Help Choose the Medicaid Cuts

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:


Undocumented Kids on All Kids Affects 50,700 kids. All state dollars. Saves:


Family Care Bring it down to 133% FPL. Affects 26,400 clients.  Saves:


General Assistance Adults Affects 9,160 clients in Cook County. Could be eliminated without controversy if Cook County waiver is implemented.  Saves:


IL Care Rx Affects 177,000 elderly clients, eliminates premium and co-pay support for prescription drugs.  Saves:


Kids with Insurance Rebate Elimination of a $50-$75 monthly subsidy for parents to obtain private insurance for their children.  Saves:


Breast & Cervical Cancer Treatment Moves eligibility down to 250% of FPL. Affects 380 clients.  Saves:


Torture Victims Elimination of medical care for victims of torture. Affects 60 clients.   Saves:


Sexual Assault Treatment Elimination of immediate healthcare needs for victims of sexual assault. Affects 1,000 clients.  Saves:


State Renal Dialysis Program Elimination of renal dialysis program. Affects 270 clients.  Saves:


State Hemophilia Program Elimination of the state program providing clotting medicine to hemophiliacs. Affects 250 clients.  Saves:


Eligibility for Nursing Facilities Increase Determination of Need score from 29 to 37.


Eligibility for Supported Living Facilities Increase Determination of Need score from 29 to 37.


Non-Citizens Renal Dialysis Program Elimination of renal dialysis program for non-citizens. Affects 700 clients.  Saves:


Total Savings for Eligibility Cuts




  • ·Elimination of Optional Services


Pediatric Palliative Care


Reach Program


Group Psychotherapy for Nursing Home Residents  


Transportation to Group Psychotherapy  


Dental Grants  


Adult Chiropractor


Adult Dental  


Adult Occupational Therapy


Adult Physical Therapy  


Adult Podiatric Care


Adult Speech Therapy  


Limits on Adult Eyeglasses 1 pair glasses every 2 years.


Durable Medical Equipment


Adult Pharmaceuticals


Case Management


Adult Transplants


Adult Rehab


Ambulatory Surgical Treatment Centers


Supported Living Facilities


New Supported Living Facilities Pays for new facilities to be built.


Institutes for Mental Disease  


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.


Total Savings for Optional Services Cuts




Utilization Controls

Copay for Federally Qualified Health Centers Per dollar co-pay.


Hospitals Non-emergency Emergency Room visit copay (for $10 co-pay).


More co-pays for all services


Medically Fragile/Technology Dependent DD Waiver


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.


Private Duty Nursing Move from private duty nurses to skilled home residents.


Hospital Readmissions Program Until FY 14.


Hospital Detox Instead of paying the $2,000 admission rate, pay $100 for 23 hours of observation.


Bariatric Surgery Require a wellness program and client participation prior to authorizing surgery.


Home Health 1% reduction achieved through utilization controls.


Integrated Care Phase I $23 million assumed in budget.

Integrated Care Phase 2 FY 13 savings.  Savings will be greater in FY 14.


Dual Eligible Double Capitation Demonstrations FY 13 savings.  Savings will be greater in FY 14.


Total Savings for Rate Adjustments and Utilization Controls:




Rate Reform and Cuts

Correct incorrect coding for normal births  


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.


Federally Qualified Health Center (FQHC)  Wrap Around Payment Require HMOs to pay the FQHC encounter rate, rather than the state paying the wrap around.


Nursing Facility Capital Rate Lower the capital return on investment rate to 4% instead of 11%.


Excellence in Academic Medicine Eliminate the static payments paid to teaching hospitals.


6% Rate Cut to Providers Assumed in Total


Total Savings for Rate Reform and Cuts




Total Savings for All Cuts


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