they can scrape together on Social Security.

“When you start talking about cutting Medicaid, those are the three vulnerable populations.”

* DHFS numbers for Medicaid enrollment by fiscal year...

2000 – 1,365,070

2001 – 1,461,754

2002 – 1,535,648

2003 – 1,596,482

2004 – 1,750,335

2005 – 1,896,234

2006 – 2,021,314

2007 – 2,150,519

2008 – 2,304,291

2009 – 2,433,625

2010 – 2,590,945

2011 – 2,704,791

The recession has played a big role in the increase, but a doubling of the rolls without corresponding revenue growth to pay for it is a very real problem.

Illinois has one of the lowest costs per Medicaid patient in the country. Its provider reimbursement rates are also quite low - and if they go much lower patients will have trouble finding care. Eliminating programs and kicking people off health care is the “best” option, but as Durbin rightly points out, it’s an extremely harsh option.

- Posted by Rich Miller        


56 Comments
  1. - Quill - Tuesday, Feb 14, 12 @ 7:01 am:

    To clarify Durbin’s point a little: Medicaid pays for nursing homes. Medicare does not. When he says “broke” and refers to people on SSI, he really means BROKE. To live in a nursing home and have Medicaid pay for it, you have to spend out all of your assets until you have a max of $2,000 in assets. This is how people lose their homes and others assets going into nursing homes—at the profit of the nursing homes of course. Once in the nursing home, the facility takes all the Medicaid dollars and all your SSI except about $30 a month. That would be BRRRROOOKKEEEE. And if people seriously expect there to be a resolution to this costly problem of people getting stuck in nursing facilities, then they better be funding ways to get out other than through the morgue. Plus national AARP points out that most seniors would rather be in their own homes than in nursing homes. Polled and done. The state would do way better to invest in community based in-home care for seniors and people with disabilities. Saves Medicaid $$$$.


  2. - southof80 - Tuesday, Feb 14, 12 @ 7:18 am:

    …and for some of those children, it became apparent to me over the past few months, that “families” are choosing not to marry and have children out-of-wedlock because medicare pays for the birth.


  3. - Quill - Tuesday, Feb 14, 12 @ 7:31 am:

    The vast majority of people who would be pregnant would be using Medicaid, not Medicare.


  4. - Anonymous - Tuesday, Feb 14, 12 @ 7:48 am:

    “Over half of all births in Illinois are paid by Medicaid”
    I find this troubling, but not in the way that Durbin intends. :/


  5. - Concerned - Tuesday, Feb 14, 12 @ 8:01 am:

    For those who are very aware if Medicaid expenditures,
    There are alot of areas that could be trimmed.
    Cutting back on the all kids and family care that Blago expanded would help. Cutting back on the spending for illegal citizens would probably solve the crisis alone. Someone should ask for those numbers and publish them.


  6. - Shock & Awww(e) - Tuesday, Feb 14, 12 @ 8:09 am:

    PQ reportedly plans $2 billion in Medicaid cuts.

    It will be interesting to see what programs he proposes maintaining funding for in his formal budget address.

    What are the priorities he sets for our state? What programs does he feel should be maintained at current funding levels while Medicaid and others are cut?

    Should be interesting.


  7. - Anonymous - Tuesday, Feb 14, 12 @ 8:19 am:

    The amount of ignorance about Medicaid is summarized in this article and the comments thus far. Medicare pays for almost no births; it’s Medicaid. Illegal citizens (an oxymoron, by the way) aren’t eligible for Medicaid (except for a limited pool of funds for emergency care). (And if Concerned is referring to illegals delivering babies, those babies are legal citizens, so their moms are covered just for the pregnancy.) The state is among the lowest in the country in spending per enrollee without managed care, yet the Republicans in the GA continue to cling to their fiction that outsourcing all the care to their pals in the managed care biz is going to save the state a bundle (it won’t). The lack of knowledge about what it truly means to be “middle class” among the 1%-ers (and the 25%-ers, who probably make up most of the commenters on this board) leads to their surprise at the high number of Medicaid-paid births. The fact is - the income level of women in the child-bearing ages - is a lot lower, on average, than people think, making many of them eligible for Medicaid.

    All of which adds up to a GA unable to deal with the problem, because they’re mostly dealing with fictions and talking points, rather than facts.


