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Medicaid tussle

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* Two Republican legislators held an angry press conference yesterday about a proposed Medicaid expansion for Cook County…

Two Republican state lawmakers on Thursday said it would be hypocritical for Gov. Pat Quinn to seek expansion of a health insurance program for low-income adults in Cook County at a time Illinois faces billions in unpaid bills and needs statewide Medicaid reforms.

Rep. Patti Bellock of Hinsdale and Sen. Dale Righter of Mattoon called on Quinn’s administration to drop a request that would allow for an expansion of Medicaid coverage to low-income childless adults in the nation’s second most-populous county.

The lawmakers said there are hundreds of millions of dollars in cost-saving reforms that were approved by the Legislature last year but not carried out. The reform package, which included requiring income and residency verification for Medicaid applicants, put a moratorium on expanding Medicaid eligibility.

“We want to reform the system when clearly that’s not their aim,” Righter said of the Quinn administration. “We’re drowning in the hypocrisy.”

* The proposal would add 100,000 people to the Medicaid rolls. The idea is to get federal money to reimburse Cook County for half the costs that Cook is already paying…

The Associated Press reported earlier in the week that the Department of Healthcare and Family Services Director Julie Hamos asked the U.S. Department of Health and Human Services for an expansion which is supposed to bring millions in federal funding to Cook County’s strained health care system.

But any expansion would require lawmakers to lift the moratorium, and Hamos said Cook County has to convince lawmakers.

Healthcare and Family Services spokesman Mike Claffey says there won’t be any costs to the state if the is application is approved by federal authorities.

“The proposal will help Cook County to recover 50 percent of the cost it will have to pay anyway to treat uninsured people,” Claffey said.

* The program wouldn’t cost the state government a dime, but that was of no consequence to the legislators…

“People in my district, they pay state taxes, they also pay federal taxes,” Righter said. “And they care how much their governments are spending, not just in Springfield but in Washington, (D.C.) as well.”

Righter voiced concern that the state would be stuck with paying for the 100,000 new enrollees if the federal health-care law is struck down in whole or part by the U.S. Supreme Court before the end of this year since they’re eligibility is based on the new law.

* Cook County Board President Toni Preckwinkle said via a press release today that this shouldn’t be a political issue…

“The proposed waiver would ensure that [Cook County Health and Hospitals System], the state’s largest provider of medical care to the uninsured and underinsured, garners additional federal resources that would bolster our health system in this time of state budget distress while relieving the state of Illinois of future budgetary pressures. This should not be a political issue.

“Our waiver proposal seeks to deliver quality care to those who require it the most while simultaneously protecting the state of Illinois from future budgetary liability.

“Last year, New Jersey Governor Chris Christie received approval for a similar waiver which garnered tens of millions of dollars in increased federal financial support for his state’s Medicaid program. If Governor Christie can work in conjunction with President Obama to achieve this goal, I believe all of us in Illinois are capable of doing the same.”

More details on the Christie waiver here.

* Meanwhile, the AP interviewed Illinois Department of Healthcare and Family Services Director Julie Hamos about possible Medicaid cuts…

“Last year, in the Medicaid reform law, the Legislature turned the All Kids program into a “most kids” program. They capped children’s eligibility at 300 percent of the federal poverty level. That could go lower, I suppose.

“And their parents are in a program called Family Care that’s currently at 185 percent of the federal poverty level. Last spring, we suggested they might want to cut adults down from 185 percent to 133 percent. This is what the Affordable Care Act (President Barack Obama’s health-care overhaul) is going to provide (in 2014).

“The Legislature didn’t want to do that. They didn’t want to throw people off the program. We didn’t either.

“Our enrollment growth in Medicaid is directly attributable to the bad economy. … Nobody wants any of these changes.”

* And in related news…

Demanding raises that Gov. Pat Quinn has canceled, dozens of members of the American Federation of State, County and Municipal Employees rallied Thursday in front of the governor’s office, causing a brief confrontation with Secretary of State police officers.

