Transcript Family Voices of Illinois and the Illinois Life Span Project

Faye Manaster,M.Ed.
Project Director
[email protected]
Family to Family
Health Information Center
Grantees Meeting
April 27,2012
Washington,DC







Information and referral services
Educational materials and manuals
Training events - stipends for families, CEUs
for professionals
Statewide
Free of charge
Toll-free information lines
All staff are family members of persons with
disabilities








Budget cuts impacting programs and services
New Medicaid income guidelines for children
and families-4300 will be dropped
Health care reform is coming
Medicaid Integrated Care Program underway
Medicaid Coordinated Care coming soon
Waiting list is growing
Transitions at age 18+ challenging
Plans to end Katie Beckett waiver





Impact is on “buy in” option for uninsured
children
New family income limit is 300%FPL
Uninsured children in families over 300% will
no longer be permitted to “buy in”
Possible options in private market (children
can no longer be denied coverage due to preexisting conditions under ACA)
Current “buy in” children over 300% FPL are
continued until 6/30/12 only




http://www.dhs.state.il.us/page.aspx?item=59264
Medicaid Reform legislation (Public Act 96-1501) required the All
Kids program to impose an income limit that is 300% of the FPL
beginning July 1 2011. Having this income limit means that the
All Kids Premium Level 3-8 program will end.
The law allowed children who were already enrolled in Premium
Level 3-8 as of July 1, 2011 to remain on the program through
June 30, 2012 as long as they were otherwise eligible. CN
12.07/S (pdf), "Important News About All Kids" is being sent to
all active All Kids Premium Level 3-8 cases in March 2012 to
remind them that the program will end at midnight on June 30,
2012.
The notice provides the income limits for the All Kids program
and advises clients to call the All Kids Customer Service toll-free
number if they believe they may remain eligible due to a change
in income or family size.






Case advocacy referrals
Guidance re possible options
Support to explore private insurance
Support to learn about other Medicaid
solutions: Spend down and Third Party
Liability
Discussion of interim strategies
Information about policy initiatives
 Read
NPR story – April 12,2012
here:
http://www.wbez.org/news/allkids-health-program-set-dropthousands-soon-98137
 Guardian contacted F2F
 Legal assistance referral arranged






Medicaid NCPAS will continue
Waiving of parental income being debated
Family cost-sharing on the table
Affects 500 children
This waiver to be in Phase 2 of Mandatory
Medical Managed Care-details in process
Family advocates formed
http://www.savemftdwaiver.com/
http://www.facebook.com/savemftdwaiver






Go to www.healthcare.gov and select “Illinois”
Enter personal demographics
Find links to possible private market
insurance plan
Find links to Federally Qualified Health
Centers (FQHCs)
Spenddowns for children still available
Families close to 300% FPL need to “look
before they leap”
http://www.familyvoicesillinois.org/documents
/documentdetails.asp?did= 2900
New income guidelines do not currently impact
children enrolled in waivers- but may affect
their siblings.







FPL = Federal Poverty Level
Here is the 300% FPL annual income limit by
family size, updated for 2011:
http://aspe.hhs.gov/poverty/11poverty.shtml
Family size of 2: $44,130
Family size of 3: $55,590
Family size of 4: $67,050
Family size of 5: $78,510
Family size of 6: $89,970






FPL = Federal Poverty Level
FPL calculator - easy to use online tool:
http://www.coalitionclinics.org/fpl.html
Enter monthly income and family size
FPL limits updated annually
Consider reapplying if family size increases
and/or income decreases
Disability status not factored into equation






All Kids Assist = 133% FPL
All Kids Share = >133-150%
All Kids Premium Level 1 =>150-200% FPL
All Kids Premium Level 2= >200-300% FPL
(Levels 3-8 now eliminated)
DSCC financial assistance= 285% FPL






More affordable insurance options coming
States are developing exchanges
For now, only ICHP High Risk Pool available to
children who will be dropped from All Kids
(nonsubsidized)
IPXP – Temporary High Risk Pool- not an
option (subsidized)
Must be uninsured for 6 months for IPXP
IL Dept. of Insurance:
http://www.insurance.illinois.gov/



July 1, 2012 Coordinated Care Program =
Medicaid Managed Care for most enrollees
(children and adults)
http://hfs.illinois.gov/cc/
January 1, 2014: Medicaid available for lowincome, childless adults (IL has applied for
1115 “early start” waiver for Cook County)
Affordable Care Act timeline:
http://www.healthcare.gov/law/timeline/inde
x.html
http://www.familyvoicesillinois.org/documents/documentdetails.a
sp?did=2901
Information to share:
1. Are you currently paying monthly premiums for your child (or
children) to participate in All Kids?
___Yes ___No
2. If yes . . .
How many children do you have enrolled in All Kids?
_______________________________________________
What are the ages of your children?
_______________________________________________
How much do you pay each month for the All Kids coverage?
_______________________________________________






Lost insurance due to losing my job
My employer does not offer insurance for
dependents
My children used up lifetime maximum coverage
under insurance from my work
My children were enrolled in COBRA and it cost too
much
I could not find a job with health benefits
Other reason (specify): _____________





A special health care need
A pre-existing condition
A chronic illness
A disability
What is the diagnosis?