  8. - More Courage - Tuesday, Feb 14, 12 @ 8:27 am:

    To say that for one third of the population, Medicaid is their only insurance is myopic and is an indicator of why we have a problem. First, we don’t know that it is their only option, it is just the option that is selected. Second, we don’t truly even know if they are eligible due to the subpar income and residency checks in Illinois (and don’t tell me that Quinn is doing something about it now, I’ll believe it when it happens). Third, if you lament the fact that it is their only option, then do something about creating other options that are not state (or federal) subsidized health insurance. Throwing your hands up and saying we can’t do anything because these are vulnerable populations will do nothing but continue the problem. If Durbin wants to do something he should talk to Obama about relaxing the Maintenance of Effort requirements in the ACA so we can run an effective program in this State. Finally, the Medicaid program needs to be reformed, but cutting rates, in a State with about the lowest rates already, is not real reform and is the easy way out.


  9. - Wensicia - Tuesday, Feb 14, 12 @ 8:35 am:

    Eligibility for All Kids should be cut back or raise co-pays.


  10. - Aldyth - Tuesday, Feb 14, 12 @ 8:53 am:

    I know it’s a human rights violation, but how about a complimentary tube tying with every second child born on the taxpayer’s nickel? And to be fair, a free vasectomy for every father with two kids born on medicaid? Might be a real incentive to use birth control.

    I know, I know. Human rights violation.


  11. - Anonymous - Tuesday, Feb 14, 12 @ 8:54 am:

    It will be hard to reform Medicaid if the GA is as uninformed as the posters here. Medicare doesn’t cover nearly any births - it’s Medicaid. “Illegal citizens” (what does that mean?)are largely NOT covered by Medicaid. (Only certain emergency care is partly covered, and that’s for the hospital’s benefit, not the illegal’s, since the hospital has to treat emergency patients regardless.) The children of illegals are citizens, so their mother’s pregnancy-related care is all that’s covered. Illinois has the lowest expenditures per recipient in the country - how is more managed care going to drive these costs down even more. Eligibility for AllKids has already been cut back. Co-pays just hit hospitals and doctors, since they largely are impossible to collect (in an emergency room, you can’t turn away someone who needs care but doesn’t have the co-pay).


  12. - Adam Smith - Tuesday, Feb 14, 12 @ 8:59 am:

    Durbin comes right out of the box with his typical liberal schtick.

    Yes, there are vulnerable populations. Yes, they need help.

    But it is cowardly and irresponsible to always start the discussion with these kind of salvos designed to stall real reform.

    We can devise a sustainable safety net but it cannot be gold-plated care for everyone, nor can it be based on the Democrats’ need to pander to political constituencies.

    More Courage is absolutely right. The legislature passed some good starting reforms last year thanks to the pressure from Republicans but Durbin, Quinn and their allies barely lifted a finger to get the necessary federal waivers.

    The Democrats will not reform Medicaid without sacrifice from beneficiaries. They cannot just drive reimbursements down to nothing and expect the program to exist. They cannot raise taxes enough to pay for the current flawed system without destroying any chance of economic recovery in Illinois.

    Thanks to their gerrymandered map the Dems have little chance of losing the legislature. If only it would give them the courage to do what must be done to preserve Medicaid by fundamentally restructuring it.


  13. - Realist - Tuesday, Feb 14, 12 @ 9:00 am:

    I always hear that Illinois’ per patient cost of medicaid is low, but what about the total number of people on medicaid in Illinois? How does that compare to other states? It doesn’t matter what the per person cost is if we have way too many people eligible for coverage.


  14. - Louie - Tuesday, Feb 14, 12 @ 9:04 am:

    Oh Please! Medicaid recipients werer growing above the rate of inflation, before the economy tanked in 2008. The eligibility standards need to be tightened up. Similar to what has happened at the federal level with food stamps.


  15. - Anon2 - Tuesday, Feb 14, 12 @ 9:05 am:

    == “Illegal citizens” (what does that mean?)are largely NOT covered by Medicaid. ==

    If a pregnant “Illegal citizens” (what does that mean?) shows up at Cook County Hospital about to go into labor, what happens?

    Forgive me, I am a uninformed poster here….


