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The new state budget and education funding: still waiting

Written by John Gordon

K-12 Education Funding Left Hanging in the Balance for Upcoming School Year

Illinois has a state budget for Fiscal Year 2018 (FY18) that began on July 1st but not the means for appropriating the dollars for K-12 education. While the legislature overrode Governor Rauner’s vetoes of the state budget and revenue bills, the budget bill (Senate Bill 6) contained language stipulating that the majority of the dollars set aside for elementary and secondary education were to be allocated according to an “evidence-based formula.” The result of this decision is that public schools in Illinois remain in jeopardy of not opening on time or only being able to stay open for a short period of time.

The amount appropriated for evidence-based funding is approximately $6.7 billion in general funds and reflects a consolidation of five prior education line items (General State Aid, bilingual education, transportation for special education students, special education personnel, and services for extraordinary special education pupils). This is an increase of $776 million from the FY 17 funds. The formula incorporates $5.9 billion in general funds into the new formula as part of a “hold-harmless” provision, which ensures no school district receives less funding from the state than they received in the 2016-2017 school year.

The evidence-based formula, by which this pool of dollars is to be allocated, is outlined in SB 1.  That bill combines 27 weighted elements into the current school aid formula including the number of low income students, special education students, students for whom English is not their first language, and up-to-date text books. The amount of money the district received in the last academic year (a district’s “Base Funding Minimum”) is then combined with the district’s local available resources. Match that against the adequacy level and the difference determines the additional state funding for the district under SB 1 -with more money going to those districts further away from their adequacy level.

The formula then separates school districts into four tiers based on their adequacy targets, with districts in Tier 1 being the furthest away from their adequacy target and districts in Tier 4 being at or above their targeted level. There is a little over $353 million in funding allocated to help districts make gains towards their targets, with 99% of the funds going to districts in tiers 1 and 2.

The main point of contention between the proponents of SB 1 and the Governor is that the FY 18 normal pensions costs for Chicago Public Schools (CPS) is incorporated into CPS’ Base Funding Minimum (approximately $221 million). The Governor believes this is equivalent to a “bailout” for CPS, while CPS and the advocates of SB 1 argue that Chicago is placed at a disadvantage because the state picks up the pension costs for every other school district.

As a consequence of the Governor’s threat, one of the Senate sponsors of the bill placed a procedural motion on it that holds the bill in the Senate and prevents the chamber from sending it to the Governor. Absent SB 1, or any similar bill, there’s no way for the State Board of Education to send the $6.7 billion to local school districts. Without the dollars, some Illinois schools may not open in August.  Others might be able to open the doors but depending on the district’s finances could not keep them open through the school year.

Therefore, either the legislature could send the Governor SB 1 and, if he vetoes it, attempt to override the veto, send a new piece of legislation, or the legislature could send SB 1 to the Governor as a part of a compromise that includes a package of other bills that he would sign into law.

Higher Education

While elementary and secondary school administrators are left wondering what will happen with their state dollars, SB 6 provides funding for FY18 (as well as funds appropriated for costs incurred in FY17) but that funding generally represents a 10% cut from FY15.

The state’s public university system suffered enormously due to the budget impasse. Five universities saw their credit rating lowered to junk status, enrollment dropped at a majority of the state universities, and Monetary Award Program (MAP) grant recipients were left with uncertainty on if their awards would be honored. (MAP provides college grants to low-income students.) Area economies that rely on a healthy university saw a downturn. With a full budget in place, these institutions and their students can begin to take stock and plan for a future with some stability.

During the last two fiscal years, Illinois funded its universities in stopgap appropriation bills. Averaging the funding for the last two years, you can see the comparison to FY15 (the last prior year Illinois had a full-year budget). The numbers show the real damage sustained by the state’s higher education system from the two-year impasse.

 

FY16-FY17 Average % change from FY 15 FY 18 % change from FY 15
Chicago State University $29,805,700 -18.0% $32,697,400 -10.0%
Eastern Illinois University $30,507,100 -29.0% $38,678,100 -10.0%
Governors State University $18,409,050 -23.5% $21,656,000 -10.0%
Illinois State University $55,258,850 -23.5% $65,004,000 -10.0%
Northeastern Illinois University $28,230,300 -23.5% $33,209,000 -10.0%
Northern Illinois University $58,747,950 -35.5% $81,983,500 -10.0%
Southern Illinois University $128,554,550 -35.6% $180,912,800 -9.3%
University of Illinois $415,221,800 -35.8% $583,005,900 -9.9%
Western Illinois University $37,377,400 -27.3% $46,300,700 -10.0%
Community Colleges $176,316,400 -36.0% $248,030,500 -10.0%

 

Not only did students face uncertainty with courses, staff, and programs cut, but there was no appropriation for Monetary Award Grants until this budget passed. Not only does SB 6 provide funding for the recently ended fiscal year ($365 million) but the program receives $401 million in funding, a 10% increase from FY 15.

