Forty-eight million Americans live in food insecure households, meaning they worry about where and how to find their next meal. Many of these individuals and families are covered by Medicaid but are not receiving critical nutritional support. They are eligible for SNAP which could help support their nutrition and improve their health, but they are not enrolled.
What is SNAP?
The Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) helps low-income households purchase adequate, nutritious food. Benefits are distributed monthly on an Electronic Benefits Transfer card, known as “Link” in Illinois, which acts much like a debit card. Money from SNAP can be spent at authorized retailers, and some farmers markets, on any foods that recipients prepare and eat at home. SNAP recipients nationally spend over 85 percent of benefits on fruits and vegetables, grains, dairy, meat and meat alternatives. Beneficiaries also increase the amount of money they spend on groceries each month, instead of simply replacing their food budget with SNAP dollars. By supplementing, not replacing, grocery budgets and allowing for the purchase of more nutritious food, SNAP reduces food insecurity in low-income households. This is particularly true of households with children.
Why Help Consumers Apply for SNAP Benefits?
Connecting more Medicaid recipients with SNAP benefits can address food insecurity and inadequate nutrition, which this population experiences at high rates, and improve health outcomes. In addition to helping a family afford healthier food, children who receive nutrition supports are healthier and more likely to finish school while participating in the program. A report recently released by the White House Council of Economic Advisers details the long-term benefits of this program, including: for mother’s receiving support during pregnancy, reductions in incidences of low birth-weights; and for adults who received support when they were children, reductions in obesity rates and metabolic syndrome, increased likelihood of having completed high school, and significant improvements in overall health and economic self-sufficiency among women.
New Opportunities in Illinois to Reduce the SNAP Gap
The Affordable Care Act has made it easier for low-income individuals and families to access public benefits by helping states pay for electronic systems to apply for benefits. In Illinois, the new Application for Benefits Eligibility enables applicants to submit a single application for both SNAP and Medicaid. However, despite this improved online application, we have not fully reduced the “SNAP Gap”—the number of Medicaid clients who are income-eligible for SNAP but do not receive this benefit. We need to work with medical providers, medical plans, social service organizations and other partners to make sure that everyone who is eligible for SNAP gets the help they need to pay for healthy food.
The newest change to the Illinois SNAP program is that on January 1, 2016, Illinois raised the gross income limit for SNAP from 130% to 165% of the federal poverty level, making nearly 40,000 low-income working families newly eligible for SNAP. With more families in Illinois now eligible for SNAP and the ability to submit a single application for both SNAP and Medicaid benefits, it’s time to close the SNAP Gap and make sure families have the food they need to stay healthy. If you’re not familiar with SNAP’s application process join us on HelpHub for more information and resources for both providers and consumers.
MacKenzie Speer
Advocacy Program Associate
Sargent Shriver National Center on Poverty Law
ACA, Medicaid and Unintended Consequences for People with Disabilities
People with disabilities who are eligible for healthcare through Medicaid may experience painful gaps in coverage during transitions. There are groups of people with disabilities that are particularly vulnerable: those who need long-term care services, those who apply but are not yet found eligible for SSI in 209b states with expanded Medicaid and youth transitioning to the adult system.
Long-term care services and supports, such as personal assistance services or durable medical equipment, are critically important to some people with disabilities. Medicaid packages for people with blindness and disabilities, or AABD or SSI Related Medicaid, offer comprehensive coverage, including long-term care supports and services. For those who need them, these services are a lifeline to independence, living in the community and employment. Either not affordable or available through the private insurance market, Medicaid has been the sole access point for people with disabilities who need long-term care services. The Adult ACA Medicaid group, or expansion group, is a Medicaid program that may or may not provide an individual with long-term care services in any given state.
209(b) Expansion States Facing Challenges with Transitions
One key difference across states is the option to automatically provide SSI Related Medicaid to recipients of the federally-administered state supplementary payments though the Supplemental Security Income (SSI) program. Ten states use at least one eligibility criterion that is more restrictive than the SSI program for Medicaid eligibility and are referred to as 209(b) states. This means that an individual in these states who applies and is found eligible for SSI must make a separate application for Medicaid coverage.