  16. - Dave V - Tuesday, Feb 14, 12 @ 9:10 am:

    It is also worth pointing out that the elderly in nursing homes and on Medicaid were not the poorest of the poor prior to being put in a nursing home. If they paid privately before going on Medicaid they were probably paying close to $5000 a month. Imagine how quickly your savings and assets would go paying at that rate. Your monthly income is not growing either. This is another reason why Home and Community Based services makes so much sense. Not only is the state picking up the cost of the care but also the housing cost.
    I’m also glad Quill pointed out the personal needs allowance of only $30 per month. Just to be real clear, the nursing homes will be getting millions more in rates due to the bed tax, none of which was allocated to giving a cent more to the residents on a monthly basis. This is what they had to use to pay for clothes, haircuts, etc. And they’ve had to stay at that amount for years now.
    Yes rates are relatively low but I’d say the medicaid providers have been able to keep themselves pretty healthy over the past few years. Especially those that are mentioned in this article. Mom and pop providers in the community have been backlogged on bills because the stimulus program that just got lifted protected only hospitals, nursing homes and physicians. They were paid within 30 days for the past few years, when prior to the stimulus they had payment delays that were usually agreed to by the providers themselves.


  17. - wordslinger - Tuesday, Feb 14, 12 @ 9:11 am:

    –…and for some of those children, it became apparent to me over the past few months, that “families” are choosing not to marry and have children out-of-wedlock because medicare pays for the birth.–

    I don’t think many births are covered by Medicare.

    Out of wedlock births are spiking all over the world among those of European ancestry — I don’t think Medicaid and the sweet life on welfare have much to do with it. And being unmarried doesn’t mean you don’t have insurance. I imagine unmarried Brad Pitt and Angelina Jolie can cover their ever-expanding brood.

    http://www.usatoday.com/news/health/2009-05-13-unmarriedbirths_N.htm


  18. - BIG R. Ph - Tuesday, Feb 14, 12 @ 9:15 am:

    You mean to tell me that when Rod was going around the State handing out gift cards to get people to sign up for All Kids that is now coming back to bite us all in the butt?

    And when Barry comes into a meeting of Medicaid providers and PROUDLY proclaims that more than 50% of the live births in Illinois we paid for by Medicaid that was a bad thing?

    Give me a break!

    We have tried for years to tell whoever wants to listen that Health Care for all is a noble idea and one that everyone can support. BUT YOU MUST HAVE A DEDICATED REVENUE STREAM TO COVER THE EXPENDITURES!!!

    You cannot just keep cutting reimbursements to providers and expect to spend less money and cover everyone.

    You cannot actuarilly set premiums for a program (All kids and Family Care) artificially low and expect it to come out revenue neutral.

    This was Blago’s problem and now Obama and Romney’s problem. They do not understand this concept.

    But guess what? Now it is OUR problem!!!!


  19. - Retired Non-Union Guy - Tuesday, Feb 14, 12 @ 9:25 am:

    Rich,

    Actually, the recession didn’t have quite as much influence as a different factor. If you figure the year over year percentages, it looks like it was driven more by expanded eligibility when Rod took office. The first two full years (FY04, FY05) the D’s controlled the House, Senate and Gov had the largest growth. Because I don’t follow this issue that closely, I’m not sure if that was because of expanded All Kids or a different program.

    However, those early jumps are what really drove up the subsequent numbers because the overall compounded growth average was only 6.4% (roughly double the inflation rate over the same period).

    Here are the year over year percentages (with the highest two years flagged):

    FY01 - 7.1%
    FY02 - 5.1%
    FY03 - 4.0%
    FY04 - 9.6% *
    FY05 - 8.3% *
    FY06 - 6.6%
    FY07 - 6.4%
    FY08 - 7.2%
    FY09 - 5.6%
    FY10 - 6.5%
    FY11 - 4.4%


  20. - Fed up - Tuesday, Feb 14, 12 @ 9:32 am:

    Seems very similar to the prison population. The more we put in prison the more prison guards we need the more prison contracts we have to hand out. The more on medicade the more bureaucracy we create ensuring jobs contracts and dependency. Just keep growing these programs it’s other people’s money right.


  21. - Cassandra - Tuesday, Feb 14, 12 @ 9:52 am:

    I think it would be worth putting money into demo programs to study keeping people out of nursing homes at a higher percentage. This is the 21st century. People are living longer and living longer in better health. This trend is rising. Even a modest reduction in nursing home days across the population would probably reduce Medicaid expenditures significantly.