While funding is in place for FY18, state university administrators still have difficult choices to make with a 10% cut from FY15. It is unclear whether faculty and staff let go by the universities during the last two years will return. In some cases, students facing the uncertainty of not having a MAP grant curtailed their academic careers. Certain university faculty, watching the financial uncertainty of the state and its universities, left the state. A state budget is in place but it may take time for our universities to recover.

SB 1- Leveling the Playing Field

Written by John Gordon

The current attempt to reform how Illinois funds school districts in the state is at a critical point. Both the Senate and the House have passed a bill that would allow new state dollars to flow to school districts in the most financial need, giving more kids opportunities for the quality education that they deserve and that is their constitutional right. Governor Rauner, while expressing support for much of what the bill proposes, declared his intent to veto the legislation. As of now, the bill remains in the Senate chamber as lawmakers and advocates attempt to persuade the Governor to sign the bill into law.

The Problem

As it currently stands, school districts in Illinois rely heavily on local taxes, largely property taxes, for funding. Roughly 67% of all school funding in Illinois comes from local taxes, while the state only provides approximately 25%.1 This has led to a very inequitable system. For every $1.00 spent on a non-low-income student, Illinois spends $0.81 for every low-income student.2 This system is also a main contributor to Illinois having among the highest property taxes in the nation.3

Senate Bill 1 aims to change this by setting a goal for increased levels of state funding for education and a system to distribute new dollars for education to those school districts in the most need of more funding. The overall goal of Senate Bill 1 is to increase funding for education by $350 million per year over the next ten years to bring the state closer to parity in terms of funding education. This funding would need to be appropriated every year by the General Assembly. The $350 million is a goal, not a set law.

How Does the New Formula Work?

One of the main provisions of Senate Bill 1 is the “Hold-Harmless” provision. This means that no school district in the state can receive less state funding than it received in the 2016-2017 school year. This is done by creating a “Base Funding Minimum Level” for each school district.

The bill also instructs the State Board of Education to establish unique “Adequacy Targets” for each school district in Illinois, based on figures that influence school spending and school needs. The adequacy targets take into account the Base Funding Minimum Level described above, the availability of local resources, and what the bill refers to as “Essential Elements” needed to ensure K-12 students in Illinois are able to graduate high school and attend college. These 27 elements have been identified by academic research. Some of the 27 elements include:

  • Up to date textbooks and learning materials
  • Up to date technology for classroom instruction
  • Increased funding for low-income and special education students
  • Increased support for students who are learning English
  • Limited classroom sizes

Where Will the Money Go?

The bill groups school districts based on how their local available income meets the established adequacy goal. The first group of districts (Tier 1) are those who are at less than 65% of their adequacy targets. The second level of school districts (Tier 2) are those who are between 65% and 90% of their adequacy targets. The third level (Tier 3) are districts between 91%-100% of their targets. The fourth level (Tier 4) are districts that are above 100% of their targets.

Per the State Board of Education, 77% of school districts in Illinois are in Tiers 1 and 2. In the bill, 99% of the new funding (the $350 million stated above) would be distributed among these school districts to increase their adequacy levels.

Property Tax Relief

Senate Bill 1 also establishes a property tax relief fund. This fund, which is also subject to appropriation, would allow school districts in high-tax, low-wealth areas of the state to receive relief in their property tax bills. If a district receives this relief grant from the state, it must reduce its levy in the following year by the dollar amount they received from the state. As stated earlier, this is subject to a separate appropriation from the General Assembly. The more the G.A. appropriates for this fund, the number of school districts that can receive this benefit will increase.

Chicago

Due to its sheer size, Chicago Public Schools (CPS) both receives and carries burdens that other school districts in Illinois do not. For example, CPS receives a block grant from the state of approximately $250 million that other districts do not receive.  However, CPS is responsible for the pensions of their unit’s teachers, while the state covers the pensions for teachers in every other school district.

The bill attempts to address both Chicago’s educational and pension needs in the bill. The block grant and CPS’ normal pension costs are added to the district’s Base Funding Minimum Level. This does indeed help Chicago with their pensions, but it comes at a cost. If these two factors were not included in CPS’ Base Funding Minimum Level, CPS would receive a larger per-pupil funding increase than they are with these two factors included.

