Illinois Lawmakers | S38 E05: Medicaid Funding Proposals Advance | Season 38 | Episode 5

(dramatic music) – Welcome to another weekly edition of “Illinois Lawmakers” coverage of the Illinois General Assembly here on public radio and television.

I’m Jak Tichenor, along with Amanda Vinicky of Channel 11 “Chicago Tonight.”

Good to have you back on the program.

– I love being with you all the time, Jack.

– The biggest news outta Springfield this week came from the Dirksen Federal Building in downtown Chicago where a jury there handed down convictions to the Commonwealth Edison Four for conspiracy, bribery and falsifying records to try to buy influence with former House Speaker, Mike Madigan.

I think it’s fair to say it’s sent shock waves through the State House.

– You know, I think there have been multiple shock waves and this is in a sense sort of almost the largest because Madigan was already on his downfall when this all sort of began.

He had been seen as untouchable and lo and behold he wasn’t, but the vestiges of the Madigan era still remain in the Capitol very much today, be it with how the House staff is set up and just how the House is run to many of the power players.

And I’m not talking about the joke there about ComEd, I’m talking about the lobbyists those who have contracts, those who can often get meetings, and truly do wield influence with legislators.

And in part that is because they know the system.

They came up under the most powerful politician in the state, but also because of Madigan’s connections.

So I think it certainly sends reverberations through the Capitol there because of just who these people are, and also because of what it does say about the culture of Springfield.

The jurors clearly indicted really not just these four individuals, but the system writ large.

I haven’t been in Springfield yet.

Plan to be there for the final week of session, but one would assume that it has people sort of double-checking, being a little more careful, and is trying to establish distance.

And so, again, we’ve had the shock waves of the the mighty Madigan getting ousted virtually as speaker, being indicted.

And yet what the verdict does, and the fact that it was guilty on all counts for all four individuals is I think certainly significant in terms of the future as well.

What it bears for Madigan and what it bears for what happens in the State House and how.

– And the federal prosecutors in that case made it clear if you’re thinking about crossing the line you better have a good lawyer because otherwise you’re gonna be on our radar screens.

– Yeah, they said, “They’ll be keeping watch.

They are going to be careful.”

I will say in an interesting aside, however, from that warning is that you did have various individuals that we know have been interviewed by the feds that were mentioned throughout the court hearings, they were never brought in.

That you have, again, some prominent folks who even testified during the court trial, and still have pretty healthy books as contract lobbyists.

So I think it both sends that message that the feds wanted to be clear about it, but there are certainly individuals who are probably breathing better right now with this trial being over with and knowing that they sort of got off without any of the accusations that faced some of their peers.

Not alleging any sort of illegal conduct there by any means.

– No.

– Of course, but just again, since this was I think the fact that the charges, the fact that the final verdict was so sweeping from the jury what it protects.

– We’ve got about a minute left.

The former speaker, of course, is facing trial about a year from now.

He maintains his innocence, but this is clearly an ominous sign.

– It’s gotta be very uncomfortable for former Speaker Madigan.

Again, just thinking about how drastic the position that he’s in now is from the perch that he was once at.

You think about that as well with one of the four defendants, particularly Anne Pramaggiore.

All of them, really, who were significant players at the tops of their game and now certainly face some sort of prison time.

I did speak with somebody who’d been involved with the prosecution of former Governor, George Ryan, that’s Patrick Collins, and he said, you know, I asked him what about flipping?

At this point now that you have, sure, Mike McClain being quite loyal to Madigan for all this time, but now that prison is really in the picture might he change his tune?

Collins was skeptical of that and said that you know, Madigan, he’s been loyal to Madigan, number one, and he sees that being difficult for him to change.

Somebody like Pramaggiore already took the stand so she can’t really change her tune at this point.

– Amanda Vinicky, thank you so much for your insights into this very important case.

– So important.

Thank you for having me.

– Health and human service issues are high on the agenda this session in Springfield.

Talking more about that is Democratic Senator, Ann Gillespie of Arlington Heights.

She’s the chair of the Senate Health and Human Services Appropriations Committee in the Senate.

Good to have you back on the program.

– Thanks so much for having me.

– Well, we’re here to talk mainly about Medicaid, which is a huge driver of the state’s budget.

There’s roughly three million people enrolled in that for out of the 13 million Illinoians.

One of the key initiatives this spring is Senate Bill 1763 that you’re co-sponsoring with Rockford Republican, Dave Syverson, and that would increase rates for Medicaid reimbursement to hospitals, and healthcare providers around the state.