    Alas, as in foster care, prison care, institutional care for the disabled and other forms of institutional care, a lot of folks make a good living out of things just as they are. Making changes threatens a lot of livings. Look at the fuss over closing down just two downstate institutions for the disabled after years of advocacy by groups who represent the disabled. Multiply it. Consider the extremely risk averse nature of our elected politicians. Assume not much is going to change in Medicaid (including cuts) at least until ACA is implemented in 2014 and then it’s really anybody’s guess.


  22. - Kasich Walker, Jr. - Tuesday, Feb 14, 12 @ 9:59 am:

    These increases are no more surprising than Apple discovering worker abuses at their Foxconn factories in Shenzhen and Chengdu, no doubt the same types of abuses found at the majority of plants in nations that are under the totalitarian rule now embraced by the western shell corporations that contract out the manufacture of products that fill our homes and workplaces.

    Those workers aren’t getting proper care, either. The trade policies that address only investor returns will insure that the standard drops further in the west.

    Happy Valentine’s Day.


  23. - formerGOPer - Tuesday, Feb 14, 12 @ 10:14 am:

    I’m glad to see Durbin and some of the commentators here mentioning the cost of nursing homes. It’s so easy to talk about the welfare moms and their kids but they’re not nearly as expensive as the elderly and disabled. I had a surreal experience at a restaurant once where the people at the table I was at were discussing the freeloading welfare people. The people at the next table over were discussing transfering mom’s assets so Medicaid would pay for her care and they could still have “their” money. I had a really strong desire to introduce the two tables to each other. It’s easy for some people to talk about going after the mothers and children but even the GOP doesn’t want to go after the elderly and disabled.


  24. - Grandson of Man - Tuesday, Feb 14, 12 @ 10:14 am:

    As a Medicaid worker, one way I try to help is fighting fraud. If a client states in writing or in person that she or he doesn’t live with the parents of their kids, I go in different databases to grab vital info and search to see if there is evidence that the parent lives with the client.

    If I run the absent parent’s SSN and find that the parent earns little or nothing, I may not do much about it. I often find, though, that the absent parent earns a substantial amount of income. At that point, I do a fraud referral for investigators to do a home visit. On many occasions, the absent parent is found to be living there. I then cancel the case. I think Illinois needs to focus more on fraud that enables ineligible people to take advantage of Medicaid that belongs to people who qualify.


  25. - CircularFiringSquad - Tuesday, Feb 14, 12 @ 10:16 am:

    Durbin’s numbers confirm that we are paying a ton for grammie and grampie in Naperville not just poor Chicagoans. How will the GOPies deal with this shocker? How much managed care can we lay on them?


  26. - Irish - Tuesday, Feb 14, 12 @ 10:24 am:

    There are other ways to reduce these costs.

    First of all, if the State paid it’s bills on time and refunded the doctors and small clinics in a reasonable time and at a reasonable rate more of them would take medicaid patients. This would reduce more costly emergency room visits. It is becoming exceedingly difficult to find any doctor who will take public aid patients.

    Secondly if the doctors and clinics and emergency room visits were montitored more closely we would see that it is very common for drugs that are definitely not necessary are being prescribed and covered by medicaid. You would be surprised to see how many times drugs like vicodin are prescribed for colds and flu. Emergency rooms are becoming the new source for getting your “fix”. And we are paying for that.

    Why is it that our leaders always want to take the over the top fix or no fix at all? Why throw the baby out with the bath water? It’s because they don’t want to be bothered with finding out where real savings can occur in established programs. That might make their job full time. So they make it an all or nothing proposition, knowing full well people won’t support either side and they can go home and get back on the golf course.

    Why do prisoners get free dental coverage for anything they want? Supposedly that is their right. If they were out in society they would have to work for that. So make them earn that coverage while they are in. I have asked a local minimum security institution for a group of workers to come out and do brush cutting etc. at a state site on many occasions. I have been told they are booked up with projects. Really? Our jails are overcrowded with people who have committed non violent crimes and they don’t have ten guys to cut brush?

    Why are we giving illegal aliens free medical coverage? I have heard a lot of people on this blog complain about the Township government. Well in our area it is one of the few areas where you work for your hand out. One of the primary duties of a township supervisor is to provide aid to people who need it. They must keep some hours at the township office to cover that need. The two townships that cover our town require that those receiving aid must do some sort of work, whether it is for the township or for another entity who has agreed to work with the township in this endeavor. Most of the time these are non-profit groups. This is a case where providing this service at a local level results in better monitoring of the program.