It is important to remember that the Chicago Public School System educates roughly 20% of the state’s overall student population. Of all students in CPS, approximately 84% are low-income.4 Any attempt to reform the school funding formula in Illinois to raise the level of equity between wealthy and non-wealthy school districts will have some benefit for Chicago.

The Necessity of Proper Funding

All of the reforms in Senate Bill 1 are predicated on proper funding levels from the state. Again, the stated goal in Senate Bill 1 is to increase the level of state funding to school by $350 million per year for the next ten years. The bill does prepare for the possibility that the state will fall short of this in any given year by distributing whatever funding is appropriated more progressively to those districts furthest away from their adequacy targets. This would reduce the level of new funding to schools in Tiers 3 and 4 to practically zero. But the lower the amount of new funding from the state, the less effective the formula will be at reducing inequality. The reduced funding will also continue to place the burden of school financing on local tax dollars, which is the biggest drivers of the inequity among school districts in Illinois.

This makes the need for a full budget agreement this summer and a return to the normal year-to-year budget process all the more critical. If the state continues down its current path, a new funding formula will be lost among the instability and financial ruin.


1. Illinois State Board of Education 2015-2016 Report Card

2. The Education Trust

3.New York Times, March 10, 2017 “Highest and Lowest Property Tax Rates in the U.S.”

4.Illinois State Board of Education 2015-2016 Report Card, Chicago School District 299

Protect Health Care for Illinois Children by Rejecting the American Health Care Act

Written by Mayumi Grigsby

Given the impact it will have on the lives of more than 1.4 million children covered by Medicaid and the Children’s Health Insurance Program (CHIP)[1], members of the state’s congressional delegation need to reject the proposed legislation, to repeal the Affordable Care Act (ACA).Health care

The proposed America Health Care Act (AHCA) that passed the U.S. House and which the U.S. Senate is now considering, would cut federal Medicaid funding by $834 billion over ten years and make other damaging structural changes to the Medicaid program.  Although little is known about the Senate bill to repeal and replace the ACA as of this writing, reports indicate that the emerging bill differs little from the House bill.

These cuts would likely mean curtailment or loss of medical services for Illinois children and their families covered by the program.

Medicaid Populations in Illinois

Medicaid provides health care coverage for Illinois’ most vulnerable groups: low-income children and their families, pregnant women, persons who are disabled, and seniors.

  • More than three million Illinoisans are covered by Medicaid and that includes nearly half of the state’s children are covered by the program.
  • Sixty-one percent of Medicaid enrollees in Illinois are people of color, so changes and funding cuts to the program would have a disproportionate impact on children of color and their families.
  • Medicaid, CHIP, and other public health insurance programs cover nearly half (44%) of children with special health care needs.[2]

Changing the Affordable Care Act’s Medicaid Expansion

Prior to the ACA, Medicaid coverage was limited to low-income parents, children, cash assistance recipients, seniors, and people with disabilities. Medicaid eligibility prior to the Medicaid Expansion was about $8,870 a year for a family of three and childless adults were ineligible. The ACA allowed states to expand their Medicaid program to include all non-elderly non-disabled adults with incomes up to 138 percent of the poverty line. Illinois was one of 31 states (along with the District of Columbia) to do so.

Illinois MedicaidI

Source: Center on Budget and Policy Priorities

The AHCA would fundamentally change how the federal government funds Medicaid.  Currently, the federal government covers 90 percent of the cost of new enrollees under the Medicaid expansion. The AHCA would lower the matching rate for new enrollees qualifying for the expansion coverage.  Starting in 2020, rather than paying 90 percent of the cost of covering these enrollees as it would under current law, the federal government would only pay 50 percent of the cost.  This represents a huge cost shift to states; it is projected that in 2021, Illinois would have to pay an additional $864 million to maintain the Medicaid expansion.  More likely, the state would be forced to cut coverage for the 635,800 Illinoisans in the Medicaid expansion.

Shifting Costs to States

Medicaid enrollment CHIP

Source: Kaiser Family Foundation

The AHCA would further shift Medicaid costs from the federal government to the states by implementing a per capita cap. The federal government now contributes a fixed amount to a state’s Medicaid costs- in Illinois this is about 50 percent of total Medicaid costs. Under a per capita cap, the federal government would only pay up to a fixed amount per beneficiary. The state would then be responsible for additional and unanticipated costs, for example, an opioid crisis or a Zika outbreak. This per capita cap could lead states to cut benefits, cut enrollment, and cut payments to doctors and providers to lessen the state’s Medicaid costs. This could lower payment rates for pediatric providers and thereby threaten health care coverage for children.

