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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

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

Proposed Medicaid changes could mean end of services for thousands in Illinois.

Proposed changes to the federal Affordable Care Act (ACA) and Medicaid could result in the reduction or elimination of services for thousands of Illinois residents now covered by Medicaid.

Medicaid provides health coverage to low-income children and their families, pregnant women, persons who are disabled, and seniors.[1] Services covered by Medicaid can include payments for hospital and nursing home care and prescription drugs.[2]

The program, jointly funded by the state and federal government, currently covers 36 percent of Illinois children.[3] In July of 2013, Illinois was one of 23 (now 32) states that opted to expand its Medicaid program under the federal Affordable Care Act (ACA).[4] The ACA expanded eligibility for Medicaid to 138 percent of the poverty line, or, families of three making $26,951.[5]

At the beginning of this year, there were 3.1 million people enrolled in the state’s Medicaid program. Of that amount, approximately 649,000 enrolled under the Affordable Care Act. Illinois now has one-quarter of its population enrolled in the Medicaid program.[6]

While Congress has not yet voted on the proposed legislation, nationally, the Congressional Budget Office has calculated that the proposed changes to the ACA could mean a loss of medical coverage for 14 million people in 2018.[7] The Office estimates that both changes to the tax subsidies that allow citizens to buy coverage and to the Medicaid program could increase the number of uninsured from 14 million to 21 million in 2020, and to 24 million in 2026. It also provides yet another major budget issue for Illinois.[8]

When the ACA became law, the federal government paid 100% of the costs for each new Medicaid enrollee through 2016. The percentage dropped to 95% this year. It is scheduled to phase down to 90% by January 1, 2020. Due to the federal reimbursement for new enrollees, Illinois received more than $3 billion dollars in Fiscal Year 2017.  Overall, Illinois spent approximately $12.5 billion in general funds (and related funds) on Medicaid in Fiscal Year 2016.

The proposed bill would make two major changes to Medicaid starting in 2020, each of which likely would reduce coverage in Illinois unless the state chooses to raise the necessary revenue.

First, it would reduce the federal matching rate for new enrollees in Illinois’ Medicaid expansion from 90 percent to Illinois’ regular Medicaid matching rate, just above 51 percent.[9] That means Illinois would have to pay nearly five times as much as under current law for new enrollees. Moreover, because low-income adults move on and off Medicaid over time, CBO estimates that the higher cost would apply to more than two-thirds of expansion enrollees within just two years. [10]

Second, the bill would cap per-person federal Medicaid funding – not just for the expansion population, but also for children, pregnant women, seniors, and people with disabilities currently covered by Illinois Medicaid.[11] The federal government now matches state Medicaid spending with no dollar limit per enrollee, meaning that federal funding increases based on the actual cost of serving vulnerable populations. Under the House bill, the per-person caps would grow more slowly than projected per-enrollee spending, and so Illinois would face increasing cuts in federal funding over time.

The implications of the federal changes in Illinois would further complicate by the state’s ongoing budget crisis. The state has been operating without a complete budget for 21 months. It has a shortfall of billions of dollars just to meet 2015 service levels and has amassed a backlog of bills totaling more than $12.5 billion[12]. Delayed payments or actual cuts have already led providers to curtail vital human services.

During an Illinois House hearing on the subject, experts testified that the proposed federal Medicaid changes could mean a loss of up to $40 billion for Illinois over a ten-year period. Absent any action by the Illinois General Assembly and the Governor to address the revenue shortfall, vulnerable Illinois residents including low-income children and their families, persons with disabilities and seniors, could see coverage cut and discontinued.

Written by S. Mayumi Grigsby


[1] http://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid

[2] http://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid

[3] http://ccf.georgetown.edu/location/illinois/

[4] https://kaiserfamilyfoundation.files.wordpress.com/2013/07/8457-the-cost-of-not-expanding-medicaid4.pdf

[5] http://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid

[6]https://www.illinois.gov/gov/budget/Documents/Budget%20Book/FY2018%20Budget%20Book/FY2018OperatingBudgetBook.pdf

[7] https://www.cbo.gov/publication/52486

[8] https://www.cbo.gov/publication/52486

[9] http://kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currentTimeframe=1&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[10] http://www.cbpp.org/research/health/house-republican-health-plan-shifts-370-billion-in-medicaid-costs-to-states

[11] http://www.cbpp.org/research/health/house-republican-health-plan-shifts-370-billion-in-medicaid-costs-to-states

[12] As of 3/14/17: https://ledger.illinoiscomptroller.gov/

Congress Must Preserve Health Care Coverage for Children

The Children’s Health Insurance Program (CHIP) is a highly successful program that, together with Medicaid, has steadily decreased the proportion of children without health insurance. This progress continued even during the Great Recession, when many families were losing employer-sponsored health insurance.