  27. - Retired Non-Union Guy - Tuesday, Feb 14, 12 @ 10:27 am:

    formerGOPer @ 10:14

    Whether you agree with the tactic or not, today that is just one more aspect of estate planning and tax avoidance …


  28. - Bman - Tuesday, Feb 14, 12 @ 10:30 am:

    I believe there are people that absolutely need assistance from federal and state governments. However I also believe the threshholds to qualify for theses programs are way too low and a result of irresponsible politicians wanting the government provide something for everybody,no matter how rediculous. Come on get real.


  29. - Irish - Tuesday, Feb 14, 12 @ 10:34 am:

    formerGOPer@10:14

    And it is more difficult than you would guess. You have to make these decisions at least five years before the individual enters the nursing home.


  30. - Grandson of Man - Tuesday, Feb 14, 12 @ 10:39 am:

    We used to have a DHS worker who only worked on self-employment and property ownership. She had access to computer programs that were unavailable to us. She retired a few years back, and her position was closed. She did a great job in finding unreported income. We found some major fraud, and it was relatively common. We found clients who owned unreported multiple-unit properties who were collecting rent, for example. We found business owners who were not reporting income, etc.

    We are now directed by our supervisors to do more fraud referrals. The problem is that we don’t have enough staff to really focus on fraud referrals.


  31. - Retired Non-Union Guy - Tuesday, Feb 14, 12 @ 10:41 am:

    One place some of the money can be found to avoid cuts is speed up the transition to managed care programs and change the goal from 50% to 100%. As I (and others) have previously pointed out, the 50% goal was passed a couple of years ago (and the deadline is a couple of years in the future) but not much has been done toward achieving the target.

    Another place is home care for the elderly. There are a lot of of 80 and 90 year old people still residing in their homes because it is cheaper for them personally. However, they are one accident or illness away from landing in a nursing home. Some simple steps to ensure their homes are safe and handicapped equipped could pay big dividends. I know there are some small programs that do some of it, but maybe they should be expanded. Also, there are some pretty strict limits on in home care; maybe those limits should be lifted some so people needing just some help can stay out of nursing homes. If you keep people out of nursing homes, you can save serious money.

    Finally, a serious review should be made of the whole payment level in Illinois’ health / welfare system to see if any of the payment levels are out of line (I know people claim the medical service levels are too low but those claims usually come from the people getting paid). I haven’t looked at it for many, many years, but thirty some years ago Illinois paid better than the surrounding states. Some of us back then used to joke we could save money by just putting computer terminals on the bridges and signing up the welfare cases as they came into the state …


  32. - Retired Non-Union Guy - Tuesday, Feb 14, 12 @ 10:47 am:

    Grandson of Man @ 10:39

    Today where anybody with an Internet connection can look up property ownership records, I would think it would be easier to find that kind of fraud … with a name and a county, it just takes a few seconds.


  33. - Don't Worry About the Government - Tuesday, Feb 14, 12 @ 10:52 am:

    All Kids gives Medicaid coverage to all children whose parents make at or below 300% Federal Poverty Level.

    This is the Federal Poverty Level Income chart for those at 300%.

    Family Size 300% Federal Poverty Level
    1 $33,510
    2 $45,390
    3 $57,270
    4 $69,150
    5 $81,030
    6 $92,910

    Immigration status does not affect eligibility for All Kids.


  34. - Dave V - Tuesday, Feb 14, 12 @ 11:02 am:

    @Cassandra for most populations there is not a need for demo programs because we have them (CCP for Seniors, DORS for Disabled etc.) The problem is that cutting them often seems easier than taking on the bigger medicaid players. And since the eligibility requirements are the same, when you cut these programs you will see nursing homes adding to their roles. To be fair, not all of those folks may go into nursing homes but if even a fraction of them do the cost to the state still rises.
    To improve the balance rather than hold it where it is we will need to see more robust community programs that can keep people out that they couldn’t before.


  35. - PublicServant - Tuesday, Feb 14, 12 @ 11:05 am:

    As for home-based care, there are a lot of forclosed homes out there that could be purchased and more cheaply rehabbed for those current nursing home residents who are capable of living on their own, or with minimal assistance than it now costs to house them in an institution.