The AHCA would also let states choose between a block grant for Medicaid, rather than a per capita cap. The “Flexible Block Grant Option for States” would give states the option to receive a portion of their federal Medicaid funding through a grant.[3] This amendment eliminates requirements that state Medicaid programs cover preventive child health care services for individuals under the age of 21, such as the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services. EPSDT services are required, preventative, health and developmental assessments and vision, dental and hearing services, as well as diagnostic and treatment services to improve physical and mental health conditions. Eliminating these requirements would impede all children’s opportunity for a healthy future.

Cuts to Medicaid Funding Would Mean Fewer People are Covered

For some children with special health care needs, access to Medicaid is based on the child’s need and not on the family’s income. This pathway makes it possible for children with special needs to access care while still living at home with family. States use waivers to receive federal matching funds to allow them provide long-term and supportive services to seniors and people with disabilities in their homes and communities. Illinois covers this population of children using a Medicaid home and community-based services waiver called the Medically Fragile/Technology Dependent Children waiver. Cuts proposed in the AHCA could force states to cut back on spending on Medicaid services, putting necessary Medicaid home and community-based services waiver programs at risk.

Special Education

Cuts to federal funding for Medicaid could also threaten funding for special education in schools. The Individuals with Disabilities Education Act (IDEA) ensures access to public education for children with disabilities. Under this law, the education needs of the child are outlined in an individualized education plan (IEP). Medicaid pays for some of these services, which tend to be perpetually underfunded in spite of a federal commitment, for children enrolled in Medicaid.

In 2015, the federal government contributed more than half – $144,391,000 out of $286,388,260 – of Medicaid spending in Illinois schools. These cost-shifting changes to Medicaid and cuts in federal spending proposed in the AHCA would pose a significant burden on Illinois as the state would have to find ways to meet the increased financial burden.

Waiving Pre-Existing Condition Prohibition

Additional harm could come to children and their families due to the AHCA allowing states to:

  • Charge higher premiums for pre-existing coverage if they create “high risk pools”
  • Do away with “essential health benefits” requirements. In Illinois, essential health benefits include pediatric oral and vision coverage and newborn care.  Curtailment of these services could negatively impact important services required to ensure healthy development in children.

Since maternity services were not commonly covered pre-ACA and reports suggest that waivers would be easily attainable by states under the AHCA, these changes could lead states to weaken requirements ensuring coverage for maternity care.

People residing in states modifying the essential health benefits’ requirements would see “substantial increases in out-of-pocket spending on health care” and services likely to be excluded include “maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits.”

House GOP Health Bill

Increasing the Number of Uninsured

According to the nonpartisan Congressional Budget Office (CBO), if the AHCA passes, there will be 23 million more uninsured people under age 65 by 2026 than would have been uninsured under the ACA.

Benefits of Medicaid

Studies show children with Medicaid coverage are healthier teenagers. These children perform better academically and are less likely to drop out of high school and more likely to graduate from college. They are also more likely to surpass their families’ economic status and are less reliant on the government. Medicaid expansion also gives coverage for maternal depression, particularly for low-income women and women of color. Maternal depression is known to stymie healthy development in children. Curtailing access to Medicaid and CHIP for children – particularly low income, children of color – denies them access to a better future.

Action is needed now

As of this writing, the state comptroller shows the state has a backlog of bills topping $15 billion. The AHCA would lead the state to lose $40 billion over 10 years and would also shift $24 billion in Medicaid costs over ten years to the state of Illinois.

The AHCA proposes changes that would lead to a loss of coverage for children. The bill would make it particularly difficult for children with special health care needs to continue to access the care they need to remain healthy and succeed in life.

Illinois’ U.S Senators have signaled their opposition to the AHCA.  The Governor, members of the legislature, and citizens across the state need to join them in opposing the measure and fighting for continued and quality health care coverage for Illinois children.


[1] Medicaid covers children age 0 to 6 with family incomes of up to 133% of the federal poverty level (FPL); and for children, age 6 to 19 with family incomes of up to 100% FPL. The Children’s Health Insurance Program (CHIP) is available for children, age 0 to 19, with family incomes too high for Medicaid. (http://southeastgenetics.org/aca/medicaid-chip-infographic.pdf) In Illinois, the program providing coverage for children is called “All Kids.” All Kids includes the state’s Medicaid and State Children’s Health Insurance Program (SCHIP) programs. Coverage is offered to all uninsured children, regardless of income, health status or citizenship. (https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7677.pdf)

[2] http://www.kff.org/medicaid/issue-brief/medicaid-and-children-with-special-health-care-needs/

[3] http://avalere.com/expertise/managed-care/insights/per-capita-caps-could-reduce-funding-for-children-covered-by-medicaid

2017 Kids Count Report: Illinois Investments Matter

Written by Anna Rowan

Data from the beginning of the state’s budget crisis show that smart investments in children lead to progress. Illinois is currently 19th in the nation in the latest rankings for child well-being, according to the 2017 KIDS COUNT Data Book from the Annie E. Casey Foundation. Yet, the lack of a full state budget for the past two years (and no foreseeable end to the impasse) puts Illinois in danger of undermining its own investments and progress.

