WBEZ | medicaid http://www.wbez.org/tags/medicaid Latest from WBEZ Chicago Public Radio en Judge orders state to pay Cook County Medicaid providers during budget impasse http://www.wbez.org/judge-orders-state-pay-cook-county-medicaid-providers-during-budget-impasse-112465 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/Screen Shot 2015-07-23 at 2.22.14 PM_0.png" alt="" /><p><p><em>Updated at 4:30 p.m.</em></p><p>A federal judge in Chicago is ordering the Illinois state government to reimburse Cook County Medicaid providers, even though Gov. Bruce Rauner and lawmakers remain far apart on agreeing to a spending plan.</p><p>Medicaid payments are one of the state&rsquo;s largest expenses in any given year. With no agreement in sight on how much money the state should spend - or what rates to tax residents - the Sargent Shriver National Center on Poverty Law sued the Illinois&#39; Dept. of Healthcare and Family Services to reimburse Cook County Medicaid providers. The Shriver Center used a decade-old court order as the grounds on which to order the state to find the money necessary to refund hospitals.</p><p>&ldquo;The money is there. The money is available,&rdquo; Judge Joan Lefkow said from the bench, in giving her order.</p><p>Democratic Senate President John Cullerton recently estimated the Illinois&#39; Medicaid system will cost the state almost $8 billion for the next 11 months. Lawyers for the attorney general&rsquo;s office, who represent the Dept. of Healthcare and Family Services, argued in court that there&rsquo;s been no evidence of any patients being denied access to medical care since the state government lost its authority to spend money on July 1, when lawmakers and the governor didn&rsquo;t agree on a spending plan. But Lefko said, regardless of Cook County hospitals&rsquo; financial issues, they&rsquo;d be further exasperated by a lack of state money.</p><p>Thursday&rsquo;s court order from Judge Joan Lefkow chalks another not-so-small government service that&#39;s been deemed essential for state government to fund. Several existing court orders or federal laws have mandated the state continue to fund services like foster care operations and issue payroll checks to government employees. Rauner also approved a spending plan to keep Illinois&#39; K-12 schools open once classes start.</p><p>Judge Lefkow&#39;s decision also guarantees a flow of money will continue for hospitals that rely heavily on Medicaid reimbursements. Timothy Egan, CEO of the New Roseland Community Hospital on Chicago&#39;s South Side, said it would have to begin diverting ambulances from its Emergency Department and stop admitting new inpatients and outpatients, starting Monday, without court action. By the end of next week, Egan said, all inpatients would be transferred out of the hospital and he would begin laying off employees.​ Egan added that 71 percent of Roseland Community Hospital&#39;s revenue comes from the state government&#39;s Medicaid program.</p><p>&ldquo;You have to keep the whole system going as if there&rsquo;s no budget impasse in order to ensure the children have access to care,&rdquo; said John Bouman, an attorney with the Sargent Shriver National Center on Poverty Law, who brought the lawsuit against the state. Bouman said the judge&rsquo;s decision applies only to Medicaid providers in Cook County, but Gov. Rauner could decide to expand the decision to suburban and downstate providers.</p><p>A.J. Wilhelmi, the Chief Government Relations Officer for the Illinois Hospital Association, encouraged Rauner to expand the decision statewide--if, however, Rauner does not, Wihelmi believes there may be other courses for legal action, including returning to court and seeking action under another consent decree that could apply statewide.</p><p style="margin-top:0in;margin-right:-.5in;margin-bottom:0in;margin-left:-.5in; margin-bottom:.0001pt"><o:p></o:p></p><p>John Hoffman, a spokesman for the Department of Healthcare and Family Services said the agency is reviewing the court order, but would not say if it has plans to expand the judge&rsquo;s decision to all other Medicaid providers outside of Cook County.</p><p>Democrats, meantime, are using the latest court order to attack Rauner&rsquo;s veto of the unbalanced budget approved earlier this year. At the time, Rauner said he would not support an unbalanced budget, and lawmakers need to approve changes to workers compensation and freeze property taxes before passing a spending plan.</p><p>&ldquo;We know that some of this stalling around the non-budget issues is leading to budget and spending decisions out of his control,&rdquo; said Steve Brown, a spokesman for Democratic House Speaker Michael Madigan.</p><p>Senate President John Cullerton said earlier this week that if court mandates keep piling up and no spending plan is approved, Illinois state government faces a $4 billion deficit. The governor&rsquo;s office did not dispute that figure.</p><p><em>Tony Arnold is WBEZ&rsquo;s state politics reporter. Follow him </em><a href="https://twitter.com/tonyjarnold"><em>@tonyjarnold</em></a><em>. </em></p><p><em>Shannon Heffernan is a WBEZ reporter. Follow her </em><a href="https://twitter.com/shannon_h"><em>@shannon_h</em></a><em>.</em></p></p> Thu, 23 Jul 2015 14:40:00 -0500 http://www.wbez.org/judge-orders-state-pay-cook-county-medicaid-providers-during-budget-impasse-112465 Immigrants face barriers on health care site http://www.wbez.org/news/immigrants-face-barriers-health-care-site-109698 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/ACA immigrants_web.jpg" alt="" /><p><p>More than two months after the Obama administration declared <a href="https://www.healthcare.gov/">healthcare.gov</a> working &ldquo;smoothly for the vast majority of users,&rdquo; immigrants who try to sign up are still encountering serious glitches.</p><p>On Wednesday, federal officials <a href="http://www.hhs.gov/news/press/2014pres/02/20140212a.html">trumpeted</a> the fact that more than 1 million people signed up for private insurance in January, with Illinois accounting for nearly 89,000 of those enrollees. With fewer than 40 days until the deadline to enroll without incurring a penalty, much of the attention has turned to so-called &ldquo;young invincibles,&rdquo; a term for young, healthy people who will likely have lower health care costs.