Today, I head west to Utica to meet with Life Span Acting Director Deb Fornoff to discuss system
gaps, PUNS recommendations and flexible day services. It should be a good day.

I had an excellent meeting Thursday with the CEO of IlliniCare, Jeff Joy.

Jeff comes to us from Johns Hopkins in Maryland where he reconstructed their Medicaid programs.
He hasbeen here for the past seven months. I wanted to talk to Jeff about the roll out of managed care
Phases One and Two. Lastly, I wanted to express my concerns about Phase Three. I had sent Jeff our
position paper opposing managed care the day before the meeting so he would know our concerns.

Jeff understands our concerns about the quick rollout of Phase One, the lack of stakeholder involvement
on Phase Two, the fast rollout and the distrust people now have putting Home Services under managed
care. I also expressed our concern about the dismantling of the specialized case management system
for people in the Traumatic Brain Injury Waiver. We discussed the Independent Service Coordination System
in Developmental Disabilities and much more.

Jeff stated a large part of his work has been around coalition building and working together to provide
the services/supports individuals need from IlliniCare. He indicated that Phase Three was really not on
anyone’s radar screen because of the implementation of Obama Care, the Medicaid expansion, Dual Eligible
Waiver and the implementation of Phase Two. Everyone working on health care in Illinois, including the
people at Health Care & Family Services, have a full plate to say the least.

Jeff wants to work with The Arc and other advocates to improve care and services at all levels. He is
an advocate for coordinated care. He said systems change is best done by keeping communication open
and to continue to talk about the difficult issues our system faces including low community rates, waiting lists
for services, self directed services and closing state institutions.

I look forward to working with Jeff and his team. I will be meeting with Illinois Aetna CEO Sanjoy Musunuri
later next month.

Both IlliniCare and Aetna will be featured speakers at our Executive Forum later this year.

Memo from HFS on the Affordable Care Act follows.


How the Health Care Law is Making a Difference for the People of Illinois

Because of the Affordable Care Act, the 87% of Illinoisans who have insurance have more choices and stronger coverage than ever before. And for the 13% of Illinoisans who don’t have insurance, or Illinois families and small businesses who buy their coverage but aren’t happy with it, a new day is just around the corner.
Soon, the new online Health Insurance Marketplace will provide families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets.
Open enrollment in the Marketplace starts Oct 1, with coverage starting as soon as Jan 1, 2014.  But Illinois families and small business can visit HealthCare.govright now to find the information they need prepare for open enrollment.
The health care law is already providing better options, better value, better health and a stronger Medicare program to the people of Illinois by:

Better Options

The Health Insurance Marketplace
Beginning Oct 1, the Health Insurance Marketplace will make it easy for Illinoisans to compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.
By the Numbers: Uninsured Illinoisans who are eligible for coverage through the Marketplace. 

  • 1,403,608 (13%) are uninsured and eligible
  • 954,776 (68%) have a full-time worker in the family
  • 592,751 (42%) are 18-35 years old
  • 662,015 (47%) are White
  • 339,143 (24%) are African American
  • 316,054 (23%) are Latino/Hispanic
  • 63,120 (4%) are Asian American or Pacific Islander
  • 800,255 (57%) are male

1,291,135 (92%) of Illinois’s uninsured and eligible population may qualify for lower costs on coverage in the Marketplace, including through Medicaid.
Illinois has received $38,989,615 in grants for research, planning, information technology development, and implementation of its Health Insurance Marketplace.
New coverage options for young adults
Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 125,000 young adults in Illinois.
Ending discrimination for pre-existing conditions
As many as 5,635,622 non-elderly Illinoisans have some type of pre-existing health condition, including 752,785 children.  Today, insurers can no longer deny coverage to children because of a pre-existing condition, like asthma or diabetes, under the health care law. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition.  The health care law also established a temporary health insurance program for individuals who were denied health insurance coverage because of a pre-existing condition.  3,279 Illinoisans with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan since the program began.

Better Value

Providing better value for your premium dollar through the 80/20 Rule
Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, or provide you a refund.  This means that 178,581 Illinois residents with private insurance coverage will benefit from $6,135,984 in refunds from insurance companies this year, for an average refund of $52 per family covered by a policy.
Scrutinizing unreasonable premium increases
In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. the new law to help fight unreasonable premium increases. Since implementing the law, the fraction of requests for insurance premium increases of 10 percent or more has dropped dramatically, from 75 percent to 14 percent nationally.  To date, the rate review program has helped save Americans an estimated $1 billion.
Removing lifetime limits on health benefits
The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 4,670,000 people in Illinois, including 1,743,000 women and 1,192,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.

Better Health

Covering preventive services with no deductible or co-pay
The health care law requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services, such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults.
In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 3,047,000 in Illinois. And for policies renewing on or after August 1, 2012, women can now get coverage without cost-sharing of even more preventive services they need.  Approximately 47 million women, including 2,048,961 in Illinois will now have guaranteed access to additional preventive services without cost-sharing.
Increasing support for community health centers
The health care law increases the funding available to community health centers nationwide. In Illinois, 42 health centers operate 548 sites, providing preventive and primary health care services to 1,098,483 people.  Health Center grantees in Illinois have received $160,162,882 under the health care law to support ongoing health center operations and to establish new health center sites, expand services, and/or support major capital improvement projects.
Community Health Centers in all 50 states have also received a total of $150 million in federal grants to help enroll uninsured Americans in the Health Insurance Marketplace, including $6,161,944 awarded to Illinois health centers.  With these funds, Illinois health centers expect to hire 132 additional workers, who will assist 195,745 Illinoisans with enrollment into affordable health insurance coverage.
Investing in the primary care workforce
As a result of historic investments through the health care law and the Recovery Act, the numbers of clinicians in the National Health Service Corps are at all-time highs with nearly 10,000 Corps clinicians providing care to more than 10.4 million people who live in rural, urban, and frontier communities.  The National Health Service Corps repays educational loans and provides scholarships to primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who practice in areas of the country that have too few health care professionals to serve the people who live there.  As of September 30, 2012, there were 495 Corps clinicians providing primary care services in Illinois, compared to 168 in 2008.
Preventing illness and promoting health
As of March 2012, Illinois had received $31,000,000 in grants from the Prevention and Public Health Fund created by the health care law. This new fund was created to support effective policies in Illinois, its communities, and nationwide so that all Americans can lead longer, more productive lives.

A Stronger Medicare Program

Making prescription drugs affordable for seniors
In Illinois, people with Medicare saved nearly $272 million on prescription drugs because of the Affordable Care Act.  In 2012 alone, 133,889 individuals in Illinois saved over $96 million, or an average of $716 per beneficiary.  In 2012, people with Medicare in the “donut hole” received a 50 percent discount on covered brand name drugs and 14 percent discount on generic drugs.  And thanks to the health care law, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed.  Nationally, over 6.6 million people with Medicare have saved over $7 billion on drugs since the law’s enactment.
Covering preventive services with no deductible or co-pay
With no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early. In 2012 alone, an estimated 34.1 million people benefited from Medicare’s coverage of preventive services with no cost-sharing.  In Illinois, 1,271,704 individuals with traditional Medicare used one or more free preventive service in 2012.
Protecting Medicare’s solvency
The health care law extends the life of the Medicare Trust Fund by ten years.  From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, substantially more slowly than the per capita rate of growth in the economy.  And the health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Over the last four years, the administration’s fraud enforcement efforts have recovered $14.9 billion from fraudsters.  For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has returned $7.90.

Last updated: Aug. 1, 2013

Tony Paulauski
Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)