Fw: PFA Speaks: Push For Access Monthly Newsletter for May 2011

[Guest guest]

PFA Speaks: Push For Access Monthly Newsletter for May 2011There is some

important information here...check out Family Voices guide to Integrated Care.

It is very comprehensive and helpful.

I will also download the file and put it in the IPADDU files under

Integrated/Managed Care.

Ellen

Ellen Garber Bronfeld

egskb@...

PFA Speaks: Push For Access Monthly Newsletter for May 2011

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PFA Speaks

The Push For Access Monthly Newsletter

June 2011

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HFS’s Integrated Care Program

The Illinois Department of Healthcare and Family Services (HFS) has

begun changing the way Medicaid recipients with disabilities will receive

services. Over time, the delivery system for Medicaid services has become more

and more complex and costly. That, combined with growing financial limitations,

has led to a necessary change to the way these services are coordinated and

managed. HFS has created a program called the Integrated Care Program -

enrollment began May 1st of this year. Under this newly created program

Medicaid recipients with disabilities, who are over 19 years of age and not

Medicare eligible, will be required to enroll in one of the two contracted

healthcare providers - Aetna Better Health and IlliniCare Health Plan. It will

be the responsibility of Aetna and IlliniCare to manage and coordinate the

healthcare of enrollees. The implementation of this program will be a multiple

step process over the course of more than a year.

The first step of this process, which they are calling Service

Package 1, is the mandatory enrollment of qualifying individuals from Suburban

Cook, Dupage, Kane, Kankakee, Lake, and Will counties. Primary services such as

physician care, specialist visits, labs and x-rays, dental care, prescriptions,

transportation, and behavioral health and substance abuse services will be

covered by the new providers in this first step. Later steps will transition

coverage for long-term care to the new providers. Each of the plans will cover

services previously covered by Medicare, as well as newly added dental care.

The differences between the two mostly lie in technical areas, such as the need

for prior authorizations. It is important that recipients and those who care

for them take the time to learn more information about each organization, in

order to make the best choice to suit their needs.

Anyone interested in learning more can do so by visiting HFS’s

Integrated Care Website. If interested, you could contact the two providers,

Aetna and IlliniCare for more help and information. Also, Family Voices of

Illinois has put together a very well assembled guide to help individuals choose

the package that fits their needs, as well as additional information on the

Integrated Care Program.

Illinois’ Community Services Budget Outlook for State Fiscal Year

2012

The campaign this year for adequate funding for community services

has been a hard fought struggle among advocates, legislators, and the Governor.

As you may be aware, funds for these services have been cut disproportionately

for consecutive years, dating back far too long. This year, as every year, it

has been a battle between the House, Senate, and Governor over whose proposed

budget will be implemented. It was the House’s budget proposal that prevailed

this year and passed by the legislature. Unfortunately for community service

providers and recipients, the amount of money they proposed for those services

is less than that of the Senate proposal. Is there a Brightside? Yes,

thankfully there is. During the budgeting process House members of the

Appropriations Committee for Human Services were clearly aware of how damaging

rate cuts would be to community service providers, and how difficult it would be

for those rates to be restored in future years. At the same time the Senate

budget for Human Services had higher funding levels, but included a rate cut to

Medicaid, which would be a devastating and totally unfair option. In response

to this problem, advocates for Human Services worked with legislators and their

staff to put safeguards in place to try and prevent community services from

receiving rate cuts, and they were successful. So, what we are left with is the

House’s lowered level of funds for community services, but also restrictions

that would require the Governor to jump through some tight legislative hoops

should he seek to reduce payment for services for our current and future years.

Also included in this year’s budget is an interfund borrowing

package which would be used to pay backlogged Medicaid bills, thus potentially

catching community providers up on some very delayed payments. It should be

noted this budget package was not supported by advocates for community services,

and it is not yet finalized. Every bill that is passed by the General Assembly

must be approved by the governor, and that includes bills that were created to

formulize a budget. However, it will be dreadful if the Governor vetoes any

portion of the budget. If he does, the chances of attaining a better deal would

be more than bleak, as more Republicans would be required to participate in an

override vote. And, if you were not already aware, the Republicans in the

Senate want to cut even MORE out of the budget.

If/when a final budget is signed, we’ll be sure to keep you up to

speed on how it will affect community services. Remember, this newsletter comes

out the beginning of each month, but you can visit the Push for Access website

at any time to find useful information. Communication from the people is still

and will always be needed to make sure our government keeps our best interests

in mind.

You are receiving our regular communications because you signed up at

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