Illinois Medicaid Provider Enrollment: Fill & Download for Free

I'm writing this in Summer of 2017 in the midst of Congressional & public debate about the American Health Care Act (U.S. House Bill) & Better Care Reconciliation Act (U.S. Senate Bill) which have both been labeled “TrumpCare.” In assessing the situation, here's what I've proposed to my Congressional delegates. (If you like what I have to say, please relay these suggestions to your Senators and House Representative as well.)Eliminate the Employer Health Care Tax Deduction for direct purchases of group health insurance plans by employers. This can't be allowed anymore if we are to move forward in any direction. As President Obama repeatedly highlighted, this status quo is an accident of history and the principal-agent problems caused are what distorts everything else.Change rules to allow insurance premiums to be paid from Health Savings Accounts (HSAs) and/or Flexible Spending Accounts (FSAs) and lift the limit on tax deductible employer contributions to HSAs to the current threshold for the "Cadillac Tax" on high priced health-care plans. I believe that is $10,200 for individuals and $27,500 for families. That way, employers' cost of employee compensation stays stable and they don't suddenly lose the expected tax benefits on that part of employee compensation. The reason that I pick these numbers is because they are already established thresholds. (I also know that Congressional Republicans have been touting HSAs as a possibility for many years.)Transition all people who are accustomed to receiving group health insurance as an employment benefit to purchasing health insurance in the individual market. This will be politically scary and potentially very ugly, but we are in a time of policy crisis right now and – to borrow a line from Winston Churchill (made once again famous by Mayor Emmanuel of Chicago – we shouldn't let a serious crisis go to waste. Given that the PPACA-mandated public exchanges exist and operate and use the same vocabulary as employers like "Open Enrollment," it is conceivable to put together outreach programs that would get people used to signing up for health insurance with their employer to simply switch the place that they sign up for health insurance.As a matter of compensation fairness, an important thing we have going for us that the ACA required employers to report the value of health care premiums on W2s. This means that everyone now has several years of documentation of the value of their compensation. That can be used as a baseline for establishing HSA contribution levels. I envision that there would be a requirement that employers payments into the updated HSAs would match (or exceed) the employer expenditures on premiums in either the year of the legislation's passage or the year preceding the legislation taking effect — whichever is greater. (In other words, if the bill passes in 2017 but the transition doesn't take full effect until 2020, employers wouldn't be able to spend the intervening years gutting existing benefits in order to have a lower baseline for the HSA contributions.) Furthermore, I’d envision the HSA contributions being subject to the same laws and regulations as salaries/wages, meaning that employer contributions couldn’t be arbitrarily cut from one year to the next without employee consent.Pointing people to the public exchanges would be an obvious default, but individual market shopping (backed by employer HSA contributions) could happen through any number of mechanisms. Health insurance companies could still work with employers and/or Labor Unions to offer discounted rates as a benefit for employees who choose to sign up directly with the insurer, employers and/or labor unions could expand that benefit further by offering employees access to private exchanges (I understand that Walgreens and Sears do this for their employees already and IBM and Time Warner do this for their retirees), individuals could work with a private broker, or individuals so-interested could just shop on their own based on who their preferred health care provider actually works with. (I'm very sensitive to the narrow network problem between insurers and care providers.) Anyone who fails to enroll themselves should be automatically enrolled via the public exchange into a qualified Bronze-level plan unless they explicitly opt-out with a valid reason.Consolidate the administrative mechanisms for transmitting Medicaid funding from the Federal Government to State Governments into the administrative mechanisms for transmitting ACA subsidies for low-income Americans to private insurers. While there is much I don't understand to with regard to the complexities of the Medicaid funding formula, it is conceivable to simplify the way that money flows out of the United States Treasury into both private AND public insurance programs. In this conception, Medicaid programs would be full-premium-subsidy public insurance programs (with a combination of Federal and State funding) for qualifying low-income Americans. This potential bureaucracy reduction is likely to have some level of appeal to Republican policymakers. I also have no objection to the premium subsidies being accounted for as tax credits, provided that they are operationally the same to individuals and families relying on them. (Note here that we are strictly talking about Medicaid. I think Medicare is best left untouched right now.)Provided that requirements for universal coverage are met under all three of these approaches, enable and allow individual States to do one of three things with their Medicaid programs:Have Medicaid enrollment be restricted to qualifying low income citizens. (Just as now.)Allow states to open up their Medicaid programs for buy-in from any state resident who wants the presumably lower rates with partial or even no subsidy. States choosing to do this would effectively be making their Medicaid programs a public option. (Many States already allow people on disability to buy into Medicaid.)If so inclined, sunset their publicly-run Medicaid program and enroll low-income residents into qualified Bronze-level private insurance plans that offer some acceptable number of health care providers & hospitals within some acceptable distance of where the enrollee lives. The explicit understanding would be that the households who would otherwise be qualified for Medicaid wouldn't have any undue premium liability with the insurer and that the State would be legally on the hook to guarantee that. (I understand that Florida and Mississippi already do this, that Iowa has done this to mixed results, and that North Carolina, Illinois, and Oklahoma are exploring this. At the end of the day, however, I am principally interested in how California and Californians handle this and have limited interest in fighting other states with how they manage their already state-run programs.)You can also check out Ian McCullough's answer to What is the conservative argument against Obamacare and what solution to the problems with our healthcare system would they offer instead?, which I originally wrote in 2013 (despite me not identifying as a Conservative). Much of that still applies, and the other answers are insightful as well.

