Chicago Looks to Expand Medicaid Despite Budget Problems

While Governor Quinn and Department of Healthcare and Family Services Director Julie Hamos are suggesting by the light of day that they understand the need to make significant changes to the Illinois Medicaid system; let’s shine a spotlight on what is going on behind the scenes in the dark of night.  You simply can’t make this stuff up.

It is the latest, utterly ridiculous, chapter in our Cook County brethren attempting to play by totally different rules than the rest of Illinois.  It represents the real “State of the State” and what Paul Harvey used to call “the rest of the story”.

I comment on the situation as one of the only, if not the only, former healthcare executive in the Illinois General Assembly, as well as a member of the Healthcare Access Committee and the Appropriations for Human Services Committee in the House of Representatives.

Illinois enacted bipartisan Medicaid reforms on January 12, 2011 to address unsustainable growth in the Medicaid program.  Growth that the Department of Healthcare and Family services (HFS) currently estimates could result in a backlog of $21 billion in unpaid Medicaid bills by the end of FY 2017.

These reforms included a two-year moratorium on new or expanded Medicaid programs.  It passed overwhelmingly on a 111-4 vote.  The Governor called the reforms “landmark achievements”.

Now, barely a year later, with the state in even worse financial shape, Chicago Democrats and the Quinn Administration want to begin EXPANDING Medicaid rolls.  On 1/30/12 (two days prior to the Governor’s State of the State address), HFS sent notice to the federal government requesting to expand Medicaid eligibility in Cook County for currently ineligible individuals.

This is unquestionably a violation of the bipartisan Medicaid Reform law.  Why would Director Hamos deliberately violate the law and risk eroding any chance of future good faith discussions related to Medicaid reforms that are imperative if we are ever to get our State budget under control?  Because the Cook County Board Chair wants it done.

At the same time the moratorium was enacted, the Medicaid reforms also required individuals to show specific proof of income and Illinois residency.  HFS has REFUSED to implement these reforms stating that communication from the feds has advised that such provisions are prohibited under the federal Affordable Care Act.

HFS has refused to file a waiver request, the ordinary protocol, in relation to the residency and income requirements even though members of the General Assembly have asked HFS specifically and directly to file such waivers.

HFS has stated that they have not filed such waivers due to a lack of manpower in the agency.  Ironically, HFS found the time to file a waiver to EXPAND Medicaid eligibility at a time when state statute contains a moratorium prohibiting any expansion for two years.

Oh yes, the punch line.  The expansion is for Cook County only and will allow 100,000 currently ineligible Chicagoans to participate in the system.  Even more blatantly corrupt, new enrollees will only be able to obtain services from one Chicago hospital . . . .Cook County Hospital (Stroger).  An outrageous attempt to corner the market for one hospital over all others in Chicago in advance of Obamacare being enacted in 2014.

What happens if the United States Supreme Court finds Obamacare illegal – which is a very legitimate possibility?  As always, you guessed it, the rest of the State will inevitably be asked to pick up these participants and add to the already categorically unsustainable debacle that is Illinois Medicaid.

If Obamacare IS allowed by the Supreme Court, this sleight of hand will limit the new enrollees to using ONLY Cook County Hospital for five years (three years AFTER the 2014 scheduled start date for Obamacare).  Why?  Because the Cook County Board Chair knows full well that Chicago residents will choose Northwestern, or any number of other choices over Cook County Hospital given the chance.  This request is the absolute height of hypocrisy.  The same crowd that insists on national healthcare wants to limit its’ own citizens options to the facility that few would actually choose on their own.  Blago must be smiling somewhere.

This entire shameful covert operation is wrong and reprehensible, particularly in light of the bipartisan effort that led to the original reforms.

This episode exemplifies the insincerity Quinn Administration has exhibited in implementing the Medicaid Reform law.  They are seeking an expedited ruling by the feds on a waiver they developed requesting significant expansion of the Medicaid program.  Yet, they will not even consider, and have on several occasions completely rebuffed, any suggestion that they seek a waiver from the Affordable Care Act that would allow the State to implement all of the 2011 Medicaid Reforms.

How can we give someone in Cook County an entitlement and tell his neighbor across the street in Will County that he cannot have the same entitlement even though both are under the prerequisite Federal Poverty Level?  Is this even legal?  Are there Equal Protection issues here?  Will this open the door for lawsuits that will force the State to early enroll the uninsured under the Federal Poverty Level in the other 101 counties?  How much would that cost the State?  It is important to remember that even Director Hamos herself acknowledges that our enrollment thresholds are already the most generous in the country.

How is it possible that we are even having such a discussion?

I am horrified that senior Administration leaders are involved in such a detestable plot.  At minimum, the will of the people through their elected representatives is being circumvented.  At worst, the law is being intentionally violated in a fashion that may well cost the taxpayers of this State hundreds of millions over and above the billions we already owe.

Administration and Chicago officials claim that this will not cost the State of Illinois any money.  Is there a suburban or downstate resident alive that believes this will ultimately be the case?  I was born at night . . . .but it wasn’t last night.

Democracy only works when the will of the people carries the day.  This bureaucratic power play must be erased, the perpetrators called out, and sanity restored.

Honesty and truth never go out of style.