AFSCME members tried to present Quinn with an oversized “collection notice” for the raises, which were withheld by the governor for 30,000 unionized employees in 14 state agencies in July. Those workers, mostly AFSCME members, were supposed to receive a 2 percent raise on July 1, a 1.25 percent raise on Jan. 1 and another 2 percent on Wednesday. None of the raises have been paid.

Quinn has said the legislature did not appropriate enough money to fund the raises.

* Related and a roundup…

* Number Of The Week: 6,230: That’s the number of jobs lost each time the state reduces general fund spending by just 1 percent, according to a new report by Make Wall Street Pay Illinois and the Alliance for a Just Society.

* Director says IDNR needs help after budget halved: “Our agency has essentially been cut in half over the last decade,” he said. “There are a lot of ramifications. People need to be engaged and involved so we can find a solution.”

* State dragging feet on Medicaid reforms, legislators say: Department of Healthcare and Family Services spokesman Mike Claffey said the department is “steadily working” to get 50 percent of Medicaid recipients into coordinated care. The agency also is putting into place an electronic system to evaluate income levels and is working with the secretary of state’s office to develop a system to prove residency. “I don’t have a specific target date (for completion),” he said.

* Illinois budget director assures local mayors that state’s economy is improving: Vaught said the state is working to get current on its payments, but remains focused on fostering growth. He said the top challenges for the state are pension reform, Medicaid cost containment, and economic growth.

* Lawmakers set hearing on Jacksonville Developmental Center closure: But while some public testimony is expected at the hearing, the American Federation of State, County and Municipal Employees said Thursday the hearing does not comply with the state’s Facilities Closure Act. “Not only does the current hearing plan violate the law, in our opinion, but it also appears to be intended to make it as difficult as possible for some parties most directly impacted to be able to participate,” said AFSCME executive director Henry Bayer in a letter to COGFA’s co-chairmen, Sen. Jeff Schoenberg, D-Evanston, and Rep. Patti Bellock, R-Hinsdale.

* Public Employee Union: Where’s Our Pay Raise?: “Labor comes before capital,” Bayer said. “This governor gave $300 million to the Chicago Mercantile Exchange. Frontline workers… he can pay them what they’re owed. They certainly deserve it, and they certainly need it a lot more than the Chicago Mercantile Exchange.”

* VIDEO: ASFCME Rally

* VIDEO: Gov. Pat Quinn on Chicago Tonight

* Students school Quinn at Capitol

* Editorial: Legislative scholarships a perk we can’t afford

* Grigsby to Fight Illinois Secretary of State’s ISAC Allegations

* IL high court ruling offers new hope to inmates

* Press Release: Attorney General Alleges Faulty Practices in Foreclosing on Homeowners in Crisis

posted by Rich Miller
Friday, Feb 3, 12 @ 11:35 am

Comments

As the article on Miller points out, more attention needs to be paid to DNR’s financial issues. At some point funding gets so low the agency can’t function, and at that point you’re ignoring the state constitution’s call for the protection of natural resources. And not just the wildlife, money-generating portion.

Comment by Peter Friday, Feb 3, 12 @ 11:53 am
It isn’t just DNR. Historic Preservation has seen an almost 60% cut over the past 10 years. The headcount at HPA went from 250 10 years ago to less than 100 today. These agencies cannot take another 9% cut, as the governor is about to propose.

Comment by lincolnlover Friday, Feb 3, 12 @ 12:22 pm
The cuts DNR and HPA have taken in the last 2 years make Brady’s proposal of 10% across the board look good.

PQ was supposed to be good for natural resources and was supposed to be close to Miller.
He promised he would not close parks. I guess he means to just make DNR fade away. DNR has just continued to be a dumping ground for hacks.

Quinns affinity for everything Chicago is no different than blago’s Even the latest biggest money hole for DNR is there. A plan that was tossed aside years ago has been recently resurrected, dusted off, became the highest priority for DNR planners, had some glitter sprinkled on it and debuted as “The Millenium Reserve”

Meanwhile the rest of the state deteriorates.

Comment by Irish Friday, Feb 3, 12 @ 12:39 pm
Illinois should look to our neighbors to the north for guidance.