What are you planning to do to find insurance
for your child/children if they can no longer
be covered by All Kids under the new law?
Have you contacted your elected officials?
Have you discussed with your child’s doctors?
Have you explored private coverage?
Have you assessed your work situation?



SSI recipients ages 19 and older
Reside in suburban Cook and collar
counties (central IL in FY 2013)
Have Medicaid (AABD) as sole health
insurance




Have private insurance plus Medicaid
Have Medicare plus Medicaid(until Dual
Eligible Pilot starts= “voluntary”)
Under age 19
Not living in target enrollment area





Young adults under age 26 can remain on-or joinparent’s health insurance
Insurance must be available (employers not
required to offer)
Must be able to pay for insurance
Check to see if parent/guardian of “Disabled Adult
Child” (DAC)is retired, disabled, or deceased
The DAC can then qualify for SSDI (Supplemental
Security Disability Income) and get Medicare after
24 months



Check to see if parent/guardian of “Disabled Adult
Child” is retired/disabled/deceased
The DAC can then qualify for SSDI (Supplemental
Security Disability Income) and get Medicare after
24 months
Workers with disabilities who have 24 quarters of
credit can get SSDI, and later, Medicare
http://www.socialsecurity.gov/pubs/10026.html#o
lder-children




Know the rules:
http://www.socialsecurity.gov/pubs/10026.html#em
ployment
Because of a medical condition(s), your child may
need certain items and services in order to work,
such as a wheelchair or a personal assistant. When
figuring your child’s SSI payment, we will not count
some or all of the amount paid for these items and
services in your child’s earnings.
Your child older than age 15 may get help with
rehabilitation and training.
Medicaid coverage will continue even if your child’s
earnings are high enough to stop the monthly SSI
payment as long as the earnings are under a certain
amount.






Don’t assume.
Call SSA toll-free at 1-800-772-1213.
SSA can answer specific questions from 7
a.m. to 7 p.m., Monday through Friday.
SSA can provide information by automated
phone service 24 hours a day.
Website: www.ssa.gov
Need more help? Contact your Senator and/or
Congressperson. Find their contact info at
www.votesmart.org

Young adults who received SSI at any time in
the past
◦ Are currently working
◦ Do not have option of work-based insurance
◦ Can buy-in to Health Benefits for Workers with
Disabilities
◦ www.hbwdillinois.com


Full Medicaid benefits
What will happen to HBWD in 2014?
The Arc of Illinois has Advocacy Toolkits


English:
www.familyvoicesillinois.org/documents/doc
umentdetails.asp?did=2851
Spanish:
www.familyvoicesillinois.org/documents/doc
umentdetails.asp?did=2908



Latest updates on the Illinois Client Enrollment
Broker website, not on HMO sites:
http://illinoiscebicp.com/files/ICP_Comparison_Ch
arts.pdf
Run by Automated Health Systems in Schaumburg,
contracted by HFS
Check frequently
◦ Toll-free: 1-877-912-8880
◦ TTY: 1-866-565-8576
◦ Hours:
Monday – Friday: 8 a.m. to 7 p.m.
Saturday : 9 a.m. to 1 p.m.

(

Aetna Better Health:

Illini Care:
http://www.aetnabetterhealth.com/Illinois/PDFDoc
s/IL_Provider_Handbook_Version_1_1%20_(5_4_11).
pdf
http://www.illinicare.com/files/2011/05/IlliniCare
Provider-Manual-FINAL-5-23-11.pdf


Detailed information
Ask questions





Be proactive.
The two MCOs are
1. Aetna Better Health:
http://www.aetnabetterhealth.com/Illinois/defa
ult.aspx
2. IlliniCare:
http://www.illinicare.com/
Study information carefully.
Follow steps in advocacy toolkit to state your case.
Most people have been “auto-enrolled” because
they did not make a choice.
Choosing A Medicaid Integrated Care Program Plan:
A Worksheet For ICP Participants




Before you choose one of the providers contracted by
HFS’s Integrated Care Plan, study their information
carefully and record your data on this chart.
When the chart is filled in, you will have detailed
information to assist you in choosing the plan that
fits your needs.
It may also allow you to recognize the need for a
written request to HFS for a Single Case Agreement.
Get your free Advocacy Toolkit at:
http://www.familyvoicesillinois.org/documents/docu
mentdetails.asp?did=2851



Consumers who are enrolled in Medicaid and are
required to participate in the Integrated Care
Program have the right to request a “single case
agreement” in order to stay with their current
doctor(s) and hospital(s).
If you do not request a single case agreement, and
the doctors/hospitals you use are not “in the
network” of one or both of the MCOs, you will only
be allowed to continue with your current providers
for 90 days.
After that time period, you must begin seeing
enrolled network providers.