The following states are currently 209(b) states: Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma and Virginia. All but Missouri, Oklahoma and Virginia have expanded Medicaid eligibility through the ACA.
Limited Access to Long-Term Care and Providers in the ACA Adult Group
Because many SSI applications take longer to process than Medicaid applications, people with disabilities can frequently be found eligible for ACA Adult Medicaid while waiting for SSI eligibility to be approved. While this group of individuals who have been approved as ACA Adult Medicaid eligible has access to healthcare, they may not have access to long-term care services.
Once SSI eligibility is approved, however, the beneficiary is no longer eligible for the category of Medicaid (ACA Adult) they are currently receiving. When they are put into the correct category for coverage (SSI Related Medicaid), they are sometimes dropped from one health plan and put into another without their knowledge. The end result is a current Medicaid beneficiary who is denied or faces delayed access to long-term care services he or she should be receiving under SSI Related Medicaid, as well as potentially losing access to providers and being forced to reapply altogether.
In addition to the lack of access to needed long-term care services, people may also experience challenges related to accessing medical service providers. In some states, the integration of the ACA and managed care has vastly changed provider infrastructure, with managed care plans for SSI Related Medicaid offering different provider networks and services than ACA Adult Medicaid managed care plans.
Many individuals, especially those new to SSI Related Medicaid, will not be aware that they are in a different category until another action is taken, such applying for a Medicaid waiver service, attempting to contact their managed care plan or going to see their providers. Both of these issues can result from the timing of an individual’s Medicaid application and approval.
Youth with Disabilities Facing Challenges with Transitions
Youth with disabilities can also potentially face significant unintended consequences around access to appropriate healthcare coverage. Children with disabilities are found eligible for SSI due to a reduction in both Activities of Daily Living and Instrumental Activities of Daily Living. This means a youth can be eligible for SSI under a broader context of criteria, like an inability to socialize or play with others.
Adult disability determinations, by contrast, are made based on a disabling condition that impacts employment—not only current employment, any employment in the country that may be available to someone with such impairments. These are vastly different criteria.
As a result, many children are found eligible and begin receiving childhood SSI and SSI Related Medicaid. However, when they turn 18, they are required to meet the adult disability guidelines in order to remain eligible. Many children fail to meet those adult requirements and their benefits are terminated. Of those that are found ineligible when they turn 18, a number are later found to be eligible in further review or appeal processes. Because Medicaid waiver programs are available only to individuals who are current Medicaid recipients, a child may have waited years to be eligible for Medicaid waivers, be found eligible, only later to be denied eligibility for adult disability—which results in losing benefits under SSI Related Medicaid and SSI eligibility. If, upon later application, the individual is once again found eligible for both adult SSI and SSI Related Medicaid, he or she must now go to the back of the waiting list for the same waiver services previously lost under a youth determination. This can result in years without necessary, critical services and care.
Experiences in the States
Health & Disability Advocates conducted a short, informal survey of seven 209(b) states that have expanded Medicaid to learn more about how states identify people who are in the “wrong” eligibility category and the processes states have in place to prevent this from happening. With six of the seven states responding to the survey, HDA found that:
• Three of six respondents offer Medicaid provider packages that are different depending on whether you are in SSI Related Medicaid or ACA Related Medicaid.
• Three of the six responding states offer some variety of waivers to individuals even if they are placed in ACA Related Medicaid.
• None of the responding states have a formal process for coordinating information about individuals who transition eligibility from one service package to another.
• Four of six states are unaware of whether individuals have been improperly placed in the wrong Medicaid eligibility package; the remaining 33% have implemented trainings, but know that individuals continue to get placed into the wrong eligibility group.
• Five states (all but North Dakota) were not aware of specific alerts that notify the Medicaid beneficiary that their eligibility for one program has ended and another started.
Upon further contact, roughly half of the states were in the early stages of identifying the issue of individuals being inappropriately placed and noted a need to develop a process for re-engaging the beneficiary to get them connected to appropriate providers for maximized health.
