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2017 Race for Results Report: Illinois Children of Color Continue to Face Barriers to Success

Written by Anna Rowan

Illinois’ success as a state is directly tied to the well-being of every one of its children. Yet, too many Illinois young people, especially children of color and children living in immigrant families, still face barriers that limit their opportunities for success, according to the 2017 Race for Results report from the Annie E. Casey Foundation.

The Race for Results report examines national and state data on key education, health and economic milestones by racial and ethnic groups. The report’s index uses a composite score of these milestones on a scale of one (lowest) to 1,000 (highest) to make comparisons. The index shows significant disparities among African-American (327) and Latino children (475) compared to Asian and Pacific Islander (844) and white children (766) in Illinois.

In comparison to other states, the index scores for White and Asian and Pacific Islander children in Illinois ranked in the top 10 nationally for their respective groups. The index score for Latino children in Illinois ranked 15th nationally, ahead of some states with similar demographics to Illinois, like New York, but behind others such as Florida and New Jersey. The Illinois index score for African-American children ranked in the bottom group (34th in the nation), behind New Jersey, New York, and Florida but ahead of other midwestern states like Ohio and Michigan.

aecf-2017raceforresultsstat3-2017

Source: The Annie E. Casey Foundation

The data clearly show that our public policies must do more to reduce inequities among groups:

  • African-American children in Illinois face the most significant barriers to success and are more likely to live in lower income families. They are also the least likely to live in a low-poverty area, with only 36 percent living in low-poverty areas, compared to 91 percent of white children. African-American young adults are also the least likely to be in school or working.
  • Hispanic children also struggle with poverty and are the least likely to live with a householder who has at least a high school degree. Additionally, early childhood education enrollment rates for Hispanic children ages 3-5 (56 percent) lag behind those of African-American (66 percent), Asian (67 percent), and white (67 percent) children.
  • White students in Illinois perform at about the national average for their demographic group in fourth grade reading and eighth grade math. Large achievement gaps between groups mirror those at the national level.

The report also provides a glimpse into the well-being of children in immigrant families, who face the additional stress and trauma of the fear of separation from their parents due to detention or deportation:

  • One in four children in Illinois lives in an immigrant family. Hispanic children make up more than half of this group.
  • Although children in immigrant families are more likely to live in poverty, they and their families are also working hard toward a better life. For example, parents of children in immigrant families are more likely to have regular, full-time employment. And foreign-born young adults are as likely as U.S.-born young adults to be in school or working.

In addition to advocating for policies and investments that connect all children to opportunities, the report makes several recommendations specific to children in immigrant families:

  • Keep families together and in their communities.
  • Help children in immigrant families meet key developmental milestones.
  • Increase economic opportunity for immigrant parents.

The 2017 Race for Results report can be viewed at www.aecf.org/raceforresults/.

 

 

 

 

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

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/

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/

Message from Voices’ President

January 20, 2017

tasha-green-cruzat-head-shot-largeIt is an uncertain time for Illinois and the nation. The new administration in Washington is certain to make decisions at the federal level that will reverberate in Illinois. As the Illinois Legislature makes tentative moves toward a resolution to the 19-month budget impasse, localities and non-profit organizations are still in dire need of resources to provide services and help residents meet their basic needs.

Voices has a role to play in addressing these challenges and offering solutions to some of today’s most intractable issues. This year as Voices celebrates our 30th Anniversary, we will be bold, courageous, and unshakable in our commitment to children, their families, and communities.

Informed by our Agenda to Build Better Lives, Voices will:

  • Demand the passage of a complete State budget that invests adequate and expanded public resources towards programs that support children and families.
  • Champion amending the state constitution to make Illinois’ tax system fairer.
  • Propose a model for Racial Equity Assessments at the state-level that considers the equity impacts of policy proposal and funding decisions and call for the model’s enactment.
  • Push for juvenile justice reforms that put less money in costly prisons and more resources into community-based alternatives that strengthen the communities where youth live.
  • Give all children a promising start in school by building the early math skills in kids birth to age 8.
  • Give you the data and tools to advocate for programs, policies, and investments that support all youth in Illinois, regardless of race, gender, household income, or zip code.

My first year at Voices have been a gratifying experience. I look forward to keeping you updated on Voices’ progress and invite you to join us in our efforts to give every Illinois child the opportunity for a brighter future.

Sincerely,

Tasha Green Cruzat

President, Voices for Illinois Children

IL Children and Families Can’t Afford to Be Hostages in a Budget Crisis!

As of July 1, the state has stopped funding vital services for children, families, and communities. Providers have already been forced to cut off families from vital services and eliminate essential jobs. Some have closed their doors. Budgets are choices. Tell our leaders it’s time to choose Illinois children, families, and communities!

Creating a brighter future through ‘A Stronger Illinois’

We are a stronger Illinois when we invest in strong families, communities, and local economies. By highlighting the stories of real Illinoisans, a new series of reports from the Fiscal Policy Center shows that our state creates a brighter future when we make critical public investments. The series also estimates how programs and the communities they serve would be impacted by the pending loss of billions of dollars in revenue.

2014 Election Toolkit

The best thing we can do this fall to make a difference for Illinois children and families is to engage candidates in our communities and vote on November 4th, 2014. Voices has assembled an election toolkit to make your job as a voter easier. In it you’ll find information on issues impacting children and families to consider when casting your vote, questions to ask candidates, our take on ballot questions, a “how to” guide for holding a candidate forum in your community, and general information about where and how to register and vote.

Progress in Early Reading Proficiency, But Large Disparities Remain

Over the last 10 years, the percentage of fourth graders in Illinois who are reading below proficient levels has fallen 4 percent, according to a new report from The Annie E. Casey Foundation. Despite this modest progress, the percentage of fourth graders who are not at proficient levels remains much too high — two in three fourth graders are still not proficient — and Illinois has one of the largest reading proficiency gaps between students in low- and high-income families. 

Illinois Kids Count 2013: “Moving Policy, Making Progress”

Illinois Kids Count 2013 — “Moving Policy, Making Progress” — focuses on  25 years of achievements and challenges in early childhood education, health care coverage, access to child care services, and seven other featured policy areas. Illinois has made significant strides in improving the lives of children and families, but that progress is now at risk, jeopardizing the health, safety, and well-being of our children and threatening efforts to build a more prosperous future for the state as a whole.