2017 KIDS COUNT

Source: Annie E. Casey Foundation

The 2017 KIDS COUNT Data Book uses 16 indicators to rank each state across four domains — health, education, economic well-being, and family and community — that represent what children need most to thrive. Illinois ranks:

  • 10th in health. Illinois has been a national leader in providing children with access to health insurance. From 2010 to 2015, Illinois cut the uninsured rates for African-American and Latino children in half, from 6 percent to 3 percent, for both groups.
  • 13th in education. Early childhood education has been a bright spot for Illinois. Less than half of 3- and 4-year olds do not attend school, ranking the state fifth in this indicator. However, the state still has significant work to do to close the achievement and attainment gaps that exist between low-income and minority students from their white and more affluent peers.
  • 25th in economic well-being. Illinois families continue to struggle with economic security. Although more kids’ parents are now working full-time, year-round jobs than in 2010, the percentage of children living in poverty has not changed when comparing the height of the Great Recession in 2010 to 2015 data.
  • 28th in the family and community domain. Illinois has made great strides in reducing the teen birth rate. There were more than 6,000 fewer teen births in 2015 than in 2010. But there are still far too many children living in high-poverty areas and in single-parent families.

The data show that key investments in health and early education have reduced racial disparities among children. Although Latino children still lag behind in preschool attendance, there is little difference between the percentage of African-American and white children who aren’t attending preschool. Additionally, all groups of kids are accessing health insurance at roughly the same rate. However, there is still work to do to lessen other disparities. For example, more than two-thirds of the half a million Illinois children living in poverty are children of color. If Illinois elected officials fail to enact a budget for a third year, we run the very real risk of causing disparities to grow and wiping out the progress we’ve made.

The 2017 KIDS COUNT Data Book with state-by-state rankings and supplemental data can be viewed at http://www.aecf.org/resources/2017-kids-count-data-book/.

 

Paid Sick Leave Benefits Children’s Health

This month, the Illinois Senate has the opportunity to pass legislation to protect children’s health by providing Illinois workers with paid sick days.

The Healthy Workplace Act (HB 2771) would allow an employee to accrue and use up to five paid sick days per year. Employees may use their paid sick days to care for themselves or a family member. It is an important measure when it comes to children’s health.

Receiving care from their parents is important for children’s mental as well as physical health. Parents have been shown to play important roles in the care of children with chronic and acute conditions such as epilepsy, asthma and diabetes.

Many studies have also shown that a parent’s presence helps with their children’s recovery. When parents are involved in children’s care, children recover more rapidly from outpatient procedures and the duration of hospital stays is reduced by 31%. When parental involvement in the care of sick children is increased, children’s anxiety decreases. On the other hand, separating young children from their parents when they are sick has been shown to have detrimental effects.

While parental involvement is key to the health of children, many parents are forced to decide whether to leave a sick child home alone, send a sick child to school, or stay home with their child and risk losing pay or getting fired because they have no access to paid sick leave. In one study, 58% of working parents continued to go to work when their children were sick. Of the parents who were able to stay home with their children when they were sick, more than half reported that the reason they could stay at home was that they received some type of paid leave. In a separate study conducted in Chicago and Los Angeles, 41% of parents with children with special needs stated that at least once in the past year they went to work even though they felt they should have taken time off to take care of their sick child.

Paid sick leave is important for all working parents but is essential for low-income working mothers, who are primarily responsible for their children’s health. More than half of low-income mothers must take time off when their children are sick compared to a third of higher income mothers. While 71% of higher income mothers have paid sick leave, only 31% of low-income mothers have the same type of support. Among the mothers who do not have other child care options and must miss work when their children are sick, 60% are not paid for that time off.

paid sick leave

 

Lack of paid sick leave compromises the health of all Illinois children. Parents without paid sick days are more than twice as likely as parents with paid sick days to send a sick child to school or day care putting at risk the health of their children and that of other children. On the other hand, parents who have paid sick or vacation leave are more than five times as likely to care for their sick children compared to those without leave shortening the time children are sick and protecting the health of other children.