    I’m not very familar with the subject, but given the astronomic costs associated with nursing home care, would this be much cheaper? And wouldn’t it be a job creator too?


  36. - A.B. - Tuesday, Feb 14, 12 @ 11:09 am:

    This is a systemic problem that needs to be addressed at a variety of levels. The reality is that both sides of the aisle have very real options to help address this, but they are bickering to much to actually do the work. Health care reform makes a few of the changes, but not enough. There is a real need for Tort Reform to help cut health care costs. We also need to start looking at how we pay for health care differently. When we stop paying per procedure and start paying based on the diagnosis aka the entire episode of care, we will see real helath care savings Those savings will be a beneficial measure to cut the costs for the providers, as well as the insurers and the government.


  37. - Grandson of Man - Tuesday, Feb 14, 12 @ 11:15 am:

    @rnug,

    The problem is that we frontline DHS workers have millions of things to do in a day, so fraud prevention has to be fit in with all the rest of the stuff.

    In my opinion, we need more workers whose sole purpose is to find unreported income. We can only do so much with the training and technology we are given. I often piece together info that is available to me and do fraud cases, but we need more help. I would like to see someone in my office who focuses solely on finding unreported or underreported income.


  38. - jeff - Tuesday, Feb 14, 12 @ 11:23 am:

    When you look at Don’t Worrys chart and realize that $42k is median income in Chicago, you understand why more than 50% of children are covered by All Kids. How is income level verified after you qualify for program? Based on my experience with other similar programs once you are in, you stay in regardless of income improvement.


  39. - Yellow Dog Democrat - Tuesday, Feb 14, 12 @ 11:33 am:

    @Rich -

    Sorry, but for once I think you are wrong.

    Expanding less costly alternatives to nursing homes reduces Medicaid costs tremendously.

    Applying Cost Effectiveness Analysis to Medicaid decreases costs tremendously.

    Providing low income women free access to quality family planning reduces costs tremendously.

    And Illinois can look to Iowa for a model of creating an independent charter agency focused on addressing Medicaid cost reductions. Charter agencies start with a relatively small lump sum of money and then enter into performance-based contracts with nonprofits and for profits, with the generated savings reinvested in the charter agency.

    Probably about $1 billion in savings sitting right there with improved outcomes.

    BTW, my grandfather was a fraud investigator for the state. You’re not going to find much savings by going after individuals. The vast majority of people and providers are honest. But where one dishonest patient might cost you tens of thousands, a dishonest provider can cost tens
    Of millions.


  40. - Cook County Commoner - Tuesday, Feb 14, 12 @ 11:42 am:

    Home based care seems to be an option for senior-care. But will that disappear if the GA is successful in shifting teacher pension costs onto homeowners?


  41. - Grandson of Man - Tuesday, Feb 14, 12 @ 11:58 am:

    @ydd,

    If what you write is true, that fraudulent providers cost Illinois more than fraudulent Medicaid recipients, thanks for the valuable info. I didn’t know that.

    I also wonder about whether employers can be given incentives to help with health insurance, since so many Medicaid recipients work and have no private health insurance.


  42. - wordslinger - Tuesday, Feb 14, 12 @ 12:23 pm:

    –If what you write is true, that fraudulent providers cost Illinois more than fraudulent Medicaid recipients, thanks for the valuable info. I didn’t know that.–

    It’s not like Medicaid patients walk into the hospital or clinic and order up tests and treatments. Providers set the care, submit the bills and collect the money. Same with private insurance as well.


  43. - 3rd Generation Chicago Native - Tuesday, Feb 14, 12 @ 12:51 pm:

    I know someone who works at Target, and they have open enrollment for insurance now, if you don’t have enough hours you don’t qualify for benefits, and this person showed me that Target included for each state where to apply for the State Health Care (provided phone numbers)
    I wonder if Walmart and other similar employers provide the same information?


  44. - Jimbo - Tuesday, Feb 14, 12 @ 1:03 pm:

    ==and if they go much lower patients will have trouble finding care==
    Patients already have this problem.


  45. - Quill - Tuesday, Feb 14, 12 @ 1:10 pm:

    @PublicServant: tehre is a program lifting off now that does exactly what you propose: buying foreclosed homes, doing home modifications, and moving in people who want to be out of nursing homes. It’s called Home First Illinois.

