Illinois Medicaid

via Google Street

Illinois hospitals will soon receive money to treat millions of people who are covered through Medicaid. The federal government has approved state's latest hospital assessment program, which gives money to hospitals for treating its poorest individuals.

via Illinois Central Management Services

lllinois' 3 million Medicaid users will soon have more access to mental health and substance abuse treatments. Officials in Washington, D.C. ok’d a new state program that sets aside about $2 billion in Medicaid funds for the services.

Greg Harris speaking at a subcommittee meeting
Sam Dunklau / NPR Illinois 91.9 FM

Democrats in Springfield are pushing ahead with a plan hospitals say can’t come soon enough. It’s worth billions of dollars for treating some of the state’s most vulnerable people. 

Medicaid is one of the largest pieces of the state’s budget, and Democrats say the governor is trying to significantly alter the way the program is managed — without oversight from the legislature.

Gov. Bruce Rauner announced in February a new format by which healthcare companies and organizations bid for contracts to administer Medicaid. Five years ago, Illinois moved to increase the use of outside parties to take care of the paperwork and administration of Medicaid.

Illinois House Chamber
Tom Lisi / NPR Illinois | 91.9 UIS

As women rallied at the Illinois Capitol Tuesday, the House passed a measure that would allow abortion to be covered by Medicaid and state-employee health insurance.


Donald Trump’s presidency has Illinois lawmakers weighing an issue not usually given as much attention in the General Assembly: abortion.


Since the 1970s, Illinois’ abortion laws have stayed mostly the same. Brigid Leahy, legislative director of Planned Parenthood of Illinois, says legal-abortion advocates are now moving to stem the tide they see coming from Washington. “We haven’t done a proactive bill like this in a number of years,” she said.


Alfredo Mejia works with speech language pathologist Brandi Sidor.
Ann & Robert H. Lurie Children’s Hospital of Chicago

Medicaid Managed Care  Is A Mixed Bag For Providers, Patients

Yvonne Hardcastle was at her wit’s end. Her son, Alfredo Mejia, was 7 years old. He was angry all the time and had been diagnosed with behavior problems and ADHD, but that didn’t feel right. She didn’t know what was wrong, but her mother’s intuition kept pushing her to find help for her boy.

An audit issued Tuesday shows Illinois government could not properly account for more than $7 billion paid to private medical insurance companies running parts of the Medicaid program.

It comes as Gov. Bruce Rauner¹s administration is planning to expand the role of private insurance.

Medicaid is Illinois' health care program for the elderly, poor and disabled, and the Rauner administration wants more of it run by private insurance.

But Democratic Rep. Fred Crespo, from Hoffman Estates, says these Managed Care Organizations, or MCOs, are squeezing patients.

Illinois has applied to the federal government for a waiver that could bring Illinois not only a significant increase in Medicaid dollars, but also more flexibility for how those dollars are spent. We talked to two members of Gov. Bruce Rauner's cabinet -- Human Services Secretary James Dimas and George Sheldon, acting secretary of the Department of Children and Family Services -- about what this waiver would mean for the state.

A new law makes a drug that counteracts opioid overdose easier to get. But is that enough?

Northlake resident Steve Kamenicky is lucky to be alive.

He’s 58 years old and says he’s used heroin for 46 years, starting at age 12. He has overdosed several times and nearly died, but he survived because of the medication naloxone hydrochloride, also known by the brand name Narcan. 

University of Wisconsin

Illinois is placing tight restrictions on a new hepatitis C drug that costs $1,000 per pill. Medicaid patients must meet 25 criteria and get prior approval before the government health care program will pay for Sovaldi.

The drug can stop the liver-damaging virus, but it comes with a budget-straining price tag.

Three area residents are among more than two dozen Illinois residents who have been charged with health care fraud stemming from federal investigations.

Federal prosecutors Thursday announced charges against 29 people who allegedly abused a health care program funded by Medicaid. 

The program pays for personal assistants to help Medicaid recipients stay in their homes.   The Feds says the defendants allegedly submitted false claims for hours worked when they had other full time jobs, were in jail or the client was hospitalized.