Is that pretty much the broad outline of that bill?

– Yes, it does.

It does a general across the board rate increase.

We haven’t done one of those for hospitals in a couple of decades at this point.

We’ve done increases on specific line items, but none across the board, so it includes that.

It also includes some floor rates for psych beds, that’s one of the crises we have in the state is having adequate hospital beds for behavioral health issues.

And so it increases the rates for those.

And it looks to provide a regular inflation factor type of increase so that we don’t have to keep coming back to the table.

– Those rates haven’t been adjusted, at least the main Medicaid rates, haven’t been adjusted since 1998, is that right?

– That’s true for the base across the board rate.

There have been increases that have been provided.

So it’s not like hospitals have not received an increased funding during that time, but not an across the board rate increase.

– And we’ve been hearing from a number of hospitals through their advocacy group, the Health and Hospital Association, that some of them are in very dire consequences right now because of inflation driving up the cost of everything you can imagine from basics like drugs, hospital equipment and staff for salary.

How are things going in your senate district?

What are you hearing from your local hospitals?

– We’re hearing similar issues.

The good news is we’ve seen, you know, a lot of nurses were leaving hospital work because of the pressures of the pandemic and just general burnout.

We are seeing those numbers start to turn, people are coming back.

Nurses are coming back into the hospital systems, and we are seeing a reduction, therefore, and the need for using temporary agency nurses, and we’re seeing some of those rates come down.

They were very high during the pandemic, 200% plus increases.

So seeing some of that come down will be helpful going forward, but there’s still some catch up and recovery work going on.

– It’s my understanding looking at the fiscal note on this that the overall cost is around $800 million for this 20% across the board increase.

The actual impact would be somewhere around $200 million because of the amount of money that the federal government also would send back under this equation.

Is that correct?

– The federal government we generally get about 50% of what the overall total spend is.

– How does this compare to what Governor Pritzker’s budget outline that was delivered back in February, how does it compare to what he was asking for Medicaid and other programs?

– This would be on top of what’s in the budget.

So this would be in addition to what’s in the proposed budget.

– How does the new revenue situation or projections from the Commission on Government Forecasting and Accountability that came out earlier this week they’re moving we expected sort of a downturn.

They’re saying there’s a sharp downturn, excuse me, in income tax revenues, particularly on the personal income tax side.

And they’re looking at their estimates going down for this current fiscal year by something like almost three-quarters of a billion dollars.

Can we still afford to do what Senate Bill 1763 hopes to do?

– Well, I think we’re gonna have to do some juggling, some shifting of what we’re gonna cover and what we aren’t.

So in the budget process right now we’re getting all of the requests in, all of the dollar amounts, and then we have to weigh what we’re gonna prioritize or not.

I don’t expect that every bill that’s on the agenda right now is gonna get the full amount, but, hopefully, we’ll be able to accommodate as much as we can to make sure that providers continue to support our Medicaid program.

– There’s another pressure on next year’s fiscal year budget.

The Illinois Department of Healthcare and Family Services is projecting the state will need to pay another, I think it’s $768 million in health benefits for immigrant adults who are in the state, provides healthcare to undocumented immigrants.

Is that something that the state is going to be able to afford?

I understand that the full cost is somewhere upwards of a billion dollars?

– We’re still running numbers on that.

It was a combination of projecting the number of people that were going to sign up for the program and then also the healthcare cost came in higher than was anticipated.

The good news is the program is doing what it was designed to do.

It’s getting people healthcare and meeting a lot of unmet healthcare needs in this community that otherwise would’ve shown up as charity care at hospitals and physician offices.

What we should see over time is as these chronic conditions are met that people are getting the healthcare they need it will start to stabilize.

Well, we have a couple of years that we need to get through before that stabilization factor will hit in.

– Republicans in Springfield were saying we need to put this whole thing on pause and take care of the rest of the citizens in the state of Illinois.

– Without question, we need to be making sure that everybody has access to healthcare.

I for one believe healthcare is a right, and do think that we need to be covering everybody.

What we need to do is look at how we can stabilize the program.

HFS is working with us, Healthcare and Family Services is working with us on things we can do to be more efficient in the management of the program.

We’re talking to our managed care partners to see how they can help us.

Talking to Cook County Health, seeing how they can help us.

And so a lot of those conversations are going on.

So we wanna work towards making sure that as much of the healthcare need is being met, but doing it in the most cost-efficient manner for the taxpayers.

