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Gov. Pritzker signs Medicaid expansion, increased transparency in Illinois

(Source: KFVS)
(Source: KFVS)(Source: KFVS)
Published: Aug. 5, 2019 at 4:02 PM CDT
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CHICAGO, Ill. (KFVS) - Illinois Gov. JB Pritzker signs Medicaid expansion, elimination of application backlogs and increased transparency in the state of Illinois on Monday, Aug. 5.

“In the past few years, Illinois has seen too many people who qualify for health care coverage needlessly knocked off the system and unable to get medical care,” said Gov. Pritzker. “Health care is a right for all, not a privilege. Today we are making sure taxpayers are getting more of what they’re paying for, and we are advancing health care for vulnerable people who need it most.”

The bicameral, bipartisan bill enables key state agencies, including Department of Aging, Department of Healthcare and Family Service, Department of Human Services and Department of Innovation and Technology, to lead efforts in Illinois to expand access to health care for low-income Illinoisans. Since Pritzker has taken office there has been a twenty percent reduction in Medicaid application backlogs.

One of the new measures taking effect will be an increase in transparency and accountability with claims provided to Managed Care Organizations (MCOs). This will allow the department to collect and analyze data and batter adjudicate claims. The Department of Healthcare and Family Services will act as the arbiter in disagreements between providers and MCOs.

MCOs will be required to make timely payments within 30 days and make expedited payments to health care providers servicing large Medicaid populations, including long-term care facilities.

MCOs will report their Medical Loss Ratio (MLR), which includes premium revenue, benefits expense, direct-paid claims and other details on payments and recoveries. They must also continually update their roster of providers within 30 days.

There is also a mandate of full reviews of the Medicaid redetermination process to identify changes that will allow more patients to be renewed automatically and ensure patients are maintaining the highest continuum of care possible.

Department of Healthcare and Family Services will develop and seek federal approval for determination and redeterminations utilizing accessible data from eligibility for other public programs, including an ACA Medicaid eligibility streamlining policy, altering the reasonable compatibility standard from five percent to ten percent.

Income eligibility for Medicaid will now only require one pay stub. Copays will be relaxed so HFS is not required to charge the maximum copay under current federal standards.

“This will make it easier for seniors, families and people with disabilities to get the healthcare they need,” said House Majority Leader Greg Harris (D-Chicago). “It holds insurance companies accountable, reduces bureaucracy and helps rebuild the financial stability of hospitals, doctors, nursing homes and other providers after the budget impasse.”

“Several years of work are behind this sweeping reform bill, but it took the leadership that the Governor brought in to DHS and HFS to finally pass this bipartisan, groundbreaking Medicaid reform measure,” said Sen. Dave Syverson (R-Rockford). “As a result of these reforms Illinois will be able to deliver healthcare more seamlessly, leading to better health outcomes.”

The fiscal year 2020 state budget includes an $80 million increase in funding for mental health and addiction treatment, an 18 percent increase in addiction treatment and prevention funding and a 13 percent increase in funding for mental health services.

Illinois’ Medicaid managed care began in 2011 and has expanded to all 102 counties in the state. About 2.1 million of Illinois’ 2.9 million Medicaid members are now in managed care.

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