One thing Wisconsin got right (long before Gov. Walker) was the creation of a Stewardship Grant program back in 1989 that enables DNR to partner with local nonprofits and local governments to preserve and protect Wisconsin’s natural resources.

Those funds are controlled by a board that includes representatives from all the public stakeholders…from The Nature Conservancy to Trout Unlimited.

Residents and visitors to Wisconsin don’t mind paying extra fees for trail permits or camping permits because they know that money is going to be spent wisely to prevent much bigger and more expensive problems down the road, and ensure that 20 years from now they can take their own kids hiking, fishing, camping and biking to the same places they enjoyed as kids.

I think its also worth pointing out that Wisconsin ensures public input and transparency into how their natural resources are managed through an elected statewide board and a citizens’ Conservation Congress.

Not one or two, but three good ideas for the Governor and lawmakers to consider.

Sometimes, its not just about the money…its also about reassuring the public their money will be well-spent on the things they consider most important.

Comment by Yellow Dog Democrat Friday, Feb 3, 12 @ 1:02 pm
@YDD I’ve long campaigned for DNR to institute vehicular user fees at the larger parks (Starved Rock, Giant City, Pere Marquette) of a few bucks a day per car in order to raise additional (not replacement) funds. Your point of “would the citizens of Illinois actually trust those funds go to DNR” is a valid one and a similar system would probably have to be set up here in the state. You can’t police entry into smaller parks because the system would outspend the dollars you’d bring in, but requiring a sticker at the larger parks and patrolling the lots a few times a day to enforce could possibly be a minor expense.

Several decades ago, some of the funds from the real estate transfer tax were allocated specifically for the acquisition and restoration of natural areas in the state. Part of the giant Republican proposal last year would have moved those back to the general fund, which would gut our nature preserves system (which currently has a few open positions but a five-year hiring freeze) even worse than it has been. It’s true that everyone has to sacrifice, but DNR already has.

Comment by Peter Friday, Feb 3, 12 @ 1:12 pm
Can someone explain why we don’t have requirements for income and residency for Medicaid applicants in Illinois?

Comment by Because I say so... Friday, Feb 3, 12 @ 1:15 pm
It is ridiculous to rationalize the expansion of Medicaid in Illinois by comparing it to the New Jersey waiver. New Jersey is aggressively moving in a different fiscal direction while Illinois doubles down on failure.

To add one beneficiary to the fundamentally flawed Illinois Medicaid system is ridiculous. Just because you can pawn the cost off on some other budgetary line item doesn’t make it anything other than bad policy.

The Quinn administration and GA Dems claimed they were reforming Medicaid last year and then failed to lift a finger to get the required federal waiver. The feds said NO and much of the needed reform went out the window.

Medicaid reform is just as important as pension reform and it can’t be done painlessly. Blago irresponsibly inflated eligibility and benefits as part of his sideshow and we are stuck with the bill. Another bill we cannot pay.

Comment by Adam Smith Friday, Feb 3, 12 @ 1:44 pm
I’m going to look at this from a nationwide perspective. Let’s say Mitt Romney wins the Presidency and the Republicans win back the Senate and keep the House. Hmmm. The ACA could soon be pulled apart like a Thanksgiving turkey and major components like the state exchanges and required Medicaid expansion could be gutted out of the ACA. Granted, it would not be a guarantee that Speaker Boehner and (more likely) Mitch McConnell could muscle such legislation through. However, Speaker Boehner and the Congressional GOP have already voted at least twice to repeal the entire ACA. The folly of states expanding Medicaid lies in the possibility that such an initiative may be stripped out of the very legislation that guarantees payments and incentives for expansion.

Comment by Team Sleep Friday, Feb 3, 12 @ 1:51 pm
The New Jersey argument is really a red herring. The NJ waiver sought to take individuals already covered through the NJ Works program and get a waiver so that they could get federal match. The Cook County waiver seeks to add new individuals to the rolls that are not currently eligible.

