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Medicaid pays for 94 percent of teen births here, but program can’t be cut

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Illinois

* Cutting Medicaid eligibility isn’t going to be easy, or perhaps even possible in some cases…

Medicaid paid for 89,621 Illinois deliveries in 2009, the most recent year for which statistics are available. That was nearly 54 percent of all births, according to the Department of Healthcare and Family Services. The total cost was $890 million. Medicaid plays an even bigger role in births to teen mothers, paying for nearly 94 percent of teen deliveries in 2009.

Since 1989, the federal government has required states to cover pregnant women whose income is at or below 133 percent of the federal poverty level. That’s the equivalent of about $14,800 annually for a single-person household. That’s the minimum states must do.

Illinois goes beyond that, covering pregnant women who make up to 200 percent of federal poverty, or about $22,300 for a single person’s annual household income. Teens who are pregnant are covered up to 300 percent of federal poverty, or about $33,500 for a one-person household.

And a newer federal requirement has tied Illinois to those higher eligibility levels.

The federal health care overhaul, President Barack Obama’s landmark legislation, requires states to keep their Medicaid eligibility stable, barring Illinois and other states from saving money by lowering income ceilings for pregnant women and other groups.

So, eligibility cuts to this particular progam are off the table, according to the AP.

* Meanwhile…

Not only does Gov. Pat Quinn’s state budget proposal call for shoehorning more inmates into fewer prisons, it also would reduce drug counseling and job training programs for prisoners.

Critics say that combination of cuts could make the state’s overcrowded penal system more dangerous and could result in more inmates returning to prison because they lack job skills and still suffer from substance abuse problems.

“If you remove those programs, you’re essentially adding more people to the prison system,” said John Maki, executive director of the John Howard Association, a prison watchdog group.

* And Gov. Quinn sidestepped any attacks on his fellow Democratic statewides, focusing instead on the two Republicans…

Quinn defended his call for statewide officers to cut their budgets by at least 9 percent, despite opposition from fellow Democrats Attorney General Lisa Madigan and Secretary of State Jesse White.

Madigan has said cutting her budget any further will make it harder to keep qualified attorneys and peruse legal action that actually brings in money for the state.

White has said such cuts would force him to close several driver’s license facilities, where he has long worked to cut waiting times.

Quinn took specific aim at Republicans Treasurer Dan Rutherford and Comptroller Judy Baar Topinka, saying they should be on board after traveling “up and down Illinois saying we need to cut spending.”

“It’s not easy, I know that,” Quinn said. “It’s very hard. But if we don’t do it, we’ll never get our budget back in the shape that we want it to be. We’ve got to have a better budget and everybody’s got to participate.”

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posted by Rich Miller
Monday, Mar 12, 12 @ 9:38 am

Comments

“…Gov. Pat Quinn’s state budget proposal… would reduce drug counseling and job training programs for prisoners.

…“If you remove those programs, you’re essentially adding more people to the prison system,” said John Maki…”
What are the statistics on the efficacy of the counseling and training programs? Without stats showing success without recidivism how could you conclude that there is a causal effect of more prisoners from reducing them?

Comment by Anonymous Monday, Mar 12, 12 @ 9:50 am
Thanks for continuing to talk about how cutting Medicaid is quite difficult, because both laws (today’s post) and lives of poor/sick/disabled folks are involved (the polls last week).

Regarding Rutherford and Topinka, they’ve called in the past to combine their offices; absent that, I wonder if there are any legal ways for them to share workers/work/back office functions that could lead to some modest savings.

Comment by Robert Monday, Mar 12, 12 @ 9:50 am
I feel a little bad for the Constituional Officers here (well, a couple of them).

Quinn is spot on with Topinka & Rutherford demanding cuts all over the state, then only being willing to cut 2-3% of their office’s budget. Give me a break.

As for White & Lisa, I do feel a little bad for them. The governor & Light Gov have the luxury of dipping into the agencies & hiring staff through intergovernmental agreements at no cost to their offices….this is a luxury that the AG & SOS don’t have. So when the Governor cuts his budget, he’s really just going to manage that by increasing his staff on loan from his agencies.

Comment by Anonymous Monday, Mar 12, 12 @ 10:14 am
–Regarding Rutherford and Topinka, they’ve called in the past to combine their offices; absent that, I wonder if there are any legal ways for them to share workers/work/back office functions that could lead to some modest savings. –

That’s interesting. Never heard that before. If possible, it would be a step to the avowed goal of the officers.

In regards to Medicaid-paid births, it’s a national issue with Illinois smack dab in the middle.

The small-government champions in Dixie and the West dominate the top of the list, per usual when it comes to government assistance.

http://www.statemaster.com/graph/hea_as_per_of_sta_bir-births-financed-medicaid-percent-state

Comment by Anonymous Monday, Mar 12, 12 @ 10:17 am
Anon 10:17 is me.