Why does Medicaid take 45–60 days for a determination?Simple answer is lack of resources and staffing. States utilizing online applications and computer technology can make a decision in as little as 1–7 days[1][1][1][1] with uploaded documentation under Medicaid Expansion[2][2][2][2] and if you are already in one of their connected social services computers[3][3][3][3] . States such as Illinois using online (all benefits considered) application process faster[4][4][4][4] . Online does not mean it will be faster.SOURCE: Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State SurveyDepending on your state, they may back date your benefits up to 3 months[5][5][5][5] . If you do not have a scanner for your computer,take a clear picture of needed documents with phone camera;download a phone scanner app;go to the library and have them scan documents.SOURCE: Medicaid Home | Medicaid.govA state-by-state guide to Medicaid: Do I qualify?The Medicaid agency usually has 45 days [but the wait time is longer in some states[6][6][6][6] ] to process your application. If the application requires a disability determination, the agency can take 90 days. But, it may take longer for the state to determine your eligibility if you do not provide the required documents on time.Oct 10, 2017Applying for Medicaid -When it comes to non-MAGI [Medicaid Adjusted Gross Income] Medicaid eligibility, both your income and your assets come into play. Most of the government programs that qualify you forMedicaid use an asset test. ... If your income and assets are above a certain level, you will not qualify for the program.May 22, 2018Your Assets, MAGI, and Medicaid Eligibility -Footnotes[1] CMS Posts New Medicaid and CHIP Application Processing Time Report[1] CMS Posts New Medicaid and CHIP Application Processing Time Report[1] CMS Posts New Medicaid and CHIP Application Processing Time Report[1] CMS Posts New Medicaid and CHIP Application Processing Time Report[2] Medicaid Expansion and Mental Health | NAMI: National Alliance on Mental Illness[2] Medicaid Expansion and Mental Health | NAMI: National Alliance on Mental Illness[2] Medicaid Expansion and Mental Health | NAMI: National Alliance on Mental Illness[2] Medicaid Expansion and Mental Health | NAMI: National Alliance on Mental Illness[3] https://ccf.georgetown.edu/wp-content/uploads/2018/03/2018-Medicaid-and-CHIP-Eligibility-Enrollment-Renewal-and-Cost-Sharing-Policies-as-of-January-2018-1.pdf[3] https://ccf.georgetown.edu/wp-content/uploads/2018/03/2018-Medicaid-and-CHIP-Eligibility-Enrollment-Renewal-and-Cost-Sharing-Policies-as-of-January-2018-1.pdf[3] https://ccf.georgetown.edu/wp-content/uploads/2018/03/2018-Medicaid-and-CHIP-Eligibility-Enrollment-Renewal-and-Cost-Sharing-Policies-as-of-January-2018-1.pdf[3] https://ccf.georgetown.edu/wp-content/uploads/2018/03/2018-Medicaid-and-CHIP-Eligibility-Enrollment-Renewal-and-Cost-Sharing-Policies-as-of-January-2018-1.pdf[4] IL Application for Benefits Eligibility (ABE) ABE Home Page[4] IL Application for Benefits Eligibility (ABE) ABE Home Page[4] IL Application for Benefits Eligibility (ABE) ABE Home Page[4] IL Application for Benefits Eligibility (ABE) ABE Home Page[5] Some states are rolling back 'retroactive Medicaid'[5] Some states are rolling back 'retroactive Medicaid'[5] Some states are rolling back 'retroactive Medicaid'[5] Some states are rolling back 'retroactive Medicaid'[6] How Long Do You Have to Wait to Receive Medicaid[6] How Long Do You Have to Wait to Receive Medicaid[6] How Long Do You Have to Wait to Receive Medicaid[6] How Long Do You Have to Wait to Receive Medicaid

