“The truth is, nobody knows for sure how many people will lose Medicaid benefits,” says Sergio Obregon, special assistant to the director of the Illinois Department of Healthcare & Family Services, which administers the federal health insurance program designed for low-income residents and people with disabilities. “But we are definitely taking steps to minimize the loss of coverage for individuals as much as possible.”
With the onset of the COVID-19 pandemic in 2020, the federal government issued billions of extra dollars to Medicaid programs across the country to ensure Americans had insurance during the worst public health emergency in memory. In exchange, state Medicaid programs were required to pause redetermination processes that routinely drop individuals from Medicaid if they no longer qualify.
As a result, Illinois Medicaid now covers around 3.9 million people, up from 2.9 million before the pandemic, HFS says. As of 2021, Illinois’ uninsured rate sat at 7%, according to the United Health Foundation. That’s down from 7.4% in 2019 but still higher than a low of 6.5% in 2016.
While the federal and Illinois state pandemic emergency declaration expires May 11, the Medicaid continuous enrollment provision is set to end earlier—on March 31—thanks to an end-of-year spending bill signed in December.
The Medicaid coverage cliff in Illinois reflects a nationwide phenomenon. About 15 million individuals nationwide are expected to lose Medicaid once the provision ends, according to federal estimates.
The Medicaid changes could have far-reaching consequences for patients and providers. Without health insurance, patients could lose access to care or face large medical bills. And hospitals and other health care providers, particularly safety nets and federally qualified health centers, could be forced to eat costs as they treat more uninsured patients.
The challenge for HFS is to not let anybody fall through the cracks and become completely uninsured. To keep as many people enrolled in Medicaid as possible, the agency says it is asking beneficiaries to submit necessary income, address and other information on time that proves they are still eligible. Eligibility for Medicaid in Illinois varies by household size and composition. For example, single adults must earn below $18,000 per year and a household of four adults must earn less than about $38,000. HFS will begin mailing renewal forms to Medicaid recipients at the end of April, and the first coverage terminations will come July 1.
If individuals no longer qualify for Medicaid, the goal is to match them with their employer-sponsored health insurance plans or those offered on the Affordable Care Act marketplace.
“There are absolutely members currently enrolled in the Medicaid program that are not eligible, and those members should be disenrolled from the Medicaid program” says Samantha Olds Frey, CEO of the Illinois Association of Medicaid Health Plans, an industry group that represents insurers that issue the public program. “The ideal scenario is a warm handoff to the marketplace, so they can enroll in private health insurance if they don’t have other health insurance, and ensure that health care coverage is not lost.”
The Medicaid disruption comes amid a record number of ACA Marketplace enrollments in Illinois. Nearly 343,000 plans were selected this year, up 6% from last year, according to the Illinois Department of Insurance. The average monthly premium for an ACA plan ranges from $350 for a Bronze plan to $484 for a Gold plan, according to the U.S. Centers for Medicare & Medicaid Services. But new tax credits could get the price down to as little as $10 per month for qualifying Americans.
“Losing Medicaid coverage does not mean Illinois residents have to go uninsured,” says Obregon at the state Healthcare & Family Services Department. “We are committed to ensuring that everyone who is eligible for Medicaid coverage maintains their coverage, and that those who are not eligible are given the necessary information regarding the alternative health insurance options that do exist.”
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February 3, 2023 at 07:07AM