My sister-in-law is a single parent working as an assistant director for a day care center. A few years ago, she was diagnosed with breast cancer and at the time she qualified for Medicaid. Fortunately, she is now cancer free but will have to take medication for the rest of her life. I wonder what she would have done if she was not covered by this. Would she have been able to get care? Would she be alive right now?
This week, she was informed that she no longer qualifies for Medicaid. Her income is just above the $20,100 income limit for a family of two and not by much. The Illinois legislature has cut over a 1.6 billion from the state’s Medicaid budget.
http://www.sj-r.com/...
CHICAGO -- A $1.6 billion Medicaid spending cut that Gov. Pat Quinn signed into law Thursday takes a bite out of a relatively generous program and will leave the state with a level of services already familiar elsewhere in the nation.
The new cuts to the health care safety-net program eliminate extras like chiropractic and dental care for adults. Many other states dumped or limited these extras in the wake of the recession - or never offered them at all.
More than 25,000 Illinois working parents will be thrown off the program, but even that change can't be viewed as extraordinary, policy experts said, because Illinois historically has been more generous than most other states, covering parents at higher income levels.
The daycare center she works for offers junk insurance at a cost she cannot afford. The insurance company probably wouldn’t accept her anyway due to her previous bout with cancer. She has made appointments for some checkups that she can hopefully get in before July 1.
A neighbor is also in the same boat. Also a single mother, she works as a CNA for a nursing home. She also makes just a little over the income cutoff. Fortunately, in both of these cases, the children will get to stay on Medicaid. Yet, if the parents are not getting needed care or die due to illness, how can they take care of their children?
What got lost in the debate was the relative bounty of the Illinois program. For 2.7 million poor and disabled Illinois residents, the cuts will create real hardships, magnified because they're happening all at once. But the changes bring Illinois in line with other financially struggling states as well as other states never known for lavish safety-net programs.
Illinois state press release
The SMART Act scales Medicaid to fit available funding sources through spending reductions, utilization controls and provider rate cuts. Its key provisions include:
• Reducing eligibility for adults in the FamilyCare program to 133 percent of the Federal Poverty Level ($30,660 for a family of four).
• The state’s subsidy for the federal prescription drug (Part D) program, IL Cares Rx, is terminated, but “Extra Help/Low Income Subsidy” provides federal assistance to low-income seniors and people with disabilities eligible for Medicare.
• New integrity measures will aggressively target client and provider fraud through:
o Enhanced eligibility verification of income and residency through use of private vendor’s access to national databases for annual redeterminations; and
o Expanded authority of the HFS Inspector General to deny, suspend and recover overpayments and conduct pre-payment and post-payment provider audits.
• Eliminates some optional services, such as group psychotherapy and adult chiropractic services, and places utilization control on certain optional services such as adult dental services (restricted to emergencies), adult podiatry services (restricted to diabetics), and adult eyeglasses (limited to 1 every 2 years).
• Limits are placed on adult and children’s prescriptions to four per month, with additional prescriptions available based on patients’ needs.
• Most provider groups receive a rate cut of 2.7% except for doctors, dentists, clinics, safety-net hospitals and critical access rural hospitals. Non-exempt hospitals receive a rate cut of 3.5%. Nursing home cuts average 2.7%, but the homes serving clients who have the highest care needs are being impacted less.
People like my neighbor and sister-in-law have a hard enough time getting by and there really is no extra money for junk health insurance if they qualified. At least the children are not being cut-off. This really brings home the need for single payer healthcare. Yes, Illinois had been more generous than say, Florida, but why are we all brought down to the lowest common denominator? I guess we are all Floridians now.