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Illinois: State Strategies to Enroll Justice-Involved Individuals in Health Coverage
Policy and Process Changes
State Legislation
HB 1046, introduced in the 2013-2014 legislative session, specifically allows incarcerated individuals to apply for Medicaid prior to the date of their release. If these individuals are found to be eligible for Medicaid, they will be able to receive coverage after their release. In addition, the bill allows for suspension of existing Medicaid benefits for persons who enter a correctional institution. Illinois is currently in the process of implementing this functionality. The bill was signed into law (see Sec. 1-8.5) in August of 2013 and became effective January 1, 2014.
Application Process Changes
Local assister entities have conducted the majority of the enrollment for justice-involved individuals. Some of these assister community organizations have reached out directly to county jails to provide enrollment assistance and help individuals understand how to appropriately access care once they reenter the community. At the state level, Get Covered Illinois, the state/federal marketplace partnership organization in Illinois, supports these efforts by providing the assister organizations with information about how the ACA affects justice-involved individuals. Get Covered Illinois has also offered suggestions and technical assistance to these organizations about how to connect with criminal justice entities and ways to potentially integrate enrollment processes into these facilities. View enrollment guide
Post-Release Outreach
Parole office
During Get Covered Illinois’s first open enrollment period in Fall 2013-Winter 2014, the state used the Department of Corrections (DOC) Parole Division’s automated messaging system to inform individuals they were likely eligible to enroll into health coverage, when in-person assistance was available at their nearest parole office, or how to enroll by phone. In Illinois, parolees must call the system using a toll free number to check-in, and often receive messages this way, rather than having parole agents call them. This allowed the state to pre-record a message describing parolees’ potential eligibility for health insurance and providing information about where to apply in person or online. Additionally, assisters were available once a week at parole offices around the state to enroll individuals. Flyers were created for parole agents to distribute to individuals on their caseloads, which provided information about when in-person assistance would be available at the parole office.
Mailings and calls
Prior to the Get Covered Illinois’ second open enrollment, trying to capitalize on earlier outreach efforts, the state worked with the parole department to carry out an outbound calling campaign in targeted regions across the state. An automated message was delivered that encouraged these individuals to enroll in health coverage and directed them to local enrollment sites. The state believes this aggressive outbound calling campaign was not as effective as the first effort; however, identifying how many of these justice-involved individuals eventually sought assistance at local enrollment sites and enrolled in coverage through this effort was a challenge because they were directed to enrollment sites in the community rather than at the parole office.
Beyond Eligibility and Enrollment Strategies
Health Literacy Materials
Recognizing that justice-involved individuals reentering the community may be unfamiliar with how to appropriately utilize health care services, officials from Get Covered Illinois have developed health literacy materials designed to help them more easily access care upon release. These materials include a palm-sized card with information on how to choose and access primary care providers, obtain prescriptions, and appropriately use emergency care. The card also includes important contact numbers, as well as space where individuals can write in information about their physicians and prescriptions. The materials were developed with input from probation offices and advocacy groups and are based on some of the most common questions they receive from the justice-involved population regarding their health care benefits. The cards are being distributed in probation offices as well as during the intake process at the Cook County jail. See palm-cards for: Medicaid and Using Insurance (in English and Spanish).
Cross-Agency Coordination and Partnerships
In Illinois, efforts to enroll justice-involved individuals in health coverage were led through the governor’s office, which established a Workgroup on Justice Populations (WJP) and multiple interagency and regional meetings were convened. Based on these meetings, the WJP developed a resource guide designed for criminal justice personnel and community partners. The guide provides background information about relevant ACA policies along with detailed process maps outlining steps to implement enrollment procedures in correctional facilities and other settings.
Looking Forward: Future Issues to Address
State officials indicated that it was helpful to have the governor’s office lead the state’s initial efforts to enroll the justice-involved population in health coverage. This is because of the executive office’s ability to bring together a wide range of stakeholders, such as state and local officials as well as community based organizations. However, they noted the importance of developing a strong relationship specifically between staff at the state Medicaid and corrections agencies to maintain and sustain enrollment processes. Institutionalizing this relationship can help collaborations continue beyond changes in gubernatorial leadership.
Adult Dental Benefits in Medicaid: Recent Experiences from Seven States
Oral health is an important part of overall health, however, access to dental coverage for low-income adults remains a challenge, particularly since these benefits are optional for state Medicaid programs. This brief summarizes policy lessons from seven states (California, Colorado, Illinois, Iowa, Massachusetts, Virginia, and Washington) that have recently added, reinstated, or enhanced their Medicaid adult dental benefits. These states took a variety of approaches—including incrementally extending benefits to populations like pregnant women—and all attempted to do so in a fiscally sustainable way that provides meaningful access for program enrollees. Important factors in their decisions included funding opportunities through the Affordable Care Act, personal engagement by high-level state policymakers, building on lessons from improvements to children’s access to dental care, and strong partnerships with dental associations and oral health coalitions.