– There’s another area of concern for a lot of people in the state and that has to do with providing a wide range of services for persons with developmental disabilities in the state of Illinois.

There’s a new study out on that that is calling for adopting a standard for DSP wages that establishes wage assumptions at 150% of the statewide minimum wage.

Can you tell us a little bit more about that study?

– Yes, that’s the Guidehouse Study.

It looked at achieving equity across developmental disability funding to make sure that those children, adults, that everybody was getting made.

They are one of our most vulnerable populations, and we need to make sure that their needs are getting met.

We have been steadily increasing, moving towards the final level in the Guidehouse Study, the one you just cited.

We’re in the final stages of getting there.

We may not be able to get there on one year for the budgetary pressures that you’ve already identified, but we will keep moving forward to make sure that we can hit that ultimate target.

– There’s another aspect of this and it’s kind of a differential for wages between the Chicagoland area where the cost of living is higher than let’s say for the rest of downstate.

How would that work?

– Well, that’s something that we’re working on with the various providers to determine how much of a variation that is actually needed.

What we have found surprisingly is that the cost of living in Chicago and some communities downstate is not as disparate as you would think.

And so it’s really dependent.

We need to look at the numbers.

We need to let the numbers drive us.

– There’s another aspect of it, raising the fringe percentage to almost 30% of wages across the services including staff types and the like.

How would that work?

– That’s part of the equalization factor.

There’s a crisis in staffing across all lines of developmental disability, and so we wanna make sure we’re not putting money into one and creating a new situation for another line.

So it’s trying to come at it equitably across all the different services.

– Senator Gillespie, thank you so much for your time on “Illinois Lawmakers.”

It’s always a pleasure.

– Thank you.

– Joining us now on “Illinois Lawmakers” Rockford Republican Senator, Dave Syverson.

Senator Syverson is the Republican spokesperson on the Senate Health and Human Services Appropriations Committee.

Good to have you back on the program, Senator.

– Great to be here.

– Lots to talk about in terms of the Medicaid program in the state of Illinois, the state’s health insurance program for low income individuals, roughly three million of the state’s 13 million residents use Medicaid.

One of the key initiatives up before lawmakers this spring is a bill that you’re co-authoring with Senator Ann Gillespie a Democrat of Arlington Heights, Senate Bill 1763.

What’s at the crux of that bill, Senator?

– Well, the crux of the bill is our hospital systems in Illinois are really struggling.

They have all lost significant amounts of dollars the last couple years in real dollars, not some of the government talk about losing money, but they have literally lost.

As hospitals their costs have gone up dramatically whether it’s labor costs, food costs, supply costs, pharmaceutical costs, their costs have gone up dramatically.

Yet unlike restaurants or gas stations, or others who can raise their prices, hospitals don’t have that ability to do that.

Medicare has been flat, actually, a slight decrease January 1.

So Medicare rates haven’t gone up.

Medicaid rates have not gone up for years, and private insurance, even though that’s becoming less and less because of the tough negotiations going on with contracts, those rates haven’t gone up.

So hospitals are not getting any increases in revenue yet their costs have gone up dramatically.

So if we don’t do something it’s only gonna lead to one of two choices.

It’s gonna be hospitals closing, or you’re gonna start seeing like you’re seeing now delays in services where people have to wait longer to get care.

– The rate really hasn’t gone up in I think 28 years according to the Illinois Health and Hospital Association.

What’s the impact been on Rockford area hospitals?

– Dramatically.

All three health systems in the region have all losses in the tens of millions of dollars.

And so it is significant and it’s causing, again, services to be eliminated and delays.

And so this proposal is probably long overdue, and probably should have had an escalator built in there as opposed to 20 years without an increase, but it’s a tough time in the budget to do this, but failing to do that is going to lead to some really disastrous healthcare outcomes.

And so this is a measure to increase the Medicaid rates and a good portion of this money will end up coming from the feds, so that’s the good news, but there is a cost to that, but we just have to weigh what other priorities.

And right now keeping our health systems functioning is gotta be a top priority.

– So the key component of this is a 20% across the board increase in Medicaid rates for hospitals and health providers?

– Yes, yes, uh-hmm.

And that’s, you know, about, I think about a two, $300 million hit to the state’s budget which is not a small number, but in turn it gets us about $600 million of federal money.

And so it is by no means is it gonna fix the problem.

It’s just gonna slow some of the bleeding down, and allow hospitals that are especially doing a lot of Medicaid, to get a little bit of an increase to help offset their losses.