</p><p>There&rsquo;s no similar focus on immigrants, WBEZ has found, who continue to face significant hurdles with identity and citizenship verification, and faulty determinations of eligibility for Medicaid. In Illinois, the task of finding and navigating around those barriers often falls to scrappy enrollment specialists who work directly with those clients at community health centers. On top of their jobs, they are finding themselves tasked with bringing the glitches to the attention to state and federal authorities, and lobbying for them to be fixes.</p><p>Illinois, which is one of seven states to engage in a state-federal partnership, relies on the federal site to handle the enrollment function for plans offered on the state&rsquo;s insurance marketplace. Under the Affordable Care Act, immigrants are required to have insurance if they reside lawfully in the U.S. &ndash; even if they are not citizens.</p><p>&ldquo;Since November I have frequently made visits, and every time I made a visit I&rsquo;ve stayed at least 3-4 hours,&rdquo; said Zejna Belko, a 51-year old Bosnian immigrant who described her attempt to enroll in the healthcare exchange with the help of enrollment counselors at the Hamdard Center on Chicago&rsquo;s far North Side. &ldquo;We&rsquo;ve also had individuals from other agencies try to help us out.&rdquo;</p><p>Belko, who&rsquo;s lived in the U.S. with a green card for 16 years, said she&rsquo;s spent up to 30 hours working with enrollment specialists. Still, they haven&rsquo;t even been able to start her application because the system cannot verify her identity. So far, Belko has twice mailed identifying documents, such as copies of her green card and social security card, to the Department of Health and Human Services, to no avail.</p><p>&ldquo;My blood pressure rises,&rdquo; she said through a translator. &ldquo;I get very frustrated and angry because I&rsquo;m an honest person and I&rsquo;m not hiding anything, and I don&rsquo;t understand what the problem is. I just want to get health care coverage.&rdquo;</p><p>In a small health center in Wicker Park, Graciela Guzman said she sees these cases all the time. Most frequently, the issues with identity verification is done via checking an applicant&rsquo;s credit history &ndash; something Guzman said many newer immigrants don&rsquo;t yet have.</p><p>&ldquo;They haven&rsquo;t been here long enough to be considered &lsquo;bankable,&rsquo;&rdquo; she said. &ldquo;Like a lot of them have been paid by cash. Maybe they don&rsquo;t have banks. Maybe they don&rsquo;t own property. So the system has a harder time just finding them.&rdquo;</p><p><strong>The Morning Shift: How an ACA enrollment specialist is helping immigrants in Chicago</strong></p><p><iframe frameborder="no" height="166" scrolling="no" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/134626873&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_artwork=true" width="100%"></iframe></p><p>Guzman works with a team of five enrollment specialists at <a href="http://www.primecarechi.org/">PrimeCare Community Health</a>, a small clinic based in St. Elizabeth&rsquo;s Hospital in Chicago&rsquo;s Wicker Park neighborhood. About half of their clients are immigrants. Her team encounters hurdles to enrollment so frequently, they&rsquo;ve managed to cobble together a complicated flow sheet of workarounds. For identity verification problems, they&rsquo;ve found that calling the federal Health Insurance Marketplace Call Center, and later uploading or mailing a client&rsquo;s identification documents, usually helps to get an application started</p><p>But there are other barriers. Through trial and error, they found success in ignoring the site&rsquo;s directions to fill out information completely, and instead repeatedly clicking &ldquo;continue and save&rdquo; when they get an error on citizenship verification. The most significant challenge, however, appears not to have a workaround.</p><p>&ldquo;Most of our clients receive incorrect eligibility determinations, that tell them that they&rsquo;re eligible for Medicaid,&rdquo; said Guzman.</p><p>This is the case for lawful permanent residents whose incomes would qualify for Medicaid, but who are barred from enrolling in that program because they&rsquo;ve lived in the U.S. less than five years. Once the site directs an enrollee to apply for Medicaid, it does not allow them back onto the private healthcare exchange, where these clients should be.</p><p>&ldquo;We have brought this to the attention of our federal counterparts,&rdquo; said a state spokesman, &ldquo;and we believe they have been working to address it by adding new questions to <a href="https://www.healthcare.gov/">healthcare.gov</a> late last week that will allow people to get through to the Marketplace once they have been issued a denial.&rdquo;</p><p>In other words, immigrants are advised to apply for Medicaid even when they know they are ineligible for it, just to receive a denial. But since Medicaid eligibility was expanded under the Affordable Care Act, a backlog in applications has led to significantly longer processing times.&nbsp;</p><p>Guzman and her team of so-called &ldquo;navigators&rdquo; say, as they discover glitches, they&rsquo;ve relayed them to state and federal officials. So far, they have enrolled more than 600 immigrants to the healthcare exchange. In addition to the discoveries they&rsquo;ve made about getting through the technical difficulties, the team is also working out ways to handle the unexpected emotional impact of the job.</p><p>&ldquo;On our days off, we&rsquo;re constantly thinking about patients, which is like ludicrous,&rdquo; said Martin Jurado, who works with Guzman at PrimeCare. &ldquo;I don&rsquo;t think anybody else does that. You know? Somebody that you&rsquo;ve barely met, you barely know, yet you know everything about their life, what they&rsquo;re going through, and you&rsquo;re carrying that, and a lot of people didn&rsquo;t tell you that, starting off the bat.&rdquo;</p><p>Guzman found that <a href="http://guzmangraciela.wordpress.com/">blogging </a>helps her process their experiences. She writes of frustrations with the healthcare exchange website, but also about clients that stick in her head.</p><p>&ldquo;People really weren&rsquo;t hearing the complexity of the website, they weren&rsquo;t hearing people&rsquo;s fears and difficulties in getting through the website,&rdquo; she said. &ldquo;And so we wanted to share some of what&rsquo;s going on.