Illinois Contraceptive Equity Summit
Julie Hamos, Director
August 20, 2014
Medicaid and Pregnancy
Total Medicaid enrollment as of 7/1/14: 3,070,432
About 1 million girls and women on Medicaid are of childbearing age (13-49 years old)
IL Medicaid pays for 94% of teen pregnancies
IL Medicaid pays for 54% of all pregnancies
Governor Quinn on Hobby Lobby Decision
“Healthcare is a human right, and the Affordable Care Act is meant to give all Americans access to decent, affordable healthcare. That means full access to healthcare for every woman in America, regardless of who they are or where they work.
“A woman’s personal health decisions should stay strictly between her and her doctor. Unfortunately, the U.S. Supreme Court’s decision takes these choices from a woman and gives them to her employer.
“We will continue to fight to preserve the right of Illinois women to make their own healthcare decisions based on their own beliefs, not the beliefs of the person signing their paycheck.”
6/30/14
IL Family Planning Action Plan
Today we are announcing the
Illinois Family Planning Action Plan – IFPAP
Our goal:
Increase access to family planning services for women and men in the Medicaid Program by providing comprehensive and continuous coverage to ensure that every pregnancy is a planned pregnancy.
Actions To Accomplish Goal
ACTION #1: Payments and operational policies should reflect the value HFS places on providing the most effective form of contraception.
ACTION #2: Health plans and providers in the Medicaid Program should make all family planning options available to Medicaid clients in a convenient and seamless manner.
Medicaid Family Planning Policy
June 26, 2014 provider notice articulated policy; updated provider notice released November 10, 2014
All Medicaid providers must provide full spectrum of family planning options, with no cost sharing
Free Choice of Provider statute allows clients to see any Medicaid provider of their choice – with no managed care restrictions
Clients should receive education and counseling on all FDA-approved birth control methods, from most effective to least effective, with most effective presented first: long acting reversible contraceptives (LARC), such as intrauterine devices (IUD) and implantable rods
Contraceptive methods must also include over-the-counter and prescription emergency contraception
LARCs and emergency contraception were most directly threatened by Hobby Lobby decision
LARC Policy in Colorado
Action #1: Changes in HFS Rates & Operational Policies
Double the provider reimbursement rates for IUDs and vasectomies
Increase 340B providers' dispensing fee (completed)
Allow medical provider reimbursement for two services on the same day when visit includes a LARC procedure and an initial or annual exam or problem visit
Allow FQHCs to bill fee-for-service for permanent, non-surgical sterilization kits (Essure)
Investigate allowing hospitals to bill for LARC insertion immediately postpartum
Action #2: Providers to Make Family Planning Accessible
Require all providers to submit family planning policies annually to HFS, including referral policies from those which invoke Right of Conscience objections
Continue working with LARC companies to ensure adequate inventory for same-day insertion, with ongoing training program
Communicate to Medicaid providers that:
Clients must receive evidence-based counseling and education about all FDA-approved contraceptives
Cost sharing, step therapy failure requirements and prior authorization are not allowed
HFS will make timely payments to doctors and FQHCs, and will require health plans to make timely payments.
Medicaid Vision Aligned with ACA
Illinois State Mandate
2011 Medicaid reform law (P.A. 96-1501) mandates 50% of clients to be enrolled in "care coordination" by 1/1/15
Even without state mandate, we believe that care coordination is needed to achieve the Triple Aim
We use "care coordination" and "managed care" interchangeably – it's about "managing" care
Care coordination requires redesign of Medicaid Program
Why Medicaid Redesign Is Needed
Clients must search for providers willing to accept Medicaid, with little help in navigating a fragmented system
Providers operate in "silos," with few incentives to coordinate services or create multidisciplinary teams
The client's holistic needs are not considered: medical, behavioral health and social needs
Fee-for-service payments reward volume of services rather than value
Care Coordination Roll-Out Plan
Clients are currently enrolling or being enrolled in Health Plans in 5 mandatory regions
Greater Chicago region – 6 counties
Rockford region – 3 counties
Central Illinois region – 15 counties
Quad Cities region – 3 counties
Metro East region – 3 counties
Clients in rural counties will continue in fee-for-service
About 2 million of 3 million Medicaid clients will be in Health Plans by early or mid-2015
Illinois’ Unique Structure
What the New World Means for Family Planning Providers
In 5 mandatory regions, providers must be part of Health Plans
Health Plans must ensure that providers are offering comprehensive family planning services
Providers will be paid by Health Plans, not the State (long-term)
Health Plans/providers exerting Right of Conscience must offer referrals that are accessible
State will monitor Health Plans to ensure that family planning services are comprehensive and accessible
Illinois Healthy Women Family Planning Waiver
IHW Waiver provided family planning services for women not eligible for Medicaid (up to 200% of the Federal Poverty Level) for over 10 years from 2004-2014
IHW was phased out December 31, 2014, because full health coverage is now available (and required) under ACA
Health Coverage Now Available
Women with no dependent children and with income up to $16,104 (single) or $21,707 (family of 2) qualify for Medicaid
Women who previously qualified for IHW – income under $23,340 (single) or $31,460 (family of 2) – can now buy private health insurance through the Marketplace, with tax subsidies
For example, a woman earning $23,340 will pay at most $125 per month on premiums for Silver Plan coverage – or 6.4% of her income
Join Us As Partners
Review Illinois Family Planning Action Plan and offer feedback/comments
Help develop strategies to educate all family planning providers about new policies
Help develop strategies to educate women and men in Medicaid so they can take advantage of family planning services
Educate women not eligible for Medicaid, but were in IHW Waiver, to apply for health insurance during open enrollment periods