If you read the fine print you get to the real reason why Cook County wants the waiver so bad and they want it now. If they get the waiver and an individual accepts coverage, then when the ACA provisions become effective in 2014, the patient is still locked into the Cook County health system. Cook County is just afraid that once 2014 gets here and these individuals become eligible under ACA, they will scurry away from the Cook County Health System and flock to the other hospitals in Cook County. Why not focus more on making your hospital an attractive place to receive care instead of trying to create a competitive advantage through a government monopoly?

Comment by More Courage Friday, Feb 3, 12 @ 2:11 pm
>

Correct, and the recent state fiscal projections from the Civic Federation, which show real disaster in the next five years, are primarily driven by [un-reformed] Medicaid growth. Their analysis has some issues, and some of their recommendations are unworkable IMHO, but their general statement of the challenge is real.

This specific waiver for Cook Co could be OK, if we assume most of the national healthcare reforms remain intact. If not, we’re all in deep trouble. The old system clearly was not working.

Comment by mark walker Friday, Feb 3, 12 @ 2:49 pm
I dont see why would should not have income verification requirements for Medicaid, seeing as the Feds have it for a host programs including things like SSI.
I dont see a problem with placing a reasonable level of fees on using the state’s natural resources at least with some of the large parks that clearly draw a large number users per year. It helps to reflect that those users get more use and value out of the parks than the average tax payers does. It also collects some fees from out state users that receive benefits from the parks. The devil is making sure that the funds raised go to the DNR and are not appropriated for other uses. For that matter working to increasing private donations to said parks and resources.

Comment by RMWStanford Friday, Feb 3, 12 @ 2:49 pm
===To add one beneficiary to the fundamentally flawed Illinois Medicaid system is ridiculous.===

Unless you happen to be that one beneficiary Adam. I hope you never find yourself sick without insurance because the benefits you would deny others might come in handy one day for you or someone you love. There but for the grace of God and whatnot.

Comment by 47th Ward Friday, Feb 3, 12 @ 2:53 pm
I think the underlying point here is that Cook County taxpayers are already paying for the healthcare of these 100,000 people thru Cook County Health Systems, and this proposal simply gets a federal match for taxpayer dollars already being spent. Am I wrong?

Comment by steve schnorf Friday, Feb 3, 12 @ 3:34 pm
AS, just how is our current Medicaid program here in Illinois flawed? It’s certainly not because our spending per recipient is high; it is quite low. And it doesn’t seem it is because the rates we pay providers are too high; in comparison with other states they seem to be generally on the low end. So just what are you talking about, specifically? Maybe we might agree if I knew.

Comment by steve schnorf Friday, Feb 3, 12 @ 4:00 pm
AS, just a warning, this is a Schnorf specialty. You can’t win the argument. Defer and move on.

Comment by Rich Miller Friday, Feb 3, 12 @ 4:01 pm
The primary flaw many really conservative types see is that we shouldn’t have any health care program that we spend so much money on for poor people, especially since they mostly vote D.

Reasonable types, such as Rep Bellock and Sen Righter, see flaws such as under utilization of managed care, services being provided to illegals, insufficient verification of eligibility, virtually no re-verification of eligibility, income eligibility thresholds that are sometimes high, etc.

Comment by steve schnorf Friday, Feb 3, 12 @ 4:12 pm
The entire Medicaid issue has become its own death spiral. Put more and more people on the roles and then be shocked that the costs have gone so high that the only solution is to cut rates. Rates get cut then providers stop seeing people because they cannot cover their own costs. Next step, hold back payments because you don’t have the money to pay the bills. Then be surprised when provider complain. Next step, put more people on Medicaid who do not have insurance or simply increase eligibility. Then when the costs of Medicaid climb again, develop managed care to further control ever increasing Medicaid costs. Acted frustrated, then add more people to the roles and repeated as often as possible.

Comment by zatoichi Friday, Feb 3, 12 @ 4:42 pm
“… since they’re eligibility is based on the new law.”

they are eligibility vs their eligibility

I suppose it’s all the same when you’re hooked on phonics.

Comment by Michelle Flaherty Saturday, Feb 4, 12 @ 11:51 am