&rdquo;</p><p>Together, she said, they have come to realize they are witnessing a moment: droves of people are coming out of the shadows because the law requires them to &ndash; and they&rsquo;re coming with needs that extend far beyond just health care.</p><p>&ldquo;We get them comfortable and primed, hopefully, for enrollment,&rdquo; she said, &ldquo;but then they&rsquo;ll turn around and kind of like almost offhandedly be like, &lsquo;so you helped me with this, can you help me with housing? Can you help me with food stamps? I have some domestic stuff going on, where do I go?&rsquo;&rdquo;</p><p>Guzman said she believes they&rsquo;re on the frontier of a new phase. She, Jurado, and the rest of their team will stick around after the crush of enrollment ends March 31st, helping people change or update their health plans. But she said they&rsquo;ll also continue to serve as access points to community resources when immigrants don&rsquo;t know where to go.</p><p><em>Odette Yousef is WBEZ&rsquo;s North Side Bureau reporter. Follow her <a href="https://twitter.com/oyousef" style="text-decoration:none;">@oyousef</a> and <a href="https://twitter.com/WBEZoutloud" style="text-decoration:none;">@WBEZoutloud</a></em></p></p> Thu, 13 Feb 2014 12:29:00 -0600 http://www.wbez.org/news/immigrants-face-barriers-health-care-site-109698 Conservative conference draws lawmakers, picketers http://www.wbez.org/news/conservative-conference-draws-lawmakers-picketers-108356 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/repubs.png" alt="" /><p><p>CHICAGO &mdash;More than a thousand conservative lawmakers and business executives from across the nation are gathering in Chicago to craft policy proposals that could be pushed in state capitols next year.</p><p>Attendees at the annual meeting of the American Legislative Exchange Council were countered Thursday by a roughly equal number of protesters upset by the close ties between big businesses and lawmakers.</p><p>The council has backed model legislation passed in Republican-led states that has sought to invalidate key portions of the federal health care law, reduce union powers and cut taxes. Participants discussed ways Thursday of injecting more private-sector involvement in state Medicaid programs and pushing laws that bar union membership from being a requirement for employment.</p><p>Protesters outside the meeting accused the organization of corporate greed and union busting.</p></p> Thu, 08 Aug 2013 13:49:00 -0500 http://www.wbez.org/news/conservative-conference-draws-lawmakers-picketers-108356 Chicago's Sacred Heart Hospital raided by feds in kickback scheme, four arrested http://www.wbez.org/news/chicagos-sacred-heart-hospital-raided-feds-kickback-scheme-four-arrested-106672 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/sacredheart.JPG" alt="" /><p><p>Federal authorities raided Sacred Heart Hospital on Chicago&rsquo;s West Side Tuesday morning. &nbsp;</p><p dir="ltr">The hospital&rsquo;s owner and chief financial officer were arrested, along with four doctors.</p><p dir="ltr">The U.S. States attorney&rsquo;s office alleges hospital officials paid kickbacks to physicians in return for referrals of Medicare and Medicaid patients.&nbsp;Prosecutors say about $2 million in Medicare reimbursement payments were seized Tuesday from various bank accounts.</p><p dir="ltr">An FBI spokeswoman in Chicago, Joan Hyde, confirmed warrants were served during a raid Tuesday morning at the hospital.</p><p dir="ltr">Hospital Chief Nursing Officer Jim Bailey says the hospital continues to provide ongoing care. He says the hospital has no additional information on the investigation.</p><p dir="ltr">Though not charged, <a href="https://docs.google.com/file/d/0B1g80TU7KaJJUFZSdDczOXNBZWs/edit?usp=sharing" target="_blank">the affidavit</a> also suggests the hospital unnecessarily admitted patients to the emergency room and performed unneeded tests to increase billing. &nbsp;</p><p dir="ltr">The investigation is also probing claims that the hospital performed unnecessary tracheostomies to collect substantial insurance reimbursements.</p><p dir="ltr">&ldquo;Today&rsquo;s arrests demonstrate our commitment to enforcing the laws intended to prevent abuses of the Medicare and Medicaid programs and to preserve the ability of those programs to provide appropriate medical services to the elderly and the needy,&rdquo; said Cory B. Nelson, Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation.</p><p dir="ltr">Arrests included:</p><ul dir="ltr"><li style="">Edward J Novak, 58, of Park Ridge, Sacred Heart&rsquo;s owner and chief executive officer</li><li style="">Roy M Payawal, 64, of Burr Ridge, executive vice president and chief financial officer</li><li style="">Doctors Venkateswara R. Kuchipudi, of Oak Brook; Percy Conrad May Jr., 75, of Chicago; Subir Maitra, 73, of Chicago and Shanin Moshiri, 57, of Chicago.</li></ul><p dir="ltr">All six defendants are scheduled to have their initial court appearance April 16.</p><p dir="ltr">The Illinois Department of Public Health says its now assessing patient care at the Chicago hospital.</p><p>The department said in a news release Tuesday afternoon that it&#39;s at Sacred Heart Hospital to assess the facility&#39;s ability to care for patients and will conduct a full inspection of the facility to see if there are any state or federal violations.</p><p>Hospital officials said they are cooperating with federal authorities.</p><p>If you or a loved one has received unnecessary treatment at Sacred Heart, or any hospital, you can report it at <a href="http://www.stopmedicarefraud.gov">www.stopmedicarefraud.gov</a></p><p><em>Shannon Heffernan is a WBEZ reporter. Follow her&nbsp;@<a href="http://twitter.com/shannon_h" target="_blank">shannon_h</a>.&nbsp;</em></p></p> Tue, 16 Apr 2013 12:42:00 -0500 http://www.wbez.org/news/chicagos-sacred-heart-hospital-raided-feds-kickback-scheme-four-arrested-106672 Cook County begins enrolling 250,000 new Medicaid recipients http://www.wbez.org/news/cook-county-begins-enrolling-250000-new-medicaid-recipients-103902 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/Dr Raju Headshot 2012.jpg" alt="" /><p><p>This week Cook County will start sending letters to about 115,000 of its low-income residents inviting them to enroll in the county&rsquo;s new Medicaid program.