Accompanying case studies provide an in-depth look at each state’s choices on adult dental benefits.
A companion webinar features a conversation with state officials from Colorado, Iowa, and Washington about their experience with Medicaid adult dental benefits.
This project was supported by the DentaQuest Foundation.
A Policy Café Dialogue on New Ideas for Oral Health Access
10/10/2013 3:30pm
Speakers:
Joseph Flores
Ensuring access to oral health services for vulnerable populations is a perennial challenge that touches many areas of states’ work – public coverage, population health, workforce, and the medical care delivery system among them. What new ideas are emerging to address this challenge? In this policy café, conference participants will engage in a series of small-group discussions to share successful strategies, think together about new ideas, and learn from one another.
Sustaining Momentum in Multi-Payer Payment Reform: Transitioning from Design to Implementation
Tuesday, July 29, 2014
1:00 – 2:15 pm ET
View Webinar Here
This webinar explores the leap from health system transformation planning to practice by showcasing four leading states that are designing and implementing multi-payer payment reforms. Through a facilitated discussion, state officials discuss policy levers to shift payment systems away from fee-for-service, offer strategies for sustaining stakeholder momentum and commitment, and share perspectives on promising practices for and operational challenges of turning a plan for multi-payer payment reform into reality.
This webinar is the first in a six-webinar series, supported by Kaiser Permanente Community Benefit, highlighting specific policy and technical issues critical to achieving multi-payer payment reform. It is useful for all states contemplating, designing, or implementing multi-payer payment reforms, particularly SIM Round 2 Model Design applicants.
Speakers:
- Moderator: Anne Gauthier, Senior Program Director, NASHP
- Marcela Myers, Director, Pennsylvania Center for Practice Transformation and Innovation, Pennsylvania Department of Health; Pennsylvania SIM Project Director
- Karen Matsuoka, Director, Health Systems and Infrastructure Administration, Maryland Department of Health and Mental Hygiene; SIM Project Director
- Mark Schaefer, Director, Healthcare Innovation, Connecticut’s Office of the Healthcare Advocate; Connecticut SIM Project Director
- Vatsala Kapur Pathy, Founder, Rootstock Solutions; Colorado SIM Project Director
Engaging Adolescents Through the Medicaid Benefit for Children and Adolescents
Wednesday, May 21, 2014
2:00 – 3:00 pm ET
State Medicaid programs are pioneering innovative strategies for reaching adolescents, both to increase the rate of adolescent well-care visits and to strengthen the provider-adolescent relationship. While adolescents are a challenging population to reach—well-care visit rates decline as children age into adolescence—they are a particularly critical group to target under the Medicaid benefit because adolescence is a time of dramatic physical, cognitive, social, and emotional change.
This NASHP webinar offers a federal perspective from the Centers for Medicare & Medicaid Services on opportunities and promising strategies for states to leverage the Medicaid benefit for children and adolescents to better engage and meet the needs of adolescents. This is followed by a conversation with presenters from two states about initiatives they have launched to better serve adolescents using the Medicaid benefit for children. Participants learn about these states’ strategies for getting Medicaid-enrolled adolescents the services they need, and key lessons learned in implementing them.
This webinar is the second in a series on the Medicaid benefit for children and adolescents: future webinars will delve more deeply into additional topics on health services for children. In conjunction with this webinar series, NASHP recently launched a Resource Map to disseminate state-specific resources and information about strategies that state policymakers and Medicaid officials can use to deliver the Medicaid benefit for children and adolescents.
Speakers
- Elizabeth Hill, Centers for Medicare & Medicaid Services
- Marian Earls, Lead Pediatric Consultant for Community Care of North Carolina and lead on state CHIPRA quality demonstration
- Sarah Nickels, Co-Director, School-Based Health Center Improvement Project, Colorado Department of Public Health and Environment
Realizing Rural Care Coordination: Considerations and Action Steps for State Policy-Makers
States seeking to promote better coordination of patient care, either within Medicaid or through participation in multi-payer initiatives, will run into long-standing challenges to delivering care and promoting health in rural areas. Rural areas often experience disparities in access to care, health status, and available infrastructure relative to their urban counterparts. This brief draws from health initiatives undertaken in Alabama, Colorado, Montana, New Mexico, North Carolina, and Vermont to identify common policy considerations and action steps for coordinating care in rural areas. The brief was supported by the Robert Wood Johnson Foundation’s State Health and Value Strategies.
April 2014
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Arkansas – Medical Homes
Arkansas Health Care Payment Improvement Initiative
In early 2011, Arkansas’s Department of Human Services proposed an initiative they call “Transforming Arkansas Medicaid” (in later documents, “Transforming Arkansas Health Care”). The Arkansas Department of Human Services (which oversees Arkansas Medicaid) has partnered with two large private insurers in the state, Arkansas Blue Cross and Blue Shield and Arkansas QualChoice, to implement this broad payment and delivery system reform initiative.
