Illinois’ All Kids Program

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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. - PowerPoint PPT Presentation

Transcript of Illinois’ All Kids Program

  • Illinois All Kids Program

    Illinois Department of Healthcare and Family Services

    Stephen E. Saunders, MD, MPH

    Child Health Services Research MeetingJune 24, 2006

  • About All KidsFirst and only state program in the nation to make sure that every child in Illinois has access to comprehensive and affordable healthcareAllows most of the 253,000 uninsured children in Illinois who need health coverage to get itHelps children get to the doctor before they get sick and before a simple problem becomes a major illnessProvides health insurance and prescription coverage at affordable ratesBegins July 2006

  • Qualifications for All Kids18 and under Illinois residentsNo citizenship requirementsNo income limit Monthly premiums and co-payments based on a sliding scale, based on income

  • Current Illinois Medicaid ProgramCombined Medicaid and SCHIP ProgramIncome threshold 200% of povertyFamily Care 185% of povertyPrimarily Fee for ServiceVoluntary managed care in six countiesOver 2 million beneficiaries currently enrolledOne year continuous eligibility

  • Program StructureAn extension of current Medicaid and SCHIP program; Medicaid and SCHIP - now ALL KIDSSame 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 scale12-months continuous eligibilityNo pre existing condition limitationsIncludes dentalProvider reimbursement - same as Medicaid

  • Eligibility ProcessOne application for entire programApplication process:Mail-inWeb Community-based Application AgentAt Department of Human Services local office, located in each countyOutreach and PR campaignOne eligibility card for entire program

  • Crowd Out ProvisionsMust be uninsured since January 1, 2006, or 12 months after December 31, 2006Exceptions:Parent looses employer sponsored health insuranceNewbornExhausted life time benefitChild covered by COBRA

  • Crowd Out Provisions (continued)Exceptions (continued)Child was covered by Title XIX or Title XXI and family income changesCustodial parent cannot access non-custodial parents insuranceAffordable health insurance definition applies at redetermination

  • Premium/Co-Pay200 300% povertyPremium $40/child/month; $80/month - maxCo-pay$10 office visit$7/$3 pharmacy$30 ER$100 hospitalization5% rate for outpatient hospitalYearly maximum - $500No co-pay for preventive health care, e.g., well child visits and immunizations

  • All Kids Monthly Premium

  • FinancingGovernors key initiative passed General Assembly November 2005GRF funded no waiversCost Savings through implementation of the:PCCM Program FY 07 for most Medicaid/SCHIP beneficiariesDisease Management Program -July 1, 2006 Disabled Adults Family Health Population with Persistent AsthmaFamily Health Population Frequent Emergency Room users

    Implementing PCCM program mid FY07

    Anticipated cost saving secondary to reduction unnecessary ER and Hospitalzation

  • Provider Buy-InInput into the planning process with monthly Stakeholders meetings30-day payment cycle for physician services, starting July 1, 2006Pediatrics rate increases for selected preventive visit and E & M codes - January 1, 2006Support by ICAAP and IAFP

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

  • 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)

  • ConclusionHealthcare reform is possible with political will and buy-inMedicaid package of services comprehensive and is a model benefit packageMedicaid structure provides an efficient platform to build upon has an established payment, claims processing system and provider enrollment processes

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