In response, I have copied my article titled, “Beware of the Medicaid ‘Bog Con’” that was published in Huffington Post in May 2016.American revel in tales of a “big con” like The Sting and Ocean’s Eleven. Medicaid has an ongoing big con that is huge yet so well hidden that We the Sheep do not know we are being fleeced … by our own government.The Big ConAny good con has three parts: the mark—the one who is conned; the take—what the con man gets; and the fake, the illusion or purposeful distortion of reality. The bigger the take, the more marks conned, and the grander the fake, the bigger is the con. By those criteria, Medicaid’s estate recovery program, also called its “claw-back,” is a very, very big con.Estate recovery—the takeMedicaid rules allow the recovery of money from the estates of deceased Medicaid recipients. The children and heirs of people enrolled in Medicaid and eventually die must pay the government back.The size of your government bill varies from state to state but includes (1) an “administrative fee” of $611 per month from age 55 until Medicare enrollment, and (2) a percentage of the medical bills incurred. The heirs can get a bill $73,320 (admin fee) plus anywhere from a few more thousands of dollars to hundreds of thousands of dollars for their parent’s care, especially the terminal time, which is typically the most expensive.If the deceased parent owned a home or there was still pension money left, Medicaid will try to grab it. This is the take of Medicaid’s estate recovery program.Wide state-to-state variabilityThe federal government provides the legal framework through the Omnibus Reconciliation Act (OBRA) of 1993. Through Medicaid enrollment, the government feeds us into a meat grinder called estate recovery. While Medicaid is jointly funded by the States and by Washington, each state administers its own program independently, including whether they choose to impose estate recovery or not.Some states such as New Mexico (NM) do not use the claw-back. NM state administration concurs with Paul Craig Roberts, Former Assistant Secretary of the Treasury for Economic Policy, who called estate recovery “a pernicious death tax on those who have the least and are the most vulnerable.”Although Medicaid enrollees now compromise more than forty percent (815,000 individuals) of the NM population, and despite a $417 million budget shortfall, NM Medicaid chose to “claw back” a total of $9000, which represents 0.00000003 percent of its revenue ($9000/$3,000,000,000).Other cash-strapped states, such as California, Illinois, and Connecticut, take a rather different approach. Nationally, Medicaid programs recovered $361,766,396 from the poorest segment of our society in 2004. There are no more recent reports. This is alarming both because of the lack of transparency (outright lies) and the fact the Affordable Care Act certainly increased estate recovery collections but they won’t tell us how much.The FakeThe illusion or fake is that Medicaid is “free.” They say you get insurance coverage and “all the care Americans deserve,” and you don’t pay a thing. Strictly speaking, that true. YOU don’t pay. Your heirs do.The second part of the fake is what they don’t tell you: auto-enrollment and even the existence of the claw-back program. Some states include estate recovery in very fine print in the eleven-page Medicaid contract. Other states hide it entirely.Auto-enrollment is more than just automatic renewal each year. The state can enroll you without your permission or even your knowledge. The federal government can refer you to your state if you access a federal program such as SNAP (Supplemental Nutrition Assistance Program.)In fairness, the Affordable Care Act did not create estate recovery. It was started in 1993 with OBRA. However, Obamacare is culpable for protecting the illusion that Medicaid is free and extending this very not-free—expensive and unaffordable—benefit to millions.The MarkThe Obama administration takes great pride in the number of Americans who now have insurance because of Obamacare. They claim a reduction in the uninsured rate from 14.5 percent to 9.2 percent and a net gain of 16.9 million newly insured individuals. Between 84 and 97 percent of newly insured Americans are receiving “free” insurance through Medicaid. Should the government be proud that they turned seventeen million American citizens into seventeen million marks?In the movie The Sting, the mark is the villain and the conman is the hero. In Medicaid estate recovery, there is no hero. There is only a greedy, sneaky government conman who has tricked the poorest and most vulnerable members of American society and turned them into “marks.”Dr. Deane Waldman, MD MBA, Professor Emeritus of Pediatrics, Pathology, and Decision Science; and author “Curing the Cancer in U.S. Healthcare.” Website: www.deanewaldman.com.