III.E.2.b.v.a. Public and Private Partnerships - Illinois - 2022
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IL Title V
State Agencies
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 Our Kids medical assistance program which is jointly financed by state and federal funds. The program also 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). Among the 62 items in the Act was 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.
In 2017, HFS convened a workgroup to design an Integrated Health Home model for the state. This is an outcome-based initiative that incorporates non-medical interventions and will help to increase the likelihood of successful pregnancies, Shannon Lightner, OWHFS deputy director, 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 of the program was delayed. Currently, the federal authority to implement the program is in the process of being changed from an 1115 waiver to an 1915(i) State Plan Amendment and is pending Centers for Medicare & Medicaid Services (CMS) approval.
Effective July 2018, CMS approved an 1115 demonstration project, the Illinois Behavioral Health Transformation. According to HFS, 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 five years by touching all regions of the state, improving care for approximately 800,000 Medicaid members with behavioral health conditions, building a delivery system focused on integrated physical and behavioral health care impacting all 3.2 million Medicaid members (and laying the foundation for a more integrated system for all 12.7 million Illinoisans), and utilizing the $2.7 billion in federal match for Medicaid services.
Illinois became the first state to extend full Medicaid benefits from 60 days to 12 months postpartum, following the federal CMS approval in April 2021. HFS submitted a Medicaid 1115 demonstration waiver to permit continuous eligibility through 12 months postpartum. CMS approval of the waiver enables federal matching dollars to implement this Medicaid expansion. This development will help to improve continuity of care for women.
There are five quality improvement pillars: (1) MCH; (2) Adult Behavioral Health; (3) Child Behavioral Health; (4) Equity; and (5) Community-Based Services and Supports. The most relevant pillars to IL Title V are MCH and Child Behavioral Health. Specifically, HFS is committed to improving maternal and infant health outcomes by reducing pre-term birth rate and infant mortality, improving the rate and quality of postpartum visits, improving well-child visits rates for infants and children and increase immunization rates for infants and children. For child behavioral health, HFS is committed to improving the behavioral health services and supports for children with mental illness by improving the integration of physical and behavioral health, improving transitions of care from inpatient to community-based services, reducing avoidable psychiatric hospitalizations through improved access to community-based services and reducing avoidable emergency department visits by leveraging statewide mobile crisis response. The equity and adult behavioral health pillars are also of interest to IL Title V. The equity pillar focuses on preventative care such as increased access to breast cancer and cervical cancer screenings and services focused on controlling high blood pressure control. The adult behavioral health pillar is of particular interest because of HFS’ commitment to improve care coordination and access to care for individuals with substance use disorders.
HFS and IDPH have taken additional steps to strengthen their working relationship. The agencies have teamed up to do the two-year Maternal and Child Health Policy Innovation Program (MCH PIP) offered by the National Academy of State Health Policy (NASHP). HFS and IDPH will develop policy initiatives to improve access to care for Medicaid-eligible pregnant and parenting women with at risk of substance use disorders and/or mental health conditions through health care system transformation. Specifically, the state team will strive to: (1) Improve Medicaid managed care coordination processes for pregnant and postpartum Medicaid enrollees to address key drivers of adverse maternal morbidity and mortality outcomes as identified by IDPH and Title V; (2) Implement new prenatal and postpartum quality metrics to monitor and drive improvement in health outcomes for prenatal and postpartum Medicaid managed care enrollees; and (3) Enhance data sharing to better inform interventions and improvements in maternal health outcomes for the targeted MCH population.
Federal Opportunities
In addition to working with state agencies, IDPH and Title V have taken advantage of various federal opportunities to strengthen the health care delivery systems that service Illinois’ MCH population. IDPH continues its work under the five-year grant it received through the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE-MM) program funded by CDC. Also, IDPH has partnered with the University of Illinois at Chicago (UIC) Innovations to ImPROve Maternal OuTcomEs in Illinois (I PROMOTE-IL), which is a five-year grant from HRSA to improve maternal health and to create a state Maternal Health Task Force. The IL Title V director serves as a co-chair of the task force. Another notable federal opportunity in which IDPH and Title V engages is the Chicago Collaborative for Maternal Health (CCMH). CCMH was funded through the Safer Childbirth Cities program launched by Merck for Mothers in 2018. The Collaborative consists of a partnership between the city of Chicago, EverThrive Illinois, and AllianceChicago.
Other Partnerships
Other notable partnerships in strengthening the health care delivery system involve improving clinical practice and provider education. Title V and I PROMOTE-IL provide funding and support to the Illinois Perinatal Quality Collaborative (ILPQC) to implement the Birth Equity Initiative. This initiative aims to support hospital capacity to facilitate systems and culture change to achieve birth equity. Title V also supports the administrative perinatal centers to provide training to all birthing hospitals on obstetrical hemorrhage through the implementation of an obstetric hemorrhage toolkit. ILPQC is providing ongoing education about obstetric hemorrhage and hypertension to providers across the state. I PROMOTE-IL is assessing protocols for pregnant and postpartum persons seeking care in emergency departments and designing emergency department provider training
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.