Helping to ensure parents have the time and the financial resources to take care of their children, paid sick leave safeguards the health of children in Illinois.

Written by Militza M. Pagán
Consultant to Voices for Illinois Children

Higher Education Funding Cuts, Reduced Enrollment

The on-going impasse in Springfield continues to put a severe strain on the public university system in Illinois. As the legislature and governor fail to approve a complete budget for the fiscal year, it puts universities in the unenviable situation of having to raise tuition and fees while also looking at ways to cut costs. Some recent examples:

  • Southern Illinois University has reduced staff by almost 10% between the academic years starting in 2014 and 2016. It has reduced its authorizing budget by $21 million since the beginning of the budget impasse. Just last week, Southern Illinois University trustees approved a loan of up to $35 million from Southern Illinois University-Edwardsville to support its Carbondale campus.
  • Since 2016, Eastern Illinois University has reduced its workforce by more than 500 people (from 1,743 employees to 1,224 employees).
  • Chicago State University eliminated more than 400 staff positions in 2016.
  • Governors State University this year approved eliminating 22 degree programs and raises tuition by 15%.
  • Northern Illinois University has announced a reduction of 150 staff positons for Fiscal Year 2018.
  • As a cost-cutting measure, Northeastern Illinois University shut down the campus for three days last month. It has also required employees to take furlough days during the last two academic years.


State University Budget Cuts

university funding May
MAP funding

 

Student Enrollment
As the funding issues continue, it appears to be having an impact on the enrollment of full-time students.

university enrollment

 

In fact, Chicago State University enrolled just 86 freshman this fall.

This decline coincides with a trend that has been occurring throughout the decade. Illinois is among the nation’s leaders in outmigration of graduating high school students, with an estimated net loss of over 16,000 students. This is not a recent development; Illinois high school students have been leaving the state for college in increasing numbers.

Illinois out-of-state students

Source:  Illinois Board of Higher Education

Illinois high school and college students deserve a world class higher education system that allows them to compete in the world economy. As it currently stands, Illinois is underfunding its universities with subsequent staff and program cuts.

This graduate season it is worth contemplating the higher education system we want for our state.  More survey data might be needed for a more accurate picture to explain enrollment declines.  However, it seems the state’s high school and college students see what the future might hold for Illinois’ higher education system and are leaving.

Written by John Gordon

What do Illinois’ Moms want for Mother’s Day?

How about continued health care coverage?  As of the beginning of this year, there were 1,679,700 women and girls enrolled under the state’s Medicaid program.

Medicaid provides health care coverage to low-income children and their families, pregnant women, persons who are disabled and seniors. In Illinois, the program currently covers approximately 3.1 million people overall. In addition, there are 649,000 Illinoisans are enrolled under the Affordable Care Act (ACA) – 288,464 of them are women.

Most women covered by the state’s Medicaid program are low-income women of color – 28% are African American and 26% are Hispanic. Medicaid covers services related to preventative screenings, maternal health and long-term care affecting senior women – services that impact women inter-generationally. As an example, Medicaid financed 50% of all births in the state of Illinois in 2014. With Medicaid responsible for funding so many services specific to women’s health care, the recent U.S. House passage of the American Health Care Act (AHCA) endangers crucial coverage for Illinois women and their children.

Medicaid and Women 1 - T

The bill is before the U.S. Senate for consideration. The Congressional Budget Office (CBO) estimated that an earlier version of the bill could lead to a loss of coverage nationally of 24 million people nationwide by 2026. The newest version has not been scored by the CBO. However, changes in the bill before the Senate could lead to higher costs and additional loss of coverage.

Fewer Uninsured
Prior to the ACA, eligibility for Medicaid coverage was limited to “children, cash assistance recipients, seniors, and people with disabilities”. The ACA’s Medicaid Expansion allowed 32 states, including Illinois, to include women with incomes at or below 138 percent of the poverty line. With Illinois choosing to opt into the Medicaid Expansion, the number of uninsured women in the state, aged 18 to 44 has dropped from almost 18% to 13.4% in 2016.

uninsured

Those improvements are now at risk.

Overall, the bill cuts $839 billion in federal spending from Medicaid over ten years. One estimate puts Illinois’ potential financial loss over ten years at $40 billion.

Two significant funding changes in the AHCA are lowering the federal matching rate (or Federal Medical Assistance Percentage -FMAP) for new enrollees covered under Illinois’ Medicaid expansion and implementing a spending cap for each enrollee in the state’s Medicaid  program. (In Illinois, if the FMAP falls below 90%, state law requires that coverage ceases at the end of three months following changes in the FMAP.)