</p><p>Adults under 65 with an income of up to 133% of the <a href="http://aspe.hhs.gov/poverty/figures-fed-reg.shtml">federal poverty level</a> will be eligible for Medicaid beginning in 2014 in states that choose to participate in the Affordable Care Act Medicaid expansion.</p><p>In Cook County, the expanded eligibility will begin even sooner, in January 2013. Cook County applied for and received a federal waiver to let the law kick in a year early.</p><p>&ldquo;We are excited not only because we got the waiver, we also get an opportunity to transform our healthcare system into the way it should be,&rdquo; said Dr. Ram Raju, CEO of Cook County Health Services.</p><p>The new Medicaid program, called County Care, will operate on a &ldquo;medical home&rdquo; model - which means the county&rsquo;s patients would have a doctor, a nurse, a social worker, and a medical assistant assigned to manage their health care.</p><p>&ldquo;What we do in the old model is, if you come through the door, you are my problem, I&rsquo;ll treat you well, I&rsquo;ll give you prescriptions. Then, you are not my problem until you come back next time six months later,&rdquo; said Dr. Raju. &ldquo;In the medical home model, even when you go home, you are still my responsibility.&rdquo;</p><p>To begin enrollment County Care, the county plans to reach out to every single eligible person currently on its books.</p><p>&ldquo;It&rsquo;s a massive task, because it is a lot of people we need to reach within a short period of time,&rdquo; said Dr. Raju. &ldquo;But one good advantage is that most of the people are already in our system.&rdquo;</p><p>A total of about 250,000 people in Cook County are probably eligible for County Care, but the county first plans to make contact with those who have already come through the Cook County system or one of its community health centers. After Nov. 26, low-income adults who are not already on the books will be able to call to find out whether they are eligible.</p><p><strong>County Care to provide mental health and substance abuse services</strong></p><p>Medicaid is generally administered by states, but the federal waiver offered under Obamacare allowed counties to apply to create Medicaid programs jointly operated by the county and the federal government. The costs of the expanded coverage under County Care bypass the Illinois&rsquo; <a href="http://will.illinois.edu/news/spotstory/ill.-house-votes-to-slash-medicaid-funding/">fiscally rocky Medicaid system</a>&nbsp;&ndash; they&rsquo;re split between the county and the federal government.</p><p>Come 2014, eligible people will be able to leave County Care and enroll in Medicaid through the state of Illinois. County Care patients are required to go to a provider within the county&rsquo;s network of hospitals and affiliated Federally Qualified Health Centers, whereas recipients of state Medicaid can go to any doctor that accepts Medicaid.</p><p>But Dr. Raju said he hopes that by then, they will want to choose County Care. In addition to setting up patients in a &ldquo;medical home&rdquo;, County Care will provide mental health and substance abuse services, which Illinois Medicaid currently does not cover. The lack of mental health services in the region has been a topic of <a href="http://www.wbez.org/news/dart-%E2%80%98we%E2%80%99re-criminalizing-mental-health%E2%80%99-102218">ongoing controversy</a>.</p><p>&ldquo;If there are substance abuse issues, we do not want them to get lost in the system,&rdquo; he said. And he thinks the medical home model should be in use around the country. &ldquo;We believe that is the future of the healthcare delivery model in this country.&rdquo;</p></p> Mon, 19 Nov 2012 00:00:00 -0600 http://www.wbez.org/news/cook-county-begins-enrolling-250000-new-medicaid-recipients-103902 Community health centers prepare for influx of new patients under Obamacare http://www.wbez.org/news/community-health-centers-prepare-influx-new-patients-under-obamacare-103877 <p><p>Medical providers are preparing for an avalanche of new patients as the federal health-care overhaul becomes a reality in Cook County.</p><p>One in five adults in Cook County is currently without health insurance, and the Affordable Care Act (ACA) mandates that all Americans access health insurance of some kind beginning in 2014.</p><p>&ldquo;The population that&rsquo;s coming into coverage hasn&rsquo;t been consumers of the service,&rdquo; said Warren Brodine, CEO of Chicago Family Health Centers (CFHC). &ldquo;So I&rsquo;d submit that none of us really knows how to care for that population completely. We don&rsquo;t know what their preferences are. Are we gonna need to be providing primary care at 10 o&rsquo;clock at night? That very well may be the case.&rdquo;</p><p>Illinois has already turned in its blueprint for an exchange, a state-run marketplace for private insurance that will also help connect low-income people to federal aid. And Cook County is planning to expand Medicaid coverage to 115,000 new patients beginning in January 2013.</p><p>What remains unclear to many &ndash; including providers themselves &ndash; is just how many new patients will start flooding the health system as soon as six weeks from now, when Cook County begins its Medicaid expansion.</p><p>&ldquo;Even without the Affordable Care Act people are really struggling to get appointments in a timely manner,&rdquo; said Kimberley Tester Smathers of Heartland Health Centers. Medicaid patients are subject to long waits because their options are limited; Illinois&rsquo; Medicaid reimbursements are&nbsp;<a href="http://www.chicagomag.com/Chicago-Magazine/The-312/February-2012/Illinois-Medicaid-Mess/">notoriously slow</a>.</p><p>In Cook County alone, over 800,000 currently uninsured people will be required to get insurance or pay a fee in 2014; many will be eligible for subsidies. But whether it&rsquo;s Medicaid or private insurance that covers their visits to the doctor, the newly insured will still need a place to get care.</p><p><strong>Community health centers prepare to fill the gap</strong></p><p>Hundreds of community health centers across the country have received ACA funding since 2010 to build new facilities and expand capacity.