IL Title V
State Agencies
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 Our Kids medical assistance program which is jointly financed by state and federal funds. The program also 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). Among the 62 items in the Act was 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.
In 2017, HFS convened a workgroup to design an Integrated Health Home model for the state. This is an outcome-based initiative that incorporates non-medical interventions and will help to increase the likelihood of successful pregnancies, Shannon Lightner, OWHFS deputy director, 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 of the program was delayed. Currently, the federal authority to implement the program is in the process of being changed from an 1115 waiver to an 1915(i) State Plan Amendment and is pending Centers for Medicare & Medicaid Services (CMS) approval.
Effective July 2018, CMS approved an 1115 demonstration project, the Illinois Behavioral Health Transformation. According to HFS, 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 five years by touching all regions of the state, improving care for approximately 800,000 Medicaid members with behavioral health conditions, building a delivery system focused on integrated physical and behavioral health care impacting all 3.2 million Medicaid members (and laying the foundation for a more integrated system for all 12.7 million Illinoisans), and utilizing the $2.7 billion in federal match for Medicaid services.
Illinois became the first state to extend full Medicaid benefits from 60 days to 12 months postpartum, following the federal CMS approval in April 2021. HFS submitted a Medicaid 1115 demonstration waiver to permit continuous eligibility through 12 months postpartum. CMS approval of the waiver enables federal matching dollars to implement this Medicaid expansion. This development will help to improve continuity of care for women.
There are five quality improvement pillars: (1) MCH; (2) Adult Behavioral Health; (3) Child Behavioral Health; (4) Equity; and (5) Community-Based Services and Supports. The most relevant pillars to IL Title V are MCH and Child Behavioral Health. Specifically, HFS is committed to improving maternal and infant health outcomes by reducing pre-term birth rate and infant mortality, improving the rate and quality of postpartum visits, improving well-child visits rates for infants and children and increase immunization rates for infants and children. For child behavioral health, HFS is committed to improving the behavioral health services and supports for children with mental illness by improving the integration of physical and behavioral health, improving transitions of care from inpatient to community-based services, reducing avoidable psychiatric hospitalizations through improved access to community-based services and reducing avoidable emergency department visits by leveraging statewide mobile crisis response. The equity and adult behavioral health pillars are also of interest to IL Title V. The equity pillar focuses on preventative care such as increased access to breast cancer and cervical cancer screenings and services focused on controlling high blood pressure control. The adult behavioral health pillar is of particular interest because of HFS’ commitment to improve care coordination and access to care for individuals with substance use disorders.
HFS and IDPH have taken additional steps to strengthen their working relationship. The agencies have teamed up to do the two-year Maternal and Child Health Policy Innovation Program (MCH PIP) offered by the National Academy of State Health Policy (NASHP). HFS and IDPH will develop policy initiatives to improve access to care for Medicaid-eligible pregnant and parenting women with at risk of substance use disorders and/or mental health conditions through health care system transformation. Specifically, the state team will strive to: (1) Improve Medicaid managed care coordination processes for pregnant and postpartum Medicaid enrollees to address key drivers of adverse maternal morbidity and mortality outcomes as identified by IDPH and Title V; (2) Implement new prenatal and postpartum quality metrics to monitor and drive improvement in health outcomes for prenatal and postpartum Medicaid managed care enrollees; and (3) Enhance data sharing to better inform interventions and improvements in maternal health outcomes for the targeted MCH population.
Federal Opportunities
In addition to working with state agencies, IDPH and Title V have taken advantage of various federal opportunities to strengthen the health care delivery systems that service Illinois’ MCH population. IDPH continues its work under the five-year grant it received through the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE-MM) program funded by CDC. Also, IDPH has partnered with the University of Illinois at Chicago (UIC) Innovations to ImPROve Maternal OuTcomEs in Illinois (I PROMOTE-IL), which is a five-year grant from HRSA to improve maternal health and to create a state Maternal Health Task Force. The IL Title V director serves as a co-chair of the task force. Another notable federal opportunity in which IDPH and Title V engages is the Chicago Collaborative for Maternal Health (CCMH). CCMH was funded through the Safer Childbirth Cities program launched by Merck for Mothers in 2018. The Collaborative consists of a partnership between the city of Chicago, EverThrive Illinois, and AllianceChicago.
Other Partnerships
Other notable partnerships in strengthening the health care delivery system involve improving clinical practice and provider education. Title V and I PROMOTE-IL provide funding and support to the Illinois Perinatal Quality Collaborative (ILPQC) to implement the Birth Equity Initiative. This initiative aims to support hospital capacity to facilitate systems and culture change to achieve birth equity. Title V also supports the administrative perinatal centers to provide training to all birthing hospitals on obstetrical hemorrhage through the implementation of an obstetric hemorrhage toolkit. ILPQC is providing ongoing education about obstetric hemorrhage and hypertension to providers across the state. I PROMOTE-IL is assessing protocols for pregnant and postpartum persons seeking care in emergency departments and designing emergency department provider training
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.
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