Recommendations Going Forward
While states are currently uncertain about the scope and breadth of these issues, it is important to identify individuals who have fallen through the cracks and may experience a significant disruption in services and eligibility. At a minimum, requiring states to create an automated notification system for changes to eligibility would provide beneficiaries greater clarity and time to plan. In North Dakota, for example, individuals receive a notice as they leave eligibility under one Medicaid group and become eligible for another. Notice of and clear information about the ramifications of the change is critical.
Another recommendation for states is to look at integration of its systems and data tracking of disability populations. Data exchanges between the state and federal systems, along with the differing eligibility criteria among various programs, should make tracking persons with disabilities a high priority for states. Minnesota, for example, is developing a new integrated system with the capacity to match data sets to a broader context of information, such as employment status. This will greatly enhance the ability of the state to make sure that people with serious health needs receive the proper services and have access to the supports they need for the greatest possible independence.
Joe Entwisle, MS, CLCP
Sr. Policy Analyst
Health & Disability Advocates
The Future of Enrollment in Illinois: Where We’ve Been and Where We’re Going
When Get Covered America came to Illinois before the first open enrollment period for the Affordable Care Act in 2013, there was a lot of work to be done. At that time 78% of the uninsured had not heard of the health insurance marketplace and were unaware of the new health coverage options or opportunities for financial help available to them for the first time. The initial awareness gap was daunting, but hundreds of thousands of Illinoisans stood to benefit from the marketplace and needed to know how the Affordable Care Act could help them.
Many Milestones Through Collaboration
Fortunately, there were a number of stakeholders like Health & Disability Advocates (HDA), the Campaign for Better Health Care (CBHC), Alivio Medical Center and the AIDS Foundation of Chicago, among others, eager and ready for the challenge ahead. This commitment helped achieve many of the goals laid out in the beginning. After two successful open enrollment periods, nearly 350,000 Illinoisans have enrolled in health insurance through the marketplace, and hundreds of thousands more have received coverage through expanded Medicaid and CHIP. Working together towards the same mission, Get Covered America and its partner organizations increased awareness and provided enrollment resources for consumers across the state.
Stepping Back to Move Forward
Because of the great work that has happened on the ground in Illinois, Get Covered America will be stepping back with full confidence in capable partners like HDA, CBHC and many others—such as Family Guidance Centers and Ada S. McKinley—to continue this important work to make health care enrollment a permanent part of communities. It’s clear that the coalition of partners who have come together on this issue have made great strides over the past two years. As the insurance landscape changes and the number of uninsured Illinoisans continues to decrease, Get Covered America wants to make sure that resources are allocated in the smartest and most effective way.
While Get Covered America won’t have an active outreach presence on-the-ground in Illinois moving forward, the organization will continue to support partners in the state with cutting edge data, best practices, tools and resources. Get Covered America will refine and continue to offer digital tools like the Get Covered Connector while also introducing new programs, like training and support for local partners and health insurance literacy resources for the newly insured.
The Enrollment Challenge Ahead
Just released by Get Covered America, the State of Enrollment Report takes a critical look at the lessons learned and what still needs to be done to get Illinois covered. Using on-the-ground knowledge and data analysis, the report identified several key initiatives integral to maximizing the number of Illinoisans who enroll in coverage. This is a great resource for partners on the ground and the foundation for a sustainable coalition for years to come.
The Get Covered America team is thrilled at what has been accomplished in Illinois so far, but there’s still important work to be done. While more Illinoisans have health coverage than ever before, there are still too many who remain uninsured and need the facts about how the Affordable Care Act can help them and their families. On-the-ground partners like CBHC, Family Guidance Centers and Alivio Medical Center will continue this work and make health care enrollment an institutional reality for years to come. And Get Covered America looks forward to supporting their efforts.
David Elin
National Fundraising Director
Enroll America
Governor Quinn Enacts Largest Increase in Health Care Coverage in State History
Governor Pat Quinn today signed legislation that enacts a critical part of President Obama’s Affordable Care Act (ACA) by making Medicaid coverage available