&nbsp;Two years after the ACA funds first started to flow,&nbsp;<a href="http://www.ahschicago.org/sites/default/files/pdfs/groundbreaking_press_release10-12.pdf">new health centers</a>&nbsp;are popping up with regularity across the&nbsp;<a href="http://news.medill.northwestern.edu/chicago/news.aspx?id=208153">city</a>&nbsp;and&nbsp;<a href="http://evanston.patch.com/articles/community-health-center-opens-in-evanston">suburbs</a>.</p><p>CFHC is currently building a new health center in Pullman funded by a $6.2 million grant under the ACA. It takes up an entire city block, and will replace an outdated facility nearby. The facility, expected to open in summer of 2013, will have the capacity to serve 10,000 new patients per year.<img alt="" class="image-original_image" src="http://llnw.wbez.org/styles/original_image/llo/insert-images/RS6668_Picture - 11.16.11 247-scr_0.jpg" style="height: 233px; width: 310px; float: right;" title="Laying the final beam at the CFHC's new Pullman site (Bulley &amp; Andrews Construction/Charles Weatherington)" /></p><p>But Brodine has no idea just how many newly insured people will flock to his organization&rsquo;s five South Side locations - or precisely what their needs will be.</p><p>&ldquo;We&rsquo;re pretty sure there&rsquo;s quite a bit of pent-up demand in underserved communities, people who today drop in at an emergency department when they have some urgent need that really should have been taken care of in the context of a primary care relationship,&rdquo; he said.</p><div><p>CFHC serves 28,000 low-income Chicagoans at five South Side locations; more than half of their patients are on Medicaid, and only 4 percent have private insurance.</p><p>The federal government&#39;s long-term goal is to help expand the capacity of community health centers by 20 million &ndash; double what they serve now. Nearly&nbsp;<a href="http://healthreform.kff.org/federal-funds-tracker.aspx">&nbsp;$80 million in federal funds has already been doled out in I</a><a href="http://healthreform.kff.org/federal-funds-tracker.aspx">llinois</a>, and in 2012 alone, the Department of Health and Human Services made grants for the creation of 219 new sites nationwide.</p><p>Community health centers, also known as Federally Qualified Health Centers (FQHCs), are non-profits tasked with providing primary care at sliding scale rates. These health centers were first created nationwide in 1965 and they are required to accept Medicaid and Medicare; most also receive federal grant funding. Many of Chicago&rsquo;s FQHCs have been providing care for low-income people for thirty or forty years.</p><p>FQHCs are used to taking on the uninsured. But now, they also need to plan ahead to be able to help patients get on insurance under the ACA, even though it is not entirely clear yet how the insurance exchange will work.</p><p>&ldquo;Some of those questions are just starting to be answered on the logistics level,&rdquo; said Smathers. &ldquo;But this is all really confusing. It&rsquo;s confusing for me, and I can&rsquo;t imagine how confusing the insurance options might be for our patients.&rdquo;</p></div><div><strong>A shift from response to prevention</strong></div><div>&nbsp;</div><div>Brodine said the state of Illinois has dragged its feet more than some states on setting up its insurance exchange and making it clear how healthcare providers will be involved in enrollment.</div><p>But to him, implementing Affordable Care is not just about increasing the number of health centers and doctors.</p><p><img alt="" class="image-original_image" src="http://llnw.wbez.org/styles/original_image/llo/insert-images/RS6671_IMG_4609-scr.JPG" style="height: 218px; width: 290px; float: left;" title="Chicago Family Health Center CEO Warren Brodine (WBEZ/Lewis Wallace)" />&ldquo;An insurance card is not enough; it&rsquo;s only half the equation.&rdquo; The other half of the equation is a transition to a system in which nearly everyone has primary care &ndash; and knows how to use it. As Mitt Romney&nbsp;<a href="http://www.washingtonpost.com/blogs/election-2012/wp/2012/09/24/romney-calls-emergency-room-a-health-care-option-for-uninsured/">reminded us</a>&nbsp;during the 2012 presidential campaign, the emergency room has long been the fall-back of the uninsured. Community health clinics will be tasked with convincing people to come to them for preventive care, rather than waiting until they already have severe health conditions.</p><p>CFHC has already brought in 1,500 new patients through a program focused on hypertension. Hypertension, or high blood pressure, has a disproportionate impact on youth of color, particularly young men. Hypertension can be easily treated if a doctor catches the signs early. And it affects a group that is unlikely to be going to the doctor preventively right now.</p><p>&ldquo;We very purposefully targeted this program toward individuals who we know would be covered in 2014, so that when they have coverage...they already know us,&rdquo; said Brodine. The project should help young people get used to preventive care and treatment, and in the process, help them get used to the idea of having a primary care physician before they become eligible for insurance.</p><p>Brodine also predicted the new healthcare model will lead to an increased focus on the quality and outcomes of preventive care.</p><p>&quot;We need to flip it around to a preventive approach, where people are exercising, people are eating right, people can get fresh fruits and vegetables in their local communities,&rdquo; he said. &ldquo;And you can&rsquo;t take away the issues of things like housing adequacy and violence as real contributors to health. Those things are going to have to be addressed in a coordinated way.&rdquo;</p><p>All of which means it&rsquo;s an exciting time to be in the business of running community health clinics, whose mandate since their creation has been to provide community-centered care in low-income areas. If Affordable Care works out the way he hopes, Brodine said he&rsquo;ll finally see some of his own dreams for community healthcare realized.</p><p>&ldquo;We want the &lsquo;health center&rsquo; to take that name,&rdquo; said Brodine, &ldquo;and mean more than a beefed up doctor&rsquo;s office, but your center of health in the community.