Do you have questions about issues like the Health Care Reform Implementation Council or other implications of the new health law? Learn from the experiences of others—or, submit your question here.
If I am working with a Medicaid eligible adult (or “ACA Adult”) in CookCounty, do I enroll him/her in CountyCare or in ABE (the new Medicaid system in Illinois)?
The applicant can enroll in ACA Adult coverage through either CountyCare or ABE but know that there are differences between the two options. There are three key variables to consider:
1. Coverage Dates:
Between 10/1-12/31, the “Door You Choose” (either ABE or CountyCare) determines when coverage begins: only if you apply through a CountyCare Application Assistor (note: this includes calling 312-864-8200 to apply by phone, a face to face meeting is not required) can you get medical benefits before Jan 1, 2014
. If you apply through ABE, coverage begins on January 1, 2014 without backdating.
2. Benefits Package:
The benefits package for the ACA Adult group has not been finalized yet. However, beginning on January 1, 2014 (whether currently enrolled in CountyCare or enrolled in the future), CountyCare benefits are expected to be more generous than the benefit package for other (non-CountyCare) ACA Adults.
3. Provider Network:
The network of CountyCare providers is a specific CountyCare managed care network (like an HMO now) but note that the CountyCare network is expanding daily and has more than 34 providers operating in 130 service locations with CCHHS providers and many non-CCHHS hospitals, PCPs, etc. ACA Adults enrolled through ABE will be given a choice of the CountyCare network or Fee For Service coverage similar to Illinois Health Connect (only providers accepting new patients). Please note that HFS plans to eventually include all ACA Adults in the Chicago region in some form of managed care. See HFS’s “Care Coordination”
page for more information.
Can agents sell inside the Illinois health insurance marketplace and get a commission?
Yes, agents and brokers may sell (and receive commission on) Marketplace Qualified Health Plans using either the Marketplace website or individual issuer websites. Agents and brokers are required to register with the federal Center for Medicare and Medicaid Services (CMS) in order to sell individual plans; CMS also encourages agents and brokers exclusively working in the small group (SHOP) market to register. The federal registration process is expected to begin in the summer of 2013 and will include three steps: (1) verifying the agent or broker’s identity; (2) taking a federal online training course; and (3) agreeing to comply with federal and state laws, rules, standards and policies, including those related to privacy and security. After the three steps are completed, the agent or broker will be given a unique identification number which will be included on the application of any consumer they assist in enrolling into an Illinois Health Insurance Marketplace plan. The commission for the enrollments will be received directly from the issuer. For more information about how agents and brokers can participate in the Illinois Marketplace (and other Federally Facilitated and State Partnership Marketplaces), please visit "Resources for Agents and Brokers in the Health Insurance Marketplace
" on CMS.gov.
Q: I work for a primary care physician’s office and we see a lot of Medicaid patients. I’ve heard that the Affordable Care Act requires an increase in Medicaid payments to primary care physicians to 100% Medicare rates. When will we see these increases take place? Can you provide any guidance for us?
On March 4, 2013, the Illinois Department of Health & Family Services (HFS) published this notice
about the increase in fees for primary care physicians. It says, "For dates of service January 1, 2013 through December 31, 2014, the department will apply an increased payment rate to enrolled practitioners for primary care services delivered by a primary care physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine. The increased payments will apply to services reimbursed by Medicaid fee-for-service, Voluntary Managed Care Organizations and Integrated Care Program Health Plans." In order to receive the increased payments, physicians must self attest that they meet certain criteria. Interested primary care providers should read the notice for more information.
Under the Affordable Care Act, will licensed acupuncture be covered by private insurance plans?
The covered benefits and services for small group and individual group plans under the Affordable Care Act have not been fully defined yet; however, the Illinois Health Reform Implementation Council (IHRIC) is meeting this month (see info on our events page here
) to discuss what the benchmark Essential Health Benefits (EHB) package will be in Illinois.
If the Illinois’ EHB benchmark includes acupuncture then a licensed acupuncturist will be able to submit to insurance for her/his services. California just chose their benchmark EHB which does include acupuncture; see their scope of benefits here
: Acupuncture Services (typically provided only for the treatment of nausea or as part of a comprehensive pain management program for the treatment of chronic pain).
Public comment on the Illinois EHB is welcomed by IHRIC by 9/19/12 and can be submitted on their website here
I am a hospital administrator in Illinois. I understand the Governor's Health Care Reform Implementation Council is considering various ways to pay for the costs associated with administering the Health Benefits Exchange including assessments on insurance carriers, consumers and providers. How much will it cost Illinois to run its Exchange?
The Affordable Care Act will provide the initial funding necessary for a state to build and maintain an Exchange through federal grants. These federal funds are available to support the costs of the Exchange through the end of 2014. Beginning January 1, 2015, federal law requires that state exchanges must be financially self-sustaining. In order to do this, states need to determine the method by which the Exchange’s operations will be financed. According to the Illinois Department of Insurance (DOI), the costs associated with the Illinois Exchange are still unknown. Illinois is currently requesting an independent analysis of estimated operational costs. Very few states have run their own exchange and the experience of those that have done so is varied: Utah's exchange was estimated to cost $600,000/year and Oregon's estimate is $48-49 million/year. The estimate for administering the Massachusetts Connector is between $10-$20 million/year. The reason for the cost difference is due to a wide variation in the responsibilities delegated to the Exchange. Information from DOI about the Illinois Exchange will be released once the independent analysis has been completed. When the information is released it will be posted at www.illinoishealthmatters.org
I am a state legislator in Illinois and I am concerned that my constituents don't know how health care reform can help them right now. How can I help constituents who call my office and are uninsured?
There are a lot of great resources out there for consumers to learn about the immediate impact of health care reform. However, many consumers need individualized help to figure out if there is a public health or private insurance program that might fit their specific needs and be affordable. There are options such as Medicaid and Medicare which require that consumers meet very specific requirements on income level, family status, disability and age. There are also new options -- such as for people with special health care needs to buy insurance through a high risk insurance pool, young adults under age 26 (even if they are not in college) and others. You can refer an individual constituent for assistance finding coverage to the following resources: http://finder.healthcare.gov/ or the Illinois Department of Insurance, Office of Consumer Health Insurance (877) 527-9431 or the Campaign for Better Health Care's toll-free hotline at 1-888-544-8271.