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Health care enrollees expected to be older, sicker

Sunday, August 18, 2013
Chicago Sun-Times
by Monifa Thomas

If a pilot program in Cook County is any indication, getting people to enroll in Medicaid come Oct. 1 — when newly-eligible Illinoisans will be able to apply — is very possible. But they’re likely to be predominantly older and unhealthy when they apply.

Those are among the key things that CountyCare — which allows a broader population in Cook County to apply for Medicaid — sheds light on, in terms of what we may be able to expect.

CountyCare offers Medicaid to anyone who is between 19 and 64 in Cook County, makes less than roughly $15,860 for an individual and is a U.S. citizen or has been a legal immigrant for at least five years.

A bill that was signed by Gov. Quinn in July would extend the same right to all Illinoisans in January. Those eligible will be able to enroll starting Oct. 1.

Medicaid used to be available only to low-income adults if they had children, were adults with disabilities or senior citizens.

One thing CountyCare illustrates is that outreach done the right way is possible, even in a tight crunch for time.

Cook County Health & Hospital System, which runs the program along with the Illinois Department of Healthcare and Family Services, says close to 90,000 applications for CountyCare have been collected in the last six months. State officials have said they expect to enroll 115,000 patients by Dec. 31.

“I am confident that we will exceed that,” said Dr. Ram Raju, chief executive of the Cook County Health and Hospitals System, based on the hundreds of calls CCHHS receives daily about the program.

John Peller, vice president of policy for the AIDS Foundation of Chicago, said that is especially impressive for a program that only got clearance to receive $115 million in grant funding from the U.S. Health and Human Services last October. Outreach began in February, Raju said.

Cook County Health & Hospital System and its partners got the word out by visiting jails and talking to prisoners as they were being released, as well as going to Salvation Army sites, churches and other faith-based buildings. A dedicated CountyCare phone line also was established.

“We didn’t want to lose people by just having a flyer,” said Donna Thompson, CEO of Access Community Health Network, one of CCHHS’ partners with CountyCare.

Data from a June 2013 report shows that of those who applied to CountyCare, 55 percent were between 50 and 64 and most already were patients at either the Cook County health system or a federally qualified health centers, as opposed to new patients.

“What I’m hearing from my providers so far is that many of the patients we’re getting are truly complex, because they have had such a pent-up demand and they’ve not been in consistent health care,” Thompson said.

Thompson, Raju and other experts said that’s not surprising, considering that’s one of the reasons the Affordable Care Act was passed in the first place.

“It’s a testament of when they’ve neglected their health over time ... their chances of having multiple chronic illnesses are really there,” Thompson said.

If the same happens when Illinois launches its online marketplace, also on Oct. 1, that could be a problem. The online Illinois Health Insurance Marketplace is supposed to offer a one-stop shop with many different options for affordable health insurance. The White House has said that nationally, approximately 2.7 million of the new enrollees in the marketplaces must be cheap-to-insure young and healthy people; otherwise, there will be too many older, sicker people and costs as well as premiums will rise.

There also were reports of delay between applying and actually being approved. About 90 percent of applications are ultimately approved, Raju said. T he Illinois Department of Healthcare and Family Services has said it has since tripled the number of staff who approve applications to speed up the process, according to a WBEZ report. (The department did not respond to the Sun-Times in time for this article.)

And Medicaid still won’t get adults dental or visual coverage.

Even so, CountyCare recipients says there’s no question that the program is better than having no insurance.

The Rev. Debra Davis, 62, of Englewood, was accepted into the program in March, after quitting her job in January because of injuries to her hand, which made it difficult to continue as a licensed practical nurse.

Davis was too young to qualify for Medicare, but too old to find a part-time job, she said. So she panicked when she started to think about what might happen if she suddenly had to go to the emergency room or considered the expense of her medication for high blood pressure, type 1 diabetes and other health problems. Davis says she gets less than $15,000 a year from Social Security and her medication would cost roughly $1,000 monthly without Medicaid.

Having Medicaid and being able to go to a doctor at ACCESS Blue Island Family Center anytime gives her more peace of mind, Davis said.

“I appreciate being able to maintain a reasonable portion of good health,” she said. “Being able to see a doctor on regular basis and being able to get my medication that I need, I feel good most of the time.”

She noted that she’s heard of other people having trouble with Medicaid, but that had not been her experience.

The law Gov. Pat Quinn signed is expected to allow an estimated 342,000 people in Illinois to apply for Medicaid by 2017.

Expanding Medicaid in the 23 states and the District of Columbia that agreed to move forward, including Illinois, is expected to provide health insurance to 17 million Americans starting in 2014.



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