In the Governor’s budget speech, he told the General Assembly he wants us to cut Medicaid by $2.7 billion. I am a member of the Joint Legislative Medicaid Committee, so I will have to help figure out if we can meet the Governor’s goal. I want your help and advice. So sit down with your family, go through this list and help decide who gets cut.
The Department of Healthcare and Family Services provided us with this menu of possible items we can choose from to cut our entire $2.7 billion. (By choosing some of these, we could lose hundreds of millions of Federal matching money which would only make things worse. But let’s not consider that here). So sharpen you pencils and begin.
Remember, you cannot stop cutting until your total reaches $2.7 Billion! Keep in mind to take into account cutting a lower cost facility such as Supported Living could force the residents into higher cost Nursing homes, or that cutting all pharmaceuticals could translate into more costly Hospital Emergency or Acute Care, etc.
- ·Eligibility Cuts
| All Kids | Down to 200% of Federal Poverty Limit (FPL) (currently 300%). Affects 19,000 kids and would need to pay feds $81 million. Saves: |
$21,747,500 |
| Undocumented Kids on All Kids | Affects 50,700 kids. All state dollars. Saves: |
$52,488,900 |
| Family Care | Bring it down to 133% FPL. Affects 26,400 clients. Saves: |
$49,884,700 |
| General Assistance Adults | Affects 9,160 clients in Cook County. Could be eliminated without controversy if Cook County waiver is implemented. Saves: |
$16,681,300 |
| IL Care Rx | Affects 177,000 elderly clients, eliminates premium and co-pay support for prescription drugs. Saves: |
$72,154,000 |
| Kids with Insurance Rebate | Elimination of a $50-$75 monthly subsidy for parents to obtain private insurance for their children. Saves: |
$4,550,000 |
| Breast & Cervical Cancer Treatment | Moves eligibility down to 250% of FPL. Affects 380 clients. Saves: |
$5,643,300 |
| Torture Victims | Elimination of medical care for victims of torture. Affects 60 clients. Saves: |
$133,600 |
| Sexual Assault Treatment | Elimination of immediate healthcare needs for victims of sexual assault. Affects 1,000 clients. Saves: |
$2,496,100 |
| State Renal Dialysis Program | Elimination of renal dialysis program. Affects 270 clients. Saves: |
$462,000 |
| State Hemophilia Program | Elimination of the state program providing clotting medicine to hemophiliacs. Affects 250 clients. Saves: |
$19,182,000 |
| Eligibility for Nursing Facilities | Increase Determination of Need score from 29 to 37. |
$4,400,000 |
| Eligibility for Supported Living Facilities | Increase Determination of Need score from 29 to 37. |
$3,300,000 |
| Non-Citizens Renal Dialysis Program | Elimination of renal dialysis program for non-citizens. Affects 700 clients. Saves: |
$14,225,100 |
|
Total Savings for Eligibility Cuts |
$195,716,300 |
|
- ·Elimination of Optional Services
| Hospice |
$100,153,100 |
|
| Pediatric Palliative Care |
$4,500,000 |
|
| Reach Program |
$3,000,000 |
|
| Group Psychotherapy for Nursing Home Residents |
$13,127,000 |
|
| Transportation to Group Psychotherapy |
$1,129,100 |
|
| Dental Grants |
$1,000,000 |
|
| Adult Chiropractor |
$884,500 |
|
| Adult Dental |
$51,428,200 |
|
| Adult Occupational Therapy |
$567,900 |
|
| Adult Physical Therapy |
$2,486,600 |
|
| Adult Podiatric Care |
$5,842,500 |
|
| Adult Speech Therapy |
$411,000 |
|
| Limits on Adult Eyeglasses | 1 pair glasses every 2 years. |
$509,900 |
Durable Medical Equipment |
$150,087,500 |
|
| Adult Pharmaceuticals |
$814,780,900 |
|
| Case Management |
$18,300 |
|
| Adult Transplants |
$17,512,700 |
|
| Adult Rehab |
$17,500,000 |
|
| Ambulatory Surgical Treatment Centers |
$5,521,300 |
|
| Supported Living Facilities |
$122,714,100 |
|
| New Supported Living Facilities | Pays for new facilities to be built. |
$5,200,000 |
| Institutes for Mental Disease |
$130,431,800 |
|
| Intermediate Care Patients Currently Cared for in Nursing Homes | HFS estimates that 30% of those living in nursing homes could be placed in a cheaper setting such as a Supported Living Facility (SLF). This number assumes that 15% of nursing home residents are transitioned to an SLF or home setting. |
$521,315,800 |
|
Total Savings for Optional Services Cuts |
$1,952,639,600 |
|
Utilization Controls
| Copay for Federally Qualified Health Centers | Per dollar co-pay. |
$973,100 |
| Hospitals | Non-emergency Emergency Room visit copay (for $10 co-pay). |
$8,866,500 |
| More co-pays for all services |
$19,004,000 |
|
| Medically Fragile/Technology Dependent DD Waiver |
$1,823,500 |
|
| Medically Fragile/Technology Dependent Waiver | Do not renew. Seek 50/50 split between state and families for nursing care. This program is for children who are on ventilators. |
$19,160,000 |
| Private Duty Nursing | Move from private duty nurses to skilled home residents. |
$554,000 |
| Hospital Readmissions Program | Until FY 14. |
$0 |
| Hospital Detox | Instead of paying the $2,000 admission rate, pay $100 for 23 hours of observation. |
$25,492,400 |
| Bariatric Surgery | Require a wellness program and client participation prior to authorizing surgery. |
$8,455,000 |
| Home Health | 1% reduction achieved through utilization controls. |
$1,100,000 |
| Integrated Care Phase I | $23 million assumed in budget. |
— |
| Integrated Care Phase 2 | FY 13 savings. Savings will be greater in FY 14. |
$3,375,000 |
| Dual Eligible Double Capitation Demonstrations | FY 13 savings. Savings will be greater in FY 14. |
$10,200,000 |
|
Total Savings for Rate Adjustments and Utilization Controls: |
$98,003,400 |
|
Rate Reform and Cuts
| Correct incorrect coding for normal births |
$1,515,400 |
|
| Long Term Acute Care (LTAC) Hospital Rate | Prior to the increased LTAC reimbursement rate there were 6 LTAC hospitals. Now there are 10. LTACs receive $1,200 to $1,500 a day per patient instead of the $300 nursing home rate for the most complex patients. The $39.6 assumes that 50% of residents in an LTAC. Could be transitioned to a nursing home. |
$39,600,000 |
| Federally Qualified Health Center (FQHC) Wrap Around Payment | Require HMOs to pay the FQHC encounter rate, rather than the state paying the wrap around. |
$13,200,000 |
| Nursing Facility Capital Rate | Lower the capital return on investment rate to 4% instead of 11%. |
$71,125,500 |
| Excellence in Academic Medicine | Eliminate the static payments paid to teaching hospitals. |
$13,800,000 |
| 6% Rate Cut to Providers | Assumed in Total |
$550,000,000 |
|
Total Savings for Rate Reform and Cuts |
$689,241,372 |
|
|
Total Savings for All Cuts |
$3,011,558,400 |
|
Enter Your $2.7 Billion in Cuts Here |
|
In addition to this list, there are other things being discusses for which there are no firm savings numbers yet, including moving clients from Fee-For-Services to coordinated care, etc. But as you can see, the decisions are quite stark if we are to simply start cutting.
I would welcome any thoughts or suggestions you have. I can be reached in Chicago at 773 348 3434, in Springfield at 217 782 3835 or greg@gregharris.org