Medical Programs – Bureau of Managed Care
Department of Healthcare and Family Services
201 South Grand Avenue East
Springfield, Illinois 62763-0001
Telephone number: 217-524-7478
Fax number: 217-524-7535
Re: Name of person enrolled in Medicaid
Birth Date
Recipient Identification Number and Case ID #
To Whom It May Concern:
I am writing on behalf of (person’s name) who received the attached letter from HFS on (specify date)
regarding enrollment in the Integrated Care Program. I am (person’s name) (specify relationship:
parent, guardian, case manager, etc.). (Person’s name) diagnoses are (list all diagnosed medical,
disability and behavioral health conditions.)
We have reviewed the provider lists supplied by both of the health plans - Aetna Better Health and
IlliniCare - and have found that neither (person’s name) doctors or the hospital where (person’s name)
receives treatment is in either network. A list of the doctors and hospitals (person’s name) uses is
attached to this letter. Due to (person’s name)‘s special health care needs, it is very important to
continue services with his/her current providers, doctors and hospitals.
Therefore, we need your intervention with the Integrated Care Program providers to please establish
Single Case Agreements with the providers on (person’s name) list.
Please contact me at (phone number) if you have any questions or need more information. Thank you
for your assistance with this request.




Your name
Your address
Your email
Attachments:
•
•
•
•
•

Cc: Person’s primary care physician
•
•
•


Current provider list
Current medication list
Copy of ICP letter received
Copy of current Medicaid card (both sides)
Copy of guardianship order (if applicable)
Tony Paulauski, The Arc of Illinois
Person’s State Senator and State Representative
Others
Send your letter with all attachments via certified mail and
request a return receipt.
You can also fax a copy of the letter and attachments to HFS.






Support consumers/families to write letters
to HFS
Requests for SCAs and other concerns need
to be in written form!
Phone calls alone will not suffice
Remember to use certified mail
Faxed letters should be followed by a hard
copy
Always keep a copy



Everyone who is enrolled in Medicaid has the right to
appeal. This includes people who are enrolled in a
managed care organization (MCO) as part of the
Integrated Care Program. Enrollees in Medicaid
Managed Care have legal rights and responsibilities,
including the right to appeal.
The Kaiser Family Foundation has a detailed fact
sheet about Medicaid appeal rights:
http://www.kff.org/medicare/7240/medicaid.cfm
The following link provides basic appeal information
from the Illinois Department of Healthcare and Family
Services (HFS):
http://www.hfs.illinois.gov/medicalbrochures/hfs591
.html




When you are enrolled in an HMO or health maintenance
organization, also called an MCO or managed care
organization, you must first follow the procedures outlined in
the member handbook provided to you by your HMO.
The HMOs are required to give you their member handbook
in your preferred language/method of communication (for
example, in a language other than English and/or in large
print or Braille).
Their member handbooks must include detailed information
about grievance and appeal rights.
You can file a written appeal with your HMO. You can also fax
your appeal, as well as sending it by certified mail.






Put it in writing.
Keep a copy.
Use certified mail.
Keep a phone log (date/time/who you spoke
with).
Send thank you notes.
Always remember that you have rights.

For problems related to services, programs and
State of Illinois agencies:
Illinois Life Span Project at The Arc of Illinois
www.illinoislifespan.org
800-588-7002 voice

For problems related to SSI, Medicaid, Medicare
and Health Benefits for Workers with Disabilities
Health and Disability Advocates
www.hdadvocates.org
312-223-9600 voice
800-427-0766 TTY

For legal problems, including problems with services for
people with disabilities from state agencies:
Equip for Equality
www.equipforequality.org
800.537.2632(voice)
800 -610-2779(TTY)

For problems related to continuation of home-based
nursing care after age 21, including problems with
services from state agencies:
US Department of Justice Joins Farley Lawsuit
www.thearcofil.org/pastissues/document.asp?did=2379
http://www.farley1.com/news.html
Call 866-931-1110 toll-free English
Call 800-588-7002 toll-free Spanish
[email protected]
www.familyvoicesillinois.org