&rdquo;</p></p> Fri, 16 Nov 2012 12:00:00 -0600 http://www.wbez.org/news/community-health-centers-prepare-influx-new-patients-under-obamacare-103877 Quinn seeks business support on Medicaid, pensions http://www.wbez.org/news/quinn-seeks-business-support-medicaid-pensions-98766 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/AP120502118702.jpg" alt="" /><p><p>Democratic Gov. Pat Quinn is asking business leaders to help him pass legislation that will mean pain for union members and poor families.</p><p>Quinn says Illinois must control the growing cost of government pensions and health care. He proposes cutting pension benefits and Medicaid services by billions of dollars.</p><p>Quinn spoke to a business conference Wednesday and asked for help in meeting what he calls "the challenge of our time."</p><p>"I did not create this pension problem. I did not creat the Medicaid problem. But my job is here to solve that problem, with your help. Because this is the moment," he said.</p><p>David Vite of the Illinois Retail Merchants Association introduced Quinn by praising his "bold and innovative" proposals to strengthen the state budget.</p><p>Unions object to the pension cuts, saying they penalize workers for decades of government failures. And social service advocates say cutting Medicaid will hurt people who most need help and kill thousands of jobs.<br>&nbsp;&nbsp;&nbsp;&nbsp;</p></p> Thu, 03 May 2012 10:14:00 -0500 http://www.wbez.org/news/quinn-seeks-business-support-medicaid-pensions-98766 Legislators return to Springfield to debate pensions, $2.7 billion in Medicaid cuts http://www.wbez.org/blogs/bez/2012-04/legislators-return-springfield-debate-pensions-27-billion-medicaid-cuts-98296 <p><div class="image-insert-image " style="text-align: center;"><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/flickr%20myoldpostcards.jpg" title="(Flickr/myoldpostcards)"></div><div class="image-insert-image ">&nbsp;</div><div>Lawmakers reconvene in Springfield Tuesday to begin debating the ongoing budget crisis, including Gov. Pat Quinn’s <a href="http://www.wbez.org/news/medicaid-group-strains-27-billion-cuts-98231">proposal for cutting $2.7 billion</a> from the state’s Medicaid funding. For the past three years, the legislature has knowingly passed unbalanced budgets, exacerbating its major debts. Leading legislators and the governor have all made statements regarding the urgency with which this issue, as well as the impending pension crisis, must be deliberated; however, according to<a href="http://www.foxillinois.com/news/illinois/Illinois-politicians-to-take-on-budget-pensions-Medicaid-147685125.html"> Fox News</a>, the governor’s working commission on pension funding has already delayed their initial report from today to later this week. On <em>Eight Forty-Eight</em> this morning, Tony Sarabia will circle up with some of our downstate reporters to discuss the governor’s impending remarks and how they might affect new policy.<br><br>But first, WBEZ reporter Becky Vevea will join us to talk about the pressing Medicaid issue. Facing a gross imbalance, Gov. Quinn proposed cutting $2.7 billion from the state’s $14 billion Medicaid budget. The cuts would mean significant reductions in service. Some have made a case for focusing these cuts on services for the elderly and disabled, since they receive the vast majority of Medicaid spending. Other potential proposals might include reducing prescription coverage, eliminating hospice programs and palliative care for children, or reducing the quantity of renewals for things like eyeglasses, dentures and adult diapers. Gov. Quinn, who organized a research team to come up with some of these suggestions, has also proposed a cigarette tax hike, a suggestion that the <em><a href="http://www.rrstar.com/updates/x1157752631/Illinois-Medicaid-group-strains-for-2-7-billion-in-cuts">Associated Press</a></em> reports has been met with consternation. Meanwhile, the <em><a href="http://articles.chicagotribune.com/2012-03-29/business/ct-biz-0327-childrens-hospital-20120324_1_medicaid-cuts-charity-care-illinois-hospitals/2">Chicago Tribune</a></em> reports that many hospitals that depend on funding from Medicaid are already struggling after losing tax-exempt status for providing charitable care.<br><br>Pensions are another looming disaster for Illinois, and Michael Puente will join us on to elucidate further how Illinois retirement spending came to &nbsp;be underfunded by<a href="http://www.wbez.org/news/economy/bga-panel-state%E2%80%99s-pension-problems-now-priority-98082"> $80 billion</a>. Both House Speaker Michael Madigan and Senate President John Cullerton. according to<a href="http://www.chicagobusiness.com/article/20120414/ISSUE05/304149979/pension-reform-is-nigh-unlikely"> Greg Hinz of Crain's <em>Chicago Business</em></a>, have made it clear that the pension issue must be a top priority. The Governor’s pension reform commission will report on proposed methods of closing the funding gap, such as freezing state pension increases, raising the retirement age and cutting back on retiree health insurance. Still, for years the state government has failed to make the appropriate deposits to the State Retirement System, and at this point, according to <em><a href="http://www.bloomberg.com/news/2012-04-09/illinois-is-pension-basket-case-you-forgot-about.html">Bloomberg</a>,</em> it has only 36% of the funding it needs. Going forward, Illinoisans can expect to pay considerably higher rates into state pensions than ever before.<br><br>And finally, to round out our panel on budget decisions, Natalie Moore will share a few ways in which public schools could be hurt &nbsp;by decisions made in Springfield this week. CPS schools especially, accustomed to receiving block grants where other schools receive funding per pupil, could face the greatest reductions they have seen since the start of the recession. This would likely mean cuts in early childhood education, transportation and special education; the <em><a href="http://www.bnd.com/2012/03/25/2114339/will-states-budget-crisis-imperil.html">Bellevile News-Democrat</a> </em>reported in late March that programs for autistic students especially may be threatened. Also facing public schools, reports Vevea, are federal mandates for more stringent teacher evaluations and student assessments, which the state is bound to uphold but for which it has not received full funding.