Among its other changes, the federal bill allows a state to:

  • waive the ACA’s community rating (which contains a prohibition against charging higher premiums for pre-existing coverage) if it creates a “high risk pool” and
  • waive the “essential health benefits” requirements.

High Risk Pool
How did these high risk pools work in the past?  In the pre-ACA era, they generally led to enrollment caps and unaffordable premiums. While the AHCA has allocated $130 billion in funding for high-risk pools, even if all of the funding were used for these pools, they would still be underfunded by at least $200 billion.

The cost of higher premiums for pre-existing conditions places an undue burden on women. Prior to the ACA, pre-existing conditions included prior C-sections, breast or cervical cancer, receiving medical treatment for domestic or sexual violence, and/or clinical depression. In Illinois, 26% of the population would have had a pre-existing condition that would make  them uninsurable.

Essential Benefits
While essential health benefits vary by state, the ACA provides a floor with a list of benefits that insurers are required to cover. In Illinois, these include: hospitalization, maternity, coverage for prescriptions, pediatric oral and vision coverage and newborn care, as well as preventative services like mammograms and bone density screenings. While the AHCA maintains preventative services for private plans, those requirements would no longer apply to the Medicaid Expansion population, meaning a loss of much needed services by women in that population.

Instead of taking away Mom’s health care coverage, let’s remind our federal officials this week (which is National Women’s Health Week) of the great strides we’ve made under the ACA and the great gift it has provided to Illinois women and their families.

Written by Mayumi Grigsby

Another Threat to Health Care for Illinois Women and Children

If Illinoisans were worried about losing coverage under the last version of the American Health Care Act (AHCA) proposed at the federal level, the latest incarnation will do little to reassure them.[1] Medicaid provides health coverage to low-income children and their families, pregnant women, persons who are disabled, and seniors.[2] The program currently covers 36 percent of Illinois children with a mix of federal and state funds.[3] Approximately 3.1 million people are currently enrolled in Illinois’ Medicaid program and 649,000 are enrolled under the Affordable Care Act (ACA).[4] Seventeen percent of Illinois women are covered by Medicaid.[5]

A reported agreement in the U.S. House of Representatives by the conservative Republican House Freedom Caucus and the moderate Republican Tuesday Group has revitalized the bill that failed to garner enough support at the federal level last month. The newest version keeps the base of the original AHCA bill while adding provisions that would further endanger coverage for vulnerable populations.[6] The previous proposed changes to the ACA, would have led to a loss of medical coverage for 14 million people in 2018.[7]  Changes to the tax subsidies allowing citizens to buy coverage and to the Medicaid program would have increased the number of uninsured from 14 million to 21 million in 2020, and to 24 million in 2026.[8]

The version garnering the endorsement of the House Freedom Caucus adds the following: a) it allows states to waive the ACA’s “community rating” requirements, which is the prohibition against charging people higher premiums for preexisting coverage, so long as the state creates a “federal high risk pool”;  b) it allows states to waive the ACA’s “Essential Health Benefits” standards, which are key services health market plans must cover, such as prescription drugs, mental health treatment and maternity care.[9] In Illinois, these benefits also include pediatric oral and vision coverage for children and coverage for autism spectrum disorders.

States would receive automatic approval for these waivers within 90 days if they attest that their purpose is to lower premiums, improve coverage levels, or advance another benefit to the public interest.[10]

These are significant steps. High-risk pools existed in many states prior to the ACA and they led to “enrollment caps, long waiting lists, unaffordable premiums, exclusions for pre-existing conditions, high deductibles, benefit caps, and annual and lifetime limits on coverage”.[11]

Illinois has existed without a complete budget for almost two years.[12] The state faces a FY 17 revenue shortfall of $5.7 billion and has amassed a backlog of bills totaling more than $13 billion.[13] Delayed payments or actual cuts continue to lead to providers curtailing vital human services.[14]

Under the previous version of the AHCA, Illinois stood to lose $40 billion over a ten-year period. Inaction by the Illinois General Assembly and the Governor to address the state’s revenue shortfall has already threatened services for vulnerable Illinois residents including low-income children and their families, persons with disabilities and seniors. The current changes proposed at the federal level further exacerbate that threat.