    I think Yellow Dog Democrat makes excellent points. Another point I have not seen raised that may help people keep Medicare and Medicaid straight is that Medicare is paid for with federal dollars. The state pays for a percentage of Medicaid, with matching dollars from the Feds. If the state cuts Medicaid, it also cuts off federal funding. So the program that has everyone flipping out in Illinois is MEDICAID, not Medicare.


  46. - reformer - Tuesday, Feb 14, 12 @ 1:36 pm:

    I notice that no one dares address the 60% of Medicaid spending that goes to nursing homes. It’s easy to be a deficit hawk and demand that we CUT,CUT,CUT! It’s harder when you see where 60 cents on the Medicaid dollar goes.


  47. - ANAL - Tuesday, Feb 14, 12 @ 1:49 pm:

    Before cuts are made, be sure to determine the State’s net cost after accounting for all Federal Financial Particiption (FFP). Growth in total spending is great, but the State’ net liability has been pretty stable over the years. Also, summary cuts may not be the best option, especially if you factor in cost shifting.


  48. - Dave V - Tuesday, Feb 14, 12 @ 2:31 pm:

    @Coook County Commoner Housing costs are an issue for HCBS but unless something changes there are protections for seniors from rising property taxes (Freezes and Exemptions). But certainly when trying to move them out of nursing homes it is a lot trickier. This is why we should make sure we are working as hard to fix the intake side as we are to getting current residents out.


  49. - Anon - Tuesday, Feb 14, 12 @ 2:43 pm:

    Shifting the Medicaid funding problem to the healthcare providers via managed care does not work. How is the MD’s at fault if the patient does not lose weight, quit smoking and does not take their medications or return for follow-up care. You add another layer to the cost of the program with the new managed care entity. Only the providers suffer and when they drop out of the program, they are called greedy.


  50. - More Courage - Tuesday, Feb 14, 12 @ 2:49 pm:

    reformer - 60% to nursing homes? not even close.

    Maybe you saw something like 5% of the people account for 60% of the costs. But to say that 60% of Medicaid costs go to nursing homes has no basis in reality.


  51. - Retired Non-Union Guy - Tuesday, Feb 14, 12 @ 3:41 pm:

    Grandson of Man @ 11:15 ,

    Believe me, I know. I have two relatives who work for the State’s social service agencies. Back when Rod expanded the number of case workers, I wrote a letter to the editor of the local paper noting that, even after the expansion (and using Rod’s numbers of workers and cases), each case worker only had about 20 minutes a year to spend on a given case.


  52. - Jimbo - Tuesday, Feb 14, 12 @ 3:49 pm:

    Nursing homes make up about 15% of total program costs. ($1.6B in FY12)


  53. - Quill - Tuesday, Feb 14, 12 @ 5:25 pm:

    The latest Kaiser statistics on Medicaid spending from a 50 state perspective are from 2009 and can be found at http://www.statehealthfacts.org/profileind.jsp?cat=4&sub=47&rgn=15.


  54. - Quill - Tuesday, Feb 14, 12 @ 5:27 pm:

    Pardon to Rich, previously the link didn’t work as posted. The latest Kaiser statistics on Medicaid spending from a 50 state perspective are from 2009 and can be found at http://www.statehealthfacts.org/profileind.jsp?cat=4&sub=47&rgn=15 .


  55. - Dave V - Tuesday, Feb 14, 12 @ 6:42 pm:

    As I said earlier, I won’t argue that cutting rates is a good option but when comparing it against people needing health care I think it is worth making a few arguments why rates may not be a worse option than the frail elderly and infants. One might ask why some of the larger medicaid provider associations rank among the largest campaign donors for Illinois elected officials. One could argue some medicaid funds end up finding their way into campaigns.


  56. - Ex-DHS - Wednesday, Feb 15, 12 @ 8:05 pm:

    grandson, yes medical provider fraud and outright false billing for non-existent patients, by non-existent providers is easily a larger fraud amount than client fraud. Blago’s padding the medicaid recipient rolls was also costly.Truth is though, DHS is a political agency controlled by the top down and the top changes every 4 years. Springfield wants no political waves from below. The last thing it wants is caseworkers who are actually effective in working with clients and resolving problems. Better to just turn caseworkers into glorified application processors. The real waste is that as a caseworker, one spends one’s time just trying to stay balanced on your own two feet without being swept under with work and endless interruptions; that you have no chance to do actual social work.This is deliberate.


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