Unfortunately, the future of CHIP is very uncertain. Congress is currently considering legislation to renew CHIP funding, which is scheduled to expire at the end of September. Failure to extend funding would have harmful consequences for children in Illinois, as well as for the state budget.

The Importance of CHIP in Illinois

As of June 2014, more than 200,000 Illinois children, as well as 12,000 pregnant women, were covered through CHIP. The income eligibility limit for children is currently 318 percent of poverty level (about $64,000 for a family of three), although most CHIP children are below 200 percent of poverty level. Families with incomes above 160 percent of poverty level are responsible for monthly premiums and co-payments on a sliding scale.

CHIP, which was established by Congress in 1997, has played a key role in improving access to health care for Illinois children. The program’s impact has gone beyond the expansion of eligibility for medical assistance. The implementa­tion of CHIP also generated efforts to enroll eligible children through outreach activities and stream­lined application procedures. As a result, CHIP has had important spillover effects by facilitating enrollment of eligible children in Medicaid.

When CHIP was reauthorized in 2009, Congress instituted performance bo­nus payments to states for increasing Medicaid enrollment. From 2009 to 2013, Illinois was awarded more than $50 million in performance bonuses. Illinois was one of only nine states to receive bonus payments for five consecutive years.

The success of CHIP has contributed significantly to the state’s remarkable progress in health care coverage for children. Between 1998 and 2011, the number of low-income children without health insurance in Illinois declined by more than half. In 2013, only six states had lower uninsured rates for all children.

The Imperative of Renewed Federal Funding

The elimination of federal CHIP funding would have a severe impact in Illinois. Some CHIP children would still be covered by Medicaid, but the state would lose about $75 million in funding because the federal match would drop from the enhanced CHIP rate (about 66%) to the regular Medicaid rate (about 51%).

Another important budgetary consideration is that the federal matching rate for CHIP in Illinois is scheduled to increase to more than 88 percent for a four-year period beginning in October 2015. Additional funding for the state would be about $115 million per year.

Among those children who would lose coverage, some would not be eligible for federal subsi­dies through the Health Insurance Marketplace. This is because of the “family glitch” in Affordable Care Act (ACA) — families can­not receive subsidies if they are offered “affordable” employment-based coverage for an individual employee, even if family coverage is not affordable.

Other children who lose CHIP coverage might be eligible for subsidies through the Marketplace — assuming that it isn’t undermined by the U.S. Supreme Court. But these children would likely receive less comprehensive benefits under the ACA benchmark health plans than under CHIP. Moreover, their families would be responsible for larger monthly premiums and co-payments for services. Families who have children with special health care needs would face major financial risk because caps on out-pocket costs will be much higher under benchmark plans than under CHIP.

When CHIP was enacted in 1997, it had broad bipartisan support. The National Governors’ Association has called for the timely extension of CHIP funding. Last year, the American Academy of Pediatrics issued a strong policy statement on the role of CHIP in expanding access to care, improving health outcomes for low-income children, reducing racial-ethnic disparities, and meeting the needs of children with chronic health conditions.

It is imperative that Congress move quickly to extend CHIP funding for at least four years. Illinois has a great deal at stake here. If CHIP funding disappears, the state’s gains in expanding access to health care for children would be in serious jeopardy.

For more information on Medicaid and CHIP in Illinois, see the recent report from the Fiscal Policy Center.

Governor Rauner Chooses Reckless Cuts

This week, Governor Rauner released a reckless, cuts-only budget that would do enormous harm to Illinois’ children, families, and communities. The Governor’s failure to propose any new revenues to address the current budget crisis — caused largely by the recent 25-percent cut to income tax rates — takes Illinois in the wrong direction. This failure is even more notable given that just last fall he supported more than $700 million in new revenues.

To make up for the loss of nearly $6 billion due to  the income tax cuts, Rauner proposed slashing large swaths of the state budget for fiscal year 2016, which begins July 1.

Cuts to Services for Children, Families, and Communities

The governor proposed deep cuts across a wide range of areas affecting kids, families, and communities. The following are selected areas that were cut in his proposal.