Written by Mayumi Grigsby


[1] http://www.chicagotribune.com/news/local/politics/ct-congress-illinois-aca-repeal-met-0316-20170315-story.html
[2] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[3] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[4] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[5] http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/
[6] http://www.cbpp.org/research/health/reported-amendment-to-house-aca-repeal-bill-guts-protections-for-people-with-pre
[7] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[8]http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[9] http://www.cbpp.org/research/health/reported-amendment-to-house-aca-repeal-bill-guts-protections-for-people-with-pre
[10] http://www.cbpp.org/research/health/reported-amendment-to-house-aca-repeal-bill-guts-protections-for-people-with-pre
[11] http://www.cbpp.org/research/health/reported-amendment-to-house-aca-repeal-bill-guts-protections-for-people-with-pre
[12] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/
[13] http://www.cbpp.org/research/state-budget-and-tax/many-states-face-revenue-shortfalls
[14] http://www.voices4kids.org/proposed-medicaid-changes-could-mean-end-of-services-for-thousands-in-illinois/

Paid Sick Leave in Illinois

The Illinois House has passed legislation (HB 2771) that would provide paid sick leave to Illinois workers who currently have no such right.

While Cook County and the City of Chicago have approved ordinances on paid sick leave that become effective July 1, 2017, there are still 1.5 million Illinois workers without the right to paid sick days.

The  Healthy Workplace Act would allow an employee to accrue and use up to five paid sick days per year.

Momentum to provide more workers paid sick leave has been building throughout Illinois and the nation. The City of Chicago and Cook County approved their measures in 2016. That same year, Arizona, Vermont and Washington-passed laws ensuring access to paid sick leave to all workers in their states.  Paid sick leave is also the law in four other states (Connecticut, California, Massachusetts and Oregon).

Jurisdictions with Paid Sick Days[1]
State and District Effective Date of Statutes
Connecticut 2012
Washington DC 2014
California 2015
Massachusetts 2015
Oregon 2016
Vermont 2017
Arizona 2017
Washington 2018
County Effective Date of Statutes
Montgomery County, MD 2016
Cook County, IL 2017
City Effective Date of Statutes
San Francisco, CA 2007
Seattle, WA 2012
New York, NY 2014
Jersey City, NJ 2014
Newark, NJ 2014
Irvington, NJ 2015
Passaic, NJ 2015
East Orange, NJ 2015
Paterson, NJ 2015
Trenton, NJ 2015
Montclair, NJ 2015
Bloomfield, NJ 2015
Oakland, CA 2015
Philadelphia, PA 2015
Emeryville, CA 2015
Pittsburgh, PA 2015
Elizabeth, NJ 2016
Plainfield, NJ 2016
San Diego, CA 2016
Tacoma, WA 2016
New Brunswick, N.J 2016
Los Angeles, CA 2016
Morristown, NJ 2017
Berkeley, CA 2017
Spokane, WA 2017
Santa Monica, CA 2017
Minneapolis, MN 2017
St. Paul, MN 2017
Chicago, IL 2017

What is paid sick leave?

Paid sick leave allows workers to take time off to recover from illness, attend a doctor’s appointment, take care of a sick loved one, or stay home to take care of children when school is canceled without a loss in pay. Workers accrue paid sick days based on the number of hours they work. The more hours an employee works, the more hours they accrue.

What are the benefits of paid sick leave?

Both employers and workers benefit from earned sick leave by reducing turnover, increasing productivity, saving on healthcare costs, reducing the spread of disease, and providing more economic security for workers.

Paid sick leave is good for children. Parents without paid sick days are more than twice as likely as parents with paid sick days to send a sick child to school or day care.

Paid sick leave provides job and financial security for minority and low-wage workers, whom are most often in jobs that lack sick leave benefits and can least afford to forego a paycheck if they become ill or must care for a family member. In Illinois, roughly 1.6 million workers are in low-wage jobs making $12 or less per hour. While only 14.7% of the Illinois population is African-American and 16.9% of the Illinois population is Latino, 33.6% of African Americans and 44.3% of Latinos in Illinois earn $12/hour or less. These lower income workers are less likely to have access to paid sick days. Nationwide, 80.6% of low-wage workers lack a single day of paid sick leave. And less than half of Latino workers in the US (46 percent) have access to paid sick time compared to 60 percent for all workers.

Working to ensure healthy and productive employees, paid sick leave helps provide a healthy Illinois economy and strengthens the economic security of the state’s citizens.

Written by Militza M. Pagán
Consultant to Voices for Illinois Children


[1] Laws differ on types of employees covered, the number of work hours required to earn paid sick leave, and the maximum number of sick leave hours employees can accrue; a detailed chart of paid sick leave statutes can be at found at http://www.nationalpartnership.org/research-library/work-family/psd/paid-sick-days-statutes.pdf