Ultimately we have to address some of the other formula issues, and how safety nets are funded and some of those things, but right now this increase will help every hospital proportionately across the entire state.

– There’s about a minute left.

I’m gonna ask about another pressure on the state budget making process right now.

And that has to do with the $768 million in health benefits for Immigrant Adults program.

I’ve heard that the actual shortfall is close to a billion dollars.

That’s a big hole to close in this budget even though we have a surplus at the moment.

– That surplus is long gone.

We’ve been trying to get this number for a long time.

And obviously the number is much larger than what we were led to believe, what the department was led to believe.

We’re talking about over 50,000 undocumenteds over the age of 42 now covered under Medicaid, not even in managed care.

These are in the straight fee-for-service highest cost care 100% paid for by the state.

We are one of the only states that covers full medical care for undocumented.

That’s close to a billion dollars this year.

That’s expected to double next year.

It’s going to cripple our state’s budget.

If the feds don’t act to close the border, if Illinois doesn’t act to address this, this will be the thing that collapses our state budget in the next 24 months.

We cannot afford to handle this.

That’s just the healthcare.

Then you have housing, and you’ve got all the other services that are tied in with that, education, daycare.

All (indistinct) is dealing with the undocumented, and it is a significant problem.

Illinois is one of the only states that cover undocumented for healthcare.

California does, but it’s limited to what services they offer.

New York does, but it’s only for those over 65.

We are the state, and if you’re an undocumented with health problems, you’re coming to Illinois and we’re picking up the entire bill that cannot continue.

– One of the things you’ve been focused on is funding for a wide range of services for people living with developmental disabilities in the state of Illinois.

There’s a recent study out on that.

What are some of the key recommendations?

– Well, the biggest problem for the last number of years the developmentally disabled community has really suffered the most.

They’ve gotten the least amount of increases.

These are individuals and families that are in a difficult situation at no fault of their own.

And yet their funding has been continued to be shortchanged.

They’ve gotten small increases.

The services that are available are limited.

Families that are taking care of their own loved ones have limited resources and we need to do more.

And it’s frustrating that at a time when we are now the largest provider I think of undocumented healthcare is we talked about a billion dollar increase in healthcare in services to undocumented.

At the same time we’re doing very little for our own residents that are dealing with the developmentally disabled population.

And this year in the budget there’s an attempt to try to put a few more dollars to help with frontline case workers, to help with (indistinct) to help give services to families, but it’s really unfortunate what’s happened the last five years as they’ve received very, very little help and assistance.

These are truly the most vulnerable people that, again, at no fault of their own are in very, very difficult times.

And yet the state’s not doing really what it should be doing for this population.

– One of the key recommendations of that study was adopting a standard for DSP wages that establishes wage assumptions at 150% of the statewide minimum wage.

Is that doable in this current budget climate?

– Well, it could have been doable if we weren’t expanding a lot of these other programs because the cost wasn’t all that great.

This is a difficult job.

We’re dealing with a very difficult population with severe disabilities.

And so finding workers to work with these individuals, and these are workers that are really doing God’s work.

I mean, this is difficult work, but the workers that are there are really passionate.

They really love on their patients and their clients.

We have to pay them more than what they’re getting paid at Amazon or at McDonald’s so they can afford to keep doing that job.

And so raising their wages was doable, but then, again, when we get hit with this big wave of the billion dollars and growing for the undocumented, all of a sudden that put a squeeze on how much of an increase now it sounds like the other side is gonna be willing to offer for the developmentally disabled.

So once again, it looks like the developmentally disabled are gonna be shortchanged because the state’s choosing other priorities.

– I wanna ask one other question before we go.

You’re not the oldest state senator, but you are the longest serving.

You’ve been there since 1993, 30 years.

I wanna ask about this week’s verdict in Chicago of the ComEd Four.

That sent shock waves through the Springfield political establishment.

How is that do you think possibly changed the culture of deal-making there at the Capitol?

– Well, in some ways, clearly, there needs to be ethics reforms.

We need to make sure that every dollar, every program is above reproach, so voters and taxpayers feel confident that what’s being done is right.

Having said that as well, when you read about some of the things that’s involved that’s just been a standard of the way government’s been run for many, many years.

If we’re gonna go after these they could probably go after a lot of other people that acted in that same way.

– Senator Syverson, thank you so much.

Always good having you on the program.

– My pleasure, thank you, appreciate it.

(dramatic music)


via Illinois Lawmakers | WTVP

May 8, 2023 at 01:29PM

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