Child Care and Early Intervention Services

In a departure from longstanding practice, Governor Rauner did not include specifics about where he would spend money at the Department of Human Services (DHS), which serves some of the state’s most vulnerable residents. Rather, he requested lump sum amounts for DHS divisions — Development Disabilities, Family and Community Services, Mental Health, Rehabilitation Services, and Alcoholism and Substance Abuse. Despite the inadequate detail, Governor Rauner indicated the following broad cuts in his budget narrative and agency presentations:

  • Denying Families Child Care Assistance: The proposal would make it so that children over 5 years old could no longer begin receiving child care assistance. Over time, this change would result in potentially over 60,000 children losing access, making it much more difficult for working parents to stay employed.
  • Increasing Child Care Copayments: The proposal would increase family copayments for the third time in five years. This would make child care less affordable for families and make it harder for them to meet other critical needs.
  • Restricting Eligibility for Early Intervention Services: The proposal includes deep funding cuts to Early Intervention, which provides a broad array of services and support for families with children under age 3 who have disabilities or developmental delays.

Due to the lack of details, other cuts within DHS may well be hidden from public view. The Rauner Administration refused to distribute agency presentations on cuts when they released the budget. Instead, officials indicated they would delay the release of materials until next week.

Education

The Governor’s proposal includes a modest increase to General State Aid (6%), which funds K-12 education, and the Early Childhood Block Grant (8%), which funds preschool programs as well as services for infants and toddlers. However, without adequate revenue, these increases are funded by cutting other programs. Thirteen State Board of Education service areas are simply eliminated, including funding for:

  • Advanced Placement programs that help kids get a head start on college and can save families money.
  • Agricultural education that is crucial to Illinois’ rural communities and agricultural economy.
  • Arts and foreign language education that is also important for admission to many colleges.
  • After School Matters, a Chicago-area afterschool program renowned for its success helping children learn more in a safe environment.

Afterschool

Funding for other services that help children learn and stay safe and healthy after school and at other times when school isn’t in session is decimated under the Governor’s proposal. In addition to cuts to After School Matters, funding for Teen REACH, which supports afterschool programs for disadvantaged youth across the state, would be eliminated. All 14,000 youth in Teen Reach would lose access to programs that promote graduation and college and career readiness, keep youth safe, and connect youth with mentors. These cuts will also make it more difficult for parents to work while ensuring that their children are safe, thereby weakening families’ economic security.

Child Protection and Child Welfare

The Department of Children and Family Services, which is already struggling to fulfill its mission and is facing new lawsuits, would see a 20-percent cut in general funds ($139 million). The agency’s general funds budget would be 36 percent below the FY 2009 level. These cuts would pose serious risks for the most vulnerable children and youth in Illinois.  

Beginning in July, 2,400 young adults aged 18 to 21 would no longer get any help making the difficult transition from foster care to independence. Already strapped for personnel to carry out its mission, DCFS staff would be slashed by over 400 positions (a 17% cut). The proposed budget does not specify how child protection services would be affected.  It is not yet clear how the state can carry out these cuts without once again violating federal law.

Public Health

Proposed cuts include:

  • 71% cut to breast and cervical cancer screenings.
  • 10% cuts to a range of areas including a reporting system to analyze and prevent violent child deaths, family planning, school health centers, infant care services, vision and hearing screening, and grants for immunizations and outreach activities at a time when the nation is facing an upsurge in measles and other childhood diseases.
  • 23% cut to HIV/AIDS education and related services.
  • Elimination of funding for multiple sclerosis, mobile health services, the Violence Prevention Task Force, and the University of Illinois Chicago’s Sickle Cell Clinic.

Higher Education

State funding to public universities is cut by over 30 percent (nearly $400 million), despite Governor Rauner’s earlier recognition that Illinois needs “top universities.” When state funding has declined in the past, universities have increased tuition rates for Illinois residents.

$1.5 Billion in Cuts to Health Care

Illinois Medicaid Spending Is Lowest in the Midwest

Despite the fact that Illinois already has the lowest Medicaid costs per enrollee in the Midwest, Governor Rauner proposed slashing the program. General funds resources for the Department of Healthcare and Family Services would be at the lowest level in more than 10 years.

