Update:Illinois’ Care Coordination and Managed Care System

In January 2011, the Illinois legislature passed a bill that requires 50% of the State’s Medicaid population to be covered in a risk-based care coordination program by 2015. Subsequently, in May 2012, the State Legislature passed the SMART Act, cutting Medicaid services and projecting cost savings through various care coordination initiatives.

The care coordination, or managed care, initiatives referenced through this bill are: the Integrated Care Program, the Dual Eligibles Capitation Demonstration and the Innovations Program. All three of these initiatives have a goal to better coordinate primary, acute, behavioral health and long-term supports and services thereby improving the delivery of health services and lowering health costs.

The move to better coordinate care across primary, acute, behavioral health and long-term supports and services is in alignment with the federal Affordable Care Act (ACA), passed in March 2010. In fact, Illinois has made an effort to take advantage of several of the ACA provisions to move towards a better coordinated and integrated health system.

One of the ACA provisions Illinois is interested in is called Medicaid health homes for individuals with chronic conditions. To date, Illinois has filed a draft Medicaid state plan amendment to create health homes. The other federal ACA inititiave relating to care coordination that Illinois interested in is the Medicare-Medicaid Alignment Initiative, or the Dual Eligibles Demonstration Project. Illinois has submitted a proposal for this demonstration project.

For more details about the various care coordination, or managed care, initiatives in Illinois, please reference the document “Illinois Health Reform 2012: Care Coordination, Managed Care and Long-Term Services and Supports” developed by Health & Medicine Policy Research Group.

Kristen Pavle
Associate Director, Center for Long-Term Care Reform
Health & Medicine Policy Research Group

Strengthen Home Care

Recently, legislators made the prudent decision to pass the Budgeting for Results law, holding Illinois accountable to fund only programs with proven effectiveness. Budgeting for Results lays out the state’s commitment to home and community-based care, including through Medicaid programs.

The development of Illinois home-care system has been a challenging venture over the past several decades; and yet the home-care system is hardly prepared for the aging of the baby boom generation. The proposed cuts to home-care programs through Medicaid budget proposals contradict the call to responsibility outlined in Budgeting for Results.

Proposals include increasing the eligibility threshold for Medicaid community-living waivers. However, our recent research for a report reveals that community-living waiver cuts will result in an increase in utilization of hospitals, emergency rooms and nursing facilities — more costly options than home care.

We call upon our legislators to strengthen, not weaken, their commitment to community living for Illinois’ most vulnerable citizens.

Kristen Pavle, 

Associate Director, Center for Long-Term Care Reform

Health & Medicine Policy Research Group

(originally posted as a Letter to the Editor here in the 5/23/12 Chicago Sun Times)