Comment by wordslinger Monday, Mar 12, 12 @ 10:29 am
With 89,621 births on medicaid my guess is the state better do something about some job creation or things are going to get pretty tough 16 or so years down the road

Comment by Informer Monday, Mar 12, 12 @ 10:42 am
Question: Most teens are included on their parent’s health insurance plans; so if they become pregnant, are they covered/utilizing their health insurance or using Medicaid? I realize this would be different plan to plan but I have a hard time believing only 6% of all teens giving birth in Illinois are not covered on their parent’s insurance.

Therefore perhaps part of the problem (and perhaps it can be fixed via Legislation) is that the Medicaid is “used first” to cover expenses and then the family’s health insurance plan kicks in. Most every teen is going to fall below the poverty level set, making them “medicaid eligible”; so as long as Medicaid is used first, the expenses for teen births will be larger. If Legislation was passed to change it so that private insurance (if a teen was covered) paid for pregnancies first, regardless of income/medicaid eligibility, then the teen pregnancy/medicaid amount would drop.

Comment by Both Sides Now Monday, Mar 12, 12 @ 11:12 am
I remember in the ’60s when Medicaid was rolled out by the feds how many warned that if you subsidize something you get more of it. They were soundly scorned as bigots, uncaring, anti-feminist, etc. There is no humane solution to this. We encouraged bad decision making, and now we must pay for it. But someone needs to stand up an say how wrong-headed it was and why.

Comment by Cook County Commoner Monday, Mar 12, 12 @ 11:29 am
While it is the case that Medicaid is required to provide the coverage for teen births, I am not aware of any federal law or rule that prohibits the state from recovering those costs or a portion thereof from insurance companies or fathers

Last time I checked, the vast majority of teen pregnancies involved fathers who were adults. The state’s Medicaid program ought to be working with maternal health advocates to make funding sustainable if we haven’t already, just as the Dept of Public Aid is reimbursed out of child support enforcements.

Comment by Yellow Dog Democrat Monday, Mar 12, 12 @ 11:29 am
@Both Sides Now-

As I understand it, recovering Medicaid costs from third
Parties is the responsibility of the Attorney General.

Perhaps that needs to change.

Comment by Yellow Dog Democrat Monday, Mar 12, 12 @ 11:41 am
This is why birth control should be available to the poor and via insurance. And why planned parenthood and similar groups are so important. What are the stats on social and financial problems of children of poor teenagers I bet they are grim. And the teen Dads generally can’t provide for the kids either. Conservatives who fight these programs are short-sighted.

Comment by Ace Matson Monday, Mar 12, 12 @ 12:01 pm
In Quinn’s defense, Dan and Judy need to put up or shut up. If they don’t want to make the big sacrifices it’s going to take, stop talking about it. Dan’s office could probably be cut 20% if he would stop using it to campaign for governor.

That being said, I think a middle ground can be found and would not cut Madigan’s budget due to cuts already made and the impact she has on the GRF. I think the rest can take a 5% cut.

Comment by Ahoy Monday, Mar 12, 12 @ 12:01 pm
===Question: Most teens are included on their parent’s health insurance plans; so if they become pregnant, are they covered/utilizing their health insurance or using Medicaid? I realize this would be different plan to plan but I have a hard time believing only 6% of all teens giving birth in Illinois are not covered on their parent’s insurance.

Therefore perhaps part of the problem (and perhaps it can be fixed via Legislation) is that the Medicaid is “used first” to cover expenses and then the family’s health insurance plan kicks in. Most every teen is going to fall below the poverty level set, making them “medicaid eligible”; so as long as Medicaid is used first, the expenses for teen births will be larger. If Legislation was passed to change it so that private insurance (if a teen was covered) paid for pregnancies first, regardless of income/medicaid eligibility, then the teen pregnancy/medicaid amount would drop.
===

An ER doctor friend of mine says that when looking at income for teen pregnancies, they do not look at the income of the parents of the teens. So unless you’re looking at an incredibly industrious pregnant teen that makes over $33K per year, even the wealthy pregnant teen from Hinsdale could be covered by Medicaid.

The other issue w/ the Obama Administration policy is this: so basically when states like Illinois go above & beyond the federal requirements, now they’re forcing those states to lock-in at those more generous levels? So basically if you were generous before and are now in a budget crisis, you aren’t allowed to scale back?

1) That’s a huge problem for Illinois & other states in a similar situation.

2) Won’t that policy create a MASSIVE chilling effect on any future states considering going above & beyond? It’s one thing to go above & beyond if you can afford it. But if the Feds are telling you that once you do it, you’re stuck with that decision forever, I’ve got to imagine that would scare most states from ever doing that again.

Comment by John Galt Monday, Mar 12, 12 @ 12:02 pm
Both sides now: 1. I wouldnt be so sure that a large number of these teens are on parental insurance plans. A lot of their parents don’t have insurance in the first place.