<br><br>Tune in to find out if the solutions to the debt crisis are right around the corner, or whether deliberations will drag on, and listen to our seasoned Springfield reporters discuss which sectors will feel the bear the brunt of Illinois’s new austerity.</div></p> Tue, 17 Apr 2012 08:24:40 -0500 http://www.wbez.org/blogs/bez/2012-04/legislators-return-springfield-debate-pensions-27-billion-medicaid-cuts-98296 All Kids health program set to drop thousands soon http://www.wbez.org/news/all-kids-health-program-set-drop-thousands-soon-98137 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/RS5374_photo-scr_1.jpg" alt="" /><p><p>Time is running out for approximately 4,000 Illinois children who've been covered by <a href="http://www.allkidscovered.com/">Illinois’ All Kids Medicaid program</a>. On July 1, they won't meet the latest eligibility guidelines. The program's biggest supporters hope to reverse the decision, but Illinois is facing a budget crisis and lawmakers are considering massive Medicaid reform to make ends meet.</p><p>The Wright household is wrapping up dinner this weekday night.&nbsp;Vinita Wright cooked fried rice and husband Jim rinses bowls as he loads the dishwasher.</p><p>The couple has guardianship over Sara Opsenica, the daughter of a family friend. Sara’s a high school freshman diagnosed with cancer, specifically, non-Hodgkin’s lymphoma.&nbsp;Vinita shows me a bag of liquid Sara gets hooked up to overnight.</p><p>VINITA WRIGHT: This is nutrition. We call it TPN. I don’t know what that means. But it’s basically nutrition. There are lipids in it, that’s why it’s white. it’s a fatty substance.</p><p>Sara’s prescriptions, hospital visits, chemotherapy have all been paid for underAll Kids. Sara was diagnosed last fall but had been on All Kids for several years. Sara’s father had been unemployed but he’s now a shuttle bus airport driver, and his health insurance coverage is haphazard; he'll be off it a while, then he’ll have coverage, only to be off again. The family says&nbsp;All Kids has been a relief.</p><div class="mediaelement-audio"><audio class="mediaelement-formatter-identified-1334268448-1" src="http://llnw.wbez.org/AfternoonShift_20120412_AllKids.mp3">&nbsp;</audio></div><p>&nbsp;</p><p>SARA OPSENICA: My dad doesn’t make a lot of money. We just have Social Security because my mom passed away. The All Kids have paid for everything. I don’t think - we have a small co-pay of my prescriptions but I don’t think my dad has gotten any hospital bills.</p><p>But things will likely change for Sara because&nbsp;Illinois is making new rules about who can be on All Kids. Families that make 300 percent above the poverty level are getting kicked off. That means the cut-off is about $60,000 for a family of four. President Barack Obama’s health care plan would cover kids like Sara, but not until 2014, and only if the law survives a challenge in the U.S. Supreme Court.</p><p>STEPHANIE ALTMAN: It’s not a lot of of people when you think all the people in Illinois, but it is a group of children who generally can’t get insurance any other way.</p><p>Stephanie Altman directs programs and policy at a non-profit group called Health and Disability Advocates. She worries what will happen to the 4,300 kids after July 1.</p><p>STEPHANIE ALTMAN: The families are working class and working at jobs where health insurance is not offered and the family is kind of living by the rules and doing all the right things and has too much money for Medicaid.</p><p>Illinois spends about $14 billion on Medicaid, and All Kids accounts for about $75 million of that. But the program is in trouble in Illinois. Governor Pat Quinn says the state needs to balance the budget, so he wants to cut Medicaid by $2.7 billion.</p><p>There’s some legislative support for shaving the state's Medicaid spending. Here’s state Senator Matt Murphy, a Republican from Palatine.</p><p>MURPHY: Illinois right now is in the unique situation of having to cut the largest percentage of their Medicaid overall budget than any state in the country. So we’re going to have to make difficult choices within our Medicaid program and prioritize for whom those dollars should be spent.</p><p>Illinois lawmakers are working on Medicaid reform this spring. One idea on the table is to keep All Kids as it is for two more years, until the National Health Care Act kicks in. State Senator Heather Steans is a Democrat from Chicago who supports an extension.</p><p>STEANS: You know in the long run it makes a lot more economical sense as well as much better health outcomes to get people in and seeing the doctor regularly, get them their immunizations, make sure they’re doing all their well visits that they can so people are not ending in much more expensive care situations.</p><p>Policymakers say the worst case scenario is that families will skip giving medicine to their kids, and those kids will end up in emergency rooms.</p><p>Back in Chicago’s West Chesterfield neighborhood, Vinita Wright is considering what will happen to Sara Opsenica, the girl in her care. Vinita says Sara’s chemo treatment should last another 16 months, but All Kids runs out in less than three.</p><p>VINITA WRIGHT: There’s so much stress connected to this cancer business...to not have to deal with a whole other several layers of stress having to do with which bill do we attempt to pay first.</p><p>Sara’s family is seeking alternatives, hoping maybe another agency can step in to pay the bills.<br>&nbsp;</p></p> Wed, 11 Apr 2012 12:43:36 -0500 http://www.wbez.org/news/all-kids-health-program-set-drop-thousands-soon-98137 Quinn's urges closings, consolidations in his budget address http://www.wbez.org/story/quinn-suggest-closings-consolidations-96621 <img typeof="foaf:Image" src="http://llnw.wbez.org/story/photo/2012-February/2012-02-22/AP1202010107167.jpg" alt="" /><p><div class="inset"><div class="insetContent"><p><span style="font-size: 10px;">Listen to Governor Pat Quinn's speech here<span style="font-style: italic;">&nbsp; </span></span></p><p><span class="filefield_audio_insert_player" href="http://www.wbez.org/sites/default/files/story/insert-image/2012-february/2012-02-22/quinn-speech.mp3" id="filefield_audio_insert_player-126220">quinn-speech.mp3</span></p></div></div><p>During his budget address Wednesday, Gov. Pat Quinn suggested cutting the state budget beyond overhauling pensions and Medicaid.