The alliance, known as the Arkansas Health Care Payment Improvement Initiative, introduced the first phase of reform in October 2012. This model attempts to move away from fee-for-service payments and towards a system that rewards value and outcomes by instituting a shared-savings/shared-risk model based on providers’ average costs for selected episodes of care. To learn more about Arkansas’s Payment Improvement Initiative, visit the Arkansas page on NASHP’s Accountable Care Activity Map.
Arkansas envisions medical homes as a key component of a transformed health care system. Currently, the state is implementing medical homes through CMS’s Comprehensive Primary Care Initiative (CPCi). In the future, the state envisions a voluntary program for interested practices, with plans to grow to include most, if not all, practices in the state.
In April 2013, Arkansas enacted the Health Care Independence Act of 2013, requiring insurers offering plans in the state’s health insurance marketplace to participate in the Health Care Payment Improvement Initiative by supporting medical homes and sharing clinical data with providers.
Federal Support:
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Arkansas is one of six states selected in February 2013 by the Centers for Medicare and Medicaid Innovation (CMMI) to receive a State Innovation Model (SIM) Model Testing Award. Arkansas received $42 million to implement and test its State Health Care Innovation Plan, which builds on the state’s Health Care Payment Improvement Initiative and emphasizes development of medical homes and health homes in the state.
- Arkansas is one of seven markets participating in CMS’s Comprehensive Primary Care Initiative (CPCi). In this multi-payer initiative, Medicare is collaborating with public and private insurers in the selected states and regions with the goal of strengthening primary care. In Arkansas, CPCi launched in October 2012, bringing together four payers, as well as 69 participating primary care practices with 275 providers across the state.
- Arkansas has received a planning grant from the Centers for Medicare & Medicaid Services (CMS) to develop a state plan amendment to implement Section 2703 of the Affordable Care Act (ACA), establishing health homes for Medicaid enrollees with chronic conditions. For more information on the Arkansas’s application, visit the state’s archive for their health homes planning initiative. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
Last Updated: April 2014
| Forming Partnerships |
Arkansas Health Care Payment Improvement Initiative: Arkansas has received input on their payment and delivery system transformation initiative from Arkansans via meetings with key stakeholders, workgroups, webinars and town hall meetings. Project staff have met with a wide range of stakeholders, including:
The state Department of Human Services partnered with Arkansas Medicaid and two large private payers, Arkansas Blue Cross and Blue Shield and Arkansas QualChoice, to form the Arkansas Care Payment Improvement Initiative. This group worked with providers, health administrators, patients and advocacy groups to design the initiative.
For more information, visit the state’s archive for this initiative.
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| Defining & Recognizing a Medical Home |
Definition:
Arkansas Health Care Payment Improvement Initiative: The Payment Improvement Initiative defines medical homes as “a doctor or care team that takes responsibility for the overall health of a patient.”
Recognition:
Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CPCi through a competitive application process. Under CMS’s Comprehensive Primary Care Initiative, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commission, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
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| Aligning Reimbursement & Purchasing |
Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in October 2012, includes five payers in the Arkansas market: Medicare, Arkansas Medicaid, Arkansas Blue Cross and Blue Shield, Humana, and Qual Choice of Arkansas.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws.
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To Align or Not to Align: State Options in Multi-Payer Medical Home Initiatives
Tuesday, March 4, 2014
3:30 pm – 5:00 pm ET
Currently, 19 states are participating in one or more multi-payer patient centered medical home initiatives (PCMH). As states develop new multi-payer PCMH initiatives, they will have to grapple with the question of how much, if any, alignment is necessary among key programmatic elements, including payment, qualification standards and evaluation measures. This webinar, supported by The Commonwealth Fund, will feature key stakeholders from New York, Michigan, and Nebraska who will share their unique approaches that span the alignment spectrum.
Speakers:
- Mary Takach, Senior Program Director, National Academy for State Health Policy
- Dr. Foster Gesten, Medical Director, Office of Quality and Patient Safety, New York State Department of Health
- Dr. Diane Marriott, Project Manager, Michigan Primary Care Transformation Demonstration Project
- Dr. Bob Rauner, Medical Director, SERPA-ACO; Project Lead, Nebraska Multi-Payer Patient-Centered Medical Home Initiative
Identification and Assessment of Children and Youth with Special Health Care Needs in Medicaid Managed Care: Approaches from Three States
Increasingly, states are relying on managed care delivery systems to serve Medicaid enrollees that have historically been exempt from enrollment in managed care, such as children and youth with special health care needs (CYSHCN). The federal Medicaid managed care regulations establish the broad requirements for states to identify and assess individuals with special health care needs. However, little has been recently documented about specific state policies or procedures for identifying and assessing CYSHCN. This report, prepared with the support of the Lucile Packard Foundation for Children’s Health, looks at such approaches in three states – California, Massachusetts and Michigan – and includes some promising practices states may consider in implementing Medicaid managed care for this vulnerable population.
February 2014
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For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