The Governor’s proposal includes:

  • Cutting access to dental and podiatry services for low-income parents and pregnant women. These services were cut previously, but were restored last year after recognition of the harm to Medicaid patients and increased costs due to hospital emergency room care.
  • Denying kidney transplants to children who need them because they lack immigration authorization from the federal government.
  • Restricting access to prescription drugs for individuals with severe mental illness.
  • Decreasing payments to facilities that care for children on ventilators and to supportive living facilities for children with severe mental illness.
  • Reducing payments to hospitals serving Medicaid populations by $735 billion.
  • Ending assistance to people with hemophilia.

Most of these cuts would cause the loss of significant federal matching dollars to both the state and Illinois hospitals. To learn more about how Medicaid and related programs work and why they are so important, read this recent report from the Fiscal Policy Center.

Cuts to Programs Designed to Save Money on Costly Nursing Home Care

The proposed budget would limit eligibility for the Department on Aging’s Community Care Program, which provides services for seniors who might otherwise need much more expensive nursing home care. The proposal also increases the threshold for need, making it more difficult for seniors to qualify. Additionally, the proposal would decrease Community Care Program services to seniors by one hour per week. According to the Administration, these combined changes to limit program access and reduce services will allow the state to serve seniors “more efficiently.”

Changes to the Home Services Program, which helps individuals with physical disabilities who might otherwise need much more expensive nursing home care, would similarly make it harder to receive needed care.

Cuts to Public Transportation

Governor Rauner proposed slashing funding for the Chicago area’s Regional Transportation Authority, as well as downstate public transit systems. The RTA would lose $127 million in funding, while other transit systems around the state would lose $75 million. This would severely crimp the budgets of public transit systems. Likely consequences would be increased fares and reduced services, both of which would make it more difficult for many state residents, particularly those with low incomes, to get to work.

Cuts to Pension Contributions for State-Funded Retirement Systems

Governor Rauner proposed further changes to pensions that he said would result in $2.2 billion in reduced contributions in FY 2016.  

With the constitutionality of the 2013 pension law in serious doubt, counting on unconfirmed, hypothetical savings from additional benefit reductions that have neither been enacted nor survived court challenges would be very irresponsible. Without the $2.2 billion cut in pension contributions, Governor Rauner would need to decimate additional essential services and investments — or, of course, raise new revenue. 

Cuts to Revenue-Sharing with Local Governments

The state shares responsibility for carrying out many essential services with local governments. Governor Rauner proposed reducing the amount of money shared with local governments by about $1.3 billion.

This proposal simply shifts the state’s budget problems onto local governments, which would then be handcuffed by Rauner’s proposed property tax freeze. Without the ability to replace lost revenue from the state, local governments would need to cut services and investments such as K-12 schools.

Large child health disparities shown in 2014 Kids Count

Today, Voices released its Illinois Kids Count 2014 report, “Child Health Matters.” In the report’s foreword, Voices President Gaylord Gieseke highlights areas of progress:

Illinois Kids Count 2014 documents some positive trends for children’s health in our state — fewer children without health insurance, declining infant mortality rates, fewer young children with lead poisoning, and fewer teen deaths from accidents, homicide, or suicide.

In particular, the federal Affordable Care Act is already helping, according to a guest essay by Dr. Kay Saving and Scott Allen of the Illinois Chapter, American Academy of of Pediatrics:

As early as 2010, ACA benefits fundamentally changed health insurance for children. The law guarantees coverage for children with pre-existing conditions, eliminated lifetime coverage limits, prevented insurers from dropping coverage when a child gets sick, and ensured young adults could stay on their parents’ plans until they turn 26. What does this mean for children? Our goal of identifying children with delays and disabilities early – which is critical to accessing services and improving outcomes – will no longer put families in impossible situations with their coverage and finances.  

However, Gieseke points out there is still a long way to go:

The data also show disturbing disparities related to household income level, race and ethnicity, special health care needs, and other factors. Because health is impacted by so many factors — individual, family, and community — reducing these disparities will require a broad set of policy strategies. 

Implementing these policy strategies to improve children’s health, of course, requires money, and Gieseke warns the state’s ability to invest in kids may decline even further soon:

At the end of 2014, Illinois is projected to lose massive amounts of revenue due to the rollback of current income tax rates, which could lead to more devastating cuts. Given this immediate challenge, Voices for Illinois Children will also be working this year to maintain the stable and sustainable revenue necessary to protect and promote the healthy development of Illinois’s youngest and most vulnerable residents. 

You can find the full report below.

Download (PDF, 9.1MB)