2. That said, even if the teen was on mom or dad’s insurance plan, I don’t know of too many plans that cover grandchildren. A big chunk of that hospital bill is (likely - I don’t know enough anout these matters to say for certain) generated by the newborn.

3. Insurance companies typically cover dependent children. Is a new mother legally considered a dependent child anymore? Seeing as how she has a dependent of her own now…

Comment by Jerry101 Monday, Mar 12, 12 @ 1:05 pm
YDD

@ recovering Medicaid costs

Healthcare and Family Services determines the state policy. As to the possibility of success, there are not a lot of sugar daddies out there.

Comment by Bigtwitch Monday, Mar 12, 12 @ 1:07 pm
Ace, I think BC should be covered by insurance. I just don’t think the government should require that it be so. The issue was about religious freedom an dgovernment intrusion, not birth control. I heard from a woman who worked for an insurance company where they’d pay for an abortion as it was cheaper than 18 ears of health care.

Comment by Wumpus Monday, Mar 12, 12 @ 1:48 pm
There is no requirement in the Illinois Constitution for the state to participate in Medicaid, and from the Federal perspective participation on the part of states is voluntary. There is nothing stopping the Illinois from turning it over to the Feds to run as they see fit. Save tons of money.

Comment by wishbone Monday, Mar 12, 12 @ 2:22 pm
==nothing stopping the Illinois from turning it over to the Feds==

The feds encourage the States to heve the program by picking up a round 1/2 the cost. If the state was not in the program, there would be no program in the state. The feds would not run it. And, all private health care in the state would be bankrupt.

Comment by Bigtwitch Monday, Mar 12, 12 @ 4:43 pm
Under the PPACA, states cannot reduce Medicaid eligibility for adults until January 1, 2014.

That may just punch a hole in some of the options DHS provided Rep. Harris last week. What else are they missing or miscommunicating to our legislators? Not a good sign.

Comment by Shock and Awww(e) Monday, Mar 12, 12 @ 5:15 pm
so we can cut public safety, prisons, IDNR, help for the disabled, education, public pensions, transportation, environment, and all other state functions, but we can’t cut and significant medicaid due to Obama administration dictates? Guess the change we need to make first is the Obama administration. OK by me.

Comment by park Monday, Mar 12, 12 @ 5:27 pm
Just to be clear, Medicaid is always the payer of last resort. If there’s insurance, that’s absolutely billed first, and in fact the Medicaid rate is so low that most hospitals wouldn’t even bother to bill Medicaid if they had private insurance. If someone has both Medicaid and private insurance they get a “third-party payer” Medicaid card which specifically says it won’t pay until the insurance has paid first.

Illinois Medicaid also has the option to pay the insurance premiums for someone if that’s to the state’s advantage. So if a teen had the option to stay on Dad’s insurance, but it would cost $300 a month, the state has a program that could pay that.

The state also aggressively goes after dads (you have to sign over your medical support rights if you get a Medicaid card) to make them put the baby on his health insurance if he has it. But the reality is that these moms don’t have dads with health insurance and the fathers of their children don’t have health insurance.

Finally, if you ended Medicaid for pregnant women, you’re just pushing all those costs onto the community hospitals. Hospitals can’t turn away women in pregnant labor. So instead of giving a woman a Medicaid card as soon as she has a confirmed pregnancy, so she can actually get prenatal care, you wait until she’s in labor and then you tell her to just show up at any hospital and throw herself (and her now high-risk pregnancy since she didn’t get prenatal care) on their mercies.

Comment by Ann Monday, Mar 12, 12 @ 7:06 pm
“The federal health care overhaul, President Barack Obama’s landmark legislation, requires states to keep their Medicaid eligibility stable, barring Illinois and other states from saving money by lowering income ceilings for pregnant women and other groups.” - If I read this correctly, even though the IL rate is higher than the Federal rate, IL can’t lower their rate to match the Federal rate.
I wonder how many people come to IL or stay in IL primarily because of it’s higher Medicaid rates.

Comment by Mark Monday, Mar 12, 12 @ 8:40 pm
@Ann -

Thanks for the clarification.

Also, does anyone over at Health and Family Services talk to these teens about adoption?

A baby whose parents can’t afford health insurance might be better off in another home.

If only we had universal access to family planning and medically accurate sex education!

Comment by Yellow Dog Democrat Tuesday, Mar 13, 12 @ 12:24 am
As to the call for more family planning services and birth control for teens as the way to stem teen pregnancy - it is available but the teens don’t want to use it. Many of them want a baby or two or more. They forget to take the pill or get the shot or what have you and that is another reason for teen pregnancy. As for adoption, many teens don’t want to do this and once their mother finds out about the pregnancy, she won’t let the daughter adopt out “her” grandchild. Also, the pregnancy and childbirth are kind of cool to the teen and her friends and give her a bit of cachet - with baby showers, etc. to look forward to. I work with many of these students and know about the attitudes involved.

Comment by Blue Tuesday, Mar 13, 12 @ 4:29 pm