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Illinois’ All Kids Program

Illinois’ All Kids Program. Illinois Department of Healthcare and Family Services Stephen E. Saunders, MD, MPH Child Health Services Research Meeting June 24, 2006. About All Kids.

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Illinois’ All Kids Program

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  1. Illinois’ All Kids Program Illinois Department of Healthcare and Family Services Stephen E. Saunders, MD, MPH Child Health Services Research Meeting June 24, 2006

  2. About All Kids • First and only state program in the nation to make sure that every child in Illinois has access to comprehensive and affordable healthcare • Allows most of the 253,000 uninsured children in Illinois who need health coverage to get it • Helps children get to the doctor before they get sick and before a simple problem becomes a major illness • Provides health insurance and prescription coverage at affordable rates • Begins July 2006

  3. Qualifications for All Kids • 18 and under • Illinois residents • No citizenship requirements • No income limit • Monthly premiums and co-payments based on a sliding scale, based on income

  4. Current Illinois Medicaid Program • Combined Medicaid and SCHIP Program • Income threshold 200% of poverty • Family Care 185% of poverty • Primarily Fee for Service • Voluntary managed care in six counties • Over 2 million beneficiaries currently enrolled • One year continuous eligibility

  5. Program Structure • An extension of current Medicaid and SCHIP program; Medicaid and SCHIP - now ALL KIDS • Same Medicaid benefit package (minus non emergency transportation or waiver services) • No income limit or asset test, no deductibles • Co-pays, premiums and out-of-pocket limits sliding scale • 12-months continuous eligibility • No pre existing condition limitations • Includes dental • Provider reimbursement - same as Medicaid

  6. Eligibility Process • One application for entire program • Application process: • Mail-in • Web • Community-based Application Agent • At Department of Human Services local office, located in each county • Outreach and PR campaign • One eligibility card for entire program

  7. Crowd Out Provisions • Must be uninsured since January 1, 2006, or 12 months after December 31, 2006 • Exceptions: • Parent looses employer sponsored health insurance • Newborn • Exhausted life time benefit • Child covered by COBRA

  8. Crowd Out Provisions (continued) • Exceptions (continued) • Child was covered by Title XIX or Title XXI and family income changes • Custodial parent cannot access non-custodial parent’s insurance • Affordable health insurance definition applies at redetermination

  9. Premium/Co-Pay • 200 – 300% poverty • Premium $40/child/month; $80/month - max • Co-pay • $10 office visit • $7/$3 pharmacy • $30 ER • $100 hospitalization • 5% rate for outpatient hospital • Yearly maximum - $500 • No co-pay for preventive health care, e.g., well child visits and immunizations

  10. All Kids Monthly Premium

  11. Financing • Governor’s key initiative passed General Assembly November 2005 • GRF funded – no waivers • Cost Savings through implementation of the: • PCCM Program – FY 07 for most Medicaid/SCHIP beneficiaries • Disease Management Program -July 1, 2006 • Disabled Adults • Family Health Population with Persistent Asthma • Family Health Population – Frequent Emergency Room users Implementing PCCM program mid FY’07 • Anticipated cost saving secondary to reduction unnecessary ER and Hospitalzation

  12. Provider Buy-In • Input into the planning process with monthly Stakeholders’ meetings • 30-day payment cycle for physician services, starting July 1, 2006 • Pediatrics rate increases for selected preventive visit and E & M codes - January 1, 2006 • Support by ICAAP and IAFP

  13. Provider Payment • Providers will be responsible for collecting co-payments under All Kids (similar to private insurance) • Providers may elect not to charge co-pays • Providers are not required to deliver services when co-pays are not paid • Provider will be reimbursed under established rates minus cost sharing co-payments

  14. Reimbursement Rates:Select Examples • CPT 99214 - E & M office visit, established patient ($72.97) • CPT 99381 – Preventive office visit, initial evaluation, healthy infant ($91.90) • CPT 99384 – Preventive office visit, initial evaluation, adolescent ($104.96)

  15. Conclusion • Healthcare reform is possible with political will and buy-in • Medicaid package of services comprehensive and is a model benefit package • Medicaid structure provides an efficient platform to build upon – has an established payment, claims processing system and provider enrollment processes

  16. Conclusion (continued) • Packaging the program to look like health insurance should further eliminate “stigma” of welfare • Sliding fee scale allows higher income families who lack insurance for their children to purchase affordable health care with the benefit of a large risk pool • Outreach and simplified enrollment is key

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