III.E.2.b.iv. Health Care Delivery System

IL Title V

Illinois’ health care delivery system is multi-faceted and has a number of programs and initiatives. The Illinois Department of Healthcare and Family Services (HFS) is Illinois’ largest insurer. It administers the All Kids medical assistance program. This program is jointly financed by state and federal funds and provides critical health care coverage to Illinois’ most vulnerable populations

In 2011, Illinois enacted significant health care reform including the Saving Medicaid Access and Resources Together (SMART) Act (Public Act 97-0689). The Act contained approximately 62 items, one of which established the goal of enrolling at least 50% of all Medicaid beneficiaries in a "care coordination," or managed care, plan by January 1, 2015. This has led to a rapid expansion of Medicaid managed care within the state. Currently, five managed care plans are serving the “Family Health” population (children, pregnant women, and childless adults eligible for Medicaid under the Affordable Care Act) statewide and two more plans are serving beneficiaries in Cook County.

Effective July 2018, the Centers for Medicare & Medicaid Services (CMS) approved an 1115 demonstration project, the Illinois Behavioral Health Transformation. According to HFA, a key aim of the project is to, “building a nation-leading behavioral health strategy will help turn the tide of the opioid epidemic, reduce violent crime and violent encounters with police, and improve maternal and child health.” Ten pilots were implemented through the demonstration including Substance Use Disorder Case Management, Peer Recovery Support Services, Evidence-Based Home Visitation for children born dependent on opioids, and Supportive Employment Services. It is expected that the behavioral health transformation will have a significant impact on the State over the next 5 years by touching all regions of the state, improving care for approximately 800K Medicaid members with behavioral health conditions, builds a delivery system focused on integrated physical and behavioral healthcare impacting all 3.2M Medicaid members (and lays the foundation for a more integrated system for all 13M Illinoisans), and utilize the $2.7 Billion in federal match for Medicaid services.

In 2017, HFS convened a workgroup to design an Integrated Health Home model for the State of Illinois. This is an outcome-based initiative that incorporates non-medical interventions and will help to increase the likelihood of successful pregnancies, Shannon Lightner, the Deputy Director of OWHFS, was part of the workgroup and represented the IL Title V and public health issues at large. The Integrated Health Homes model was projected to launch in early 2020, along with a quality incentive program for managed care organizations to increase the number of women who can deliver full-term babies. Unfortunately, due to the COVID-19 Pandemic, the launch was delayed until early 2021.

Illinois’ IL Title V and HFS have agreed, through an interagency agreement (IGA), to partner and collaborate to improve the health status of Illinois’ women, infants, and children, including children with special health care needs, by sharing data and assuring the provision of preventive services, health examinations, necessary treatment, support, and follow‐up care permitted under the Social Security Administration (SSA) and enumerated in each program’s respective state plans. The agencies agree that by partnering they can enhance their data capabilities, maximize the utilization of care, increase program effectiveness and protect against the duplication of efforts, expenditures and resource allocation. In addition, the partnership further promotes the continuity of care, sharing and leveraging of expertise, and greater accountability within and amongst the agencies.

HFS has also agreed to provide IDPH staff access to Medicaid data regarding maternal mortality cases. This ensures that for every case where the decedent was a Medicaid beneficiary, IDPH can have a full understanding of all her health encounters, providing for a more thorough case review. The arrangement is beneficial to the MMRC and MMRC-V in their review of cases and subsequent recommendations to Title V to improve Maternal health outcomes.

CYSHCN

Most CYSHCN eligible for Medicaid will be required to enroll in one of five managed care plans beginning November 1, 2019. Additionally, according to Illinois law, children who receive in-home shift nursing services, as well as medically fragile and technology dependent children who are eligible for the home and community-based services waiver cannot be mandated to enrollment in a managed care plan. To continue to strengthen the relationship between Title V and Title XIX agencies, senior UIC-DSCC staff are communicating regularly with HFS leadership. It is important to build a positive rapport and maintain open communication because both agencies have a vested interest in the various programs affecting CYSHCN.