Ill. Atty General

Gov. Pat Quinn is promising tighter controls after a review found that the Illinois Medicaid program paid an estimated $12 million for medical services for people who were dead.  

Quinn told reporters Saturday he's not happy with the findings and the state is on track to recoup all of the money.  

The Associated Press learned of the mistakes from an internal state government memo it obtained Friday through the Freedom of Information Act.  

Under the new Medicaid eligibility requirements, Oliver Wellman’s parents make too much money to qualify for the 24-7 nursing care he needs because of his tracheostomy, but not enough to be able to afford to pay for the care themselves.
WUIS/Illinois Issues

Maria, the mother in a family of four living in Willowbrook, doesn’t want her real name or that of her family made public. A private, proud woman, Maria would rather keep her problems to herself and solve them herself.

But Maria is in a Catch-22 that might force her to quit her job. Her daughter needs expensive medical care, and Maria and her husband don’t make enough money to cover the costs but make too much to get help. Out of frustration, she shares her story.

Dana Heupel
WUIS/Illinois Issues

One political party in Illinois is bound and determined to slash health care for poor people and retirees while waging attacks on organized labor and teachers — at the same time giving tax breaks to huge corporations like Sears and CME Group, which operates interests, such as the Chicago Mercantile Exchange and the Chicago Board of Trade.


And then there’s the other political party, the Republicans …

Dr. Edward Pont
WUIS/Illinois Issues

Because of the controversies surrounding expected cuts to Illinois’ Medicaid program during this year’s legislative session, Illinois Issues is publishing this guest column by Dr. Edward Pont, a pediatrician who is a member of Gov. Pat Quinn’s Medicaid Advisory Committee. The magazine’s publication of this column does not indicate either endorsement or rejection of Dr. Pont’s ideas. Executive Editor Dana Heupel’s Editor’s Note column will return in the July-August issue.


House Speaker Michael Madigan, a Chicago Democrat, spoke about Medicaid on public television’s Illinois Lawmakers: “Boiling it down in more simple terms … who are the people that are eligible? How much of it will they get? How often will they get it?
NPR Illinois | 91.9 UIS

The thought of this spring’s legislative session going into summer overtime was greeted by groans from members of the General Assembly. During his budget address in February, Gov. Pat Quinn told lawmakers they can’t go home until they pass comprehensive Medicaid reform. Now, they face the daunting task of cutting $2.7 billion in Medicaid spending growth from the Fiscal Year 2013 budget. 

WUIS/Illinois Issues

By October, Illinois state officials hope to take a small but significant step in reining in Medicaid costs. By then, they hope to move about 38,000 patients in the Chicago suburbs into HMO-style managed care plans. That group comprises some of the most expensive — and most vulnerable — types of Medicaid enrollees: the elderly, blind and disabled. Together, they cost the state about $700 million a year, or more than $18,000 each.

Aaron Chambers
WUIS/Illinois Issues

Medicaid expenses are booming. Illinois lawmakers know that. Now they know other states are dealing with the same problem.

At the National Conference of States Legislatures’ annual meeting last month in San Antonio, legislators from all 50 states learned they’re in the same boat. Across the board, Medicaid is eating up a greater share of the states’ budgets. And the end is nowhere in sight.

In Tony Cappasso's article in your Spotlight on Medicaid series ("Why costs have gone up," March, page 28), Ann Patia, the former director of the Illinois Department of Public Aid, makes an astounding assumption. She seems to imply that by cutting Medicaid payments to hospitals earlier this year, the department was able to "control Medicaid spending without hurting Medicaid patients." Does Ms. Patia really believe it is possible to neglect the institutions that provide essential medical and social services to Medicaid patients without hurting the patients themselves?

Mike Cramer

Pharmacist Mike Schaltenbrand finds himself in need of a prescription. He needs something - and soon - to soothe his ailing bottom line. 

The owner of two inner-city pharmacies in East St. Louis, Schaltenbrand has been severely affected by the state's ongoing efforts to reel in its burgeoning Medicaid budget. In the span of two months, his income has declined by 25 percent because of changes made in Springfield aimed at cutting the state's costs of providing health care services to the poor.