</p><p>&nbsp;</p><p>Quinn wants to close two prisons - including the state's maximum security Tamms prison and a women's facility in Dwight - and consolidate nearly 50 office buildings statewide to save on rent. Under his plan, six trasition centers that help parolees once they've been released would be closed, and the state would instead use electronic monitoring to track them. &nbsp;</p><p>Twenty-four Department of Human Service offices would be consolidated, two juvenile justice centers in Joliet and Murphysboro, and 16 telecommunications centers used by Illinois State Police would be blended. Under the plan, inmates would be relocated to other prisons by the end of August. Quinn called the closures hard but necessary in his budget address.</p><p>"They impact every region in our state but the need for lower spending in our budget gives us no choice," Quinn said. "In times like these, we must be accountable and responsible."</p><p>The planned closures and consolidations are expected to save the state about $88 million dollars. It also means about one thousand layoffs. In all, Quinn says his cuts would trim more than $400 million from state agencies under the governor's control.</p><p>&nbsp;</p><p>Quinn also called for a $2.7 billion reduction in the state's Medicaid program. That's about a fifth of the Medicaid budget. The state's actual savings would be about half that, as the other half is federal money.&nbsp; The cuts&nbsp;could have outsized consequences for hospitals that serve the poor and uninsured. Safety net hospitals see a disproportionate number of low-income and disabled patients.&nbsp;So those facilities could be hit hard by any across-the-board cut in Medicaid reimbursement. &nbsp;Patrick Kitchen, a partner at consulting firm McGladrey, which with&nbsp;several safety net providers, said, "Programmatic reduction are almost guaranteed coming out of these proposed cuts. And in the near term, I think closures are certainly a possibility."&nbsp;</p><p>The Association of Safety Net Hospitals released a statement saying, quote: "blanket cuts are not a viable solution."&nbsp;But the cuts may not be applied equally to all providers - at least one lawmaker has called for softening the blow to safety net hospitals.</p><p>Jack Lavin, Quinn’s chief of staff, &nbsp;acknowledged to reporters in a Tuesday briefing that the cuts will be difficult.</p><p>"Every year we say this is toughest budget. But I’ll say it again. This year, this is the toughest budget we’ve ever faced," he said.</p><p>The state owes more than $8 billion in unpaid bills, about $2 billion of which are Medicaid-related.</p><p>"Medicaid spending must be restructured to keep the system alive and well. This is not something you can blithely delay for another year," Quinn said in his speech Wednesday. "Don't plan on going home for the summer until we get this job done."</p><p>Quinn said he would consider cutting payments to healthcare providers.</p><p>The state also is required to pay more than $5 billion into its pensions systems. Those two problems are swallowing the state's general revenue fund, which is its main checking account.</p><p>One area that might see a boost is education. Quinn has proposed a slight increase in funding for K-12 education and higher education. He wants to devote $50 million more toward the Monetary Award Program, a college scholarship program.</p><p><strong>'Loophole lobby'</strong></p><p>Quinn on Wednesday urged lawmakers to ignore a group he called "the loophole lobby." The governor called out just one specific "loophole" - which benefits oil companies - but said his revenue chief will work with lawmakers to identify more.</p><p>"For too long, we've had a revenue code that looks like Swiss cheese, with plenty of loopholes for the powerful. Many of these loopholes are based on politics, not economics," Quinn said.<br> <br> The money saved would help pay down the state's billions in unpaid bills, Quinn said, and allow for what he called "targeted tax relief" for families and businesses.</p><p><strong>A predictably mixed reaction</strong></p><p>But some Republicans questioned Quinn's use of the term "loopholes."</p><p>"Those of us who actually appreciate people that create jobs in the state of Illinois call them 'incentives,'" state Sen. Kirk Dillard of Hinsdale said.</p><p>Dillard added that if Illinois had a "friendly" business climate, the state wouldn't need to "give away any loopholes."</p><p>A similar statement followed from the Illinois Chamber of Commerce. It said the business community is "tired of hearing the incessant annual chorus of 'loophole closing.'"</p><p>Republican state Sen. Tim Bivins of Dixon questioned whether prisons are the right place to cut.</p><p>"We need to provide the core services of government, you know, your public safety and that certainly would include prisons," Bivins said Tuesday night. "We already have an overcrowding problem...I don't know how all that's going to wash. I have to see more details and exactly where [Quinn is] going with that."</p><p>Quinn's proposal to close two of the state's eight youth prisons was greeted warmly by Betsy Clarke of the advocacy group, the Juvenile Justice Initiative. Clarke noted the state's youth prison population is lower than it's been in decades.</p><p>"[The reduced population is] really very good news for the public in Illinois," Clarke said. "And this is really right-sizing the number of facilities. We have too many facilities for that lower population."</p><p>The union represeting many of the adult and youth prison employees warned of fallout from the facility closures. AFSCME Council 31 has been engaged in a bitter fight with Quinn in recent years over aborted pay raises and other spending-cutting measures.</p><p>"Budget cuts have gone too far already, harming priorities like public safety and care for the most vulnerable," the union's executive director, Henry Bayer, said in a statement. "Further devastating cuts to public services and thousands of lost jobs are the worst possible approach to what ails our state."</p><p>The final budget will depend on negotiations with the General Assembly. Lawmakers have until May 31, the final day of their spring session, to agree on a balanced budget.</p><p><em>WBEZ's Sam Hudzik, Gabriel Spitzer and Dulce M. Mora contributed.</em></p></p> Wed, 22 Feb 2012 12:30:00 -0600 http://www.wbez.org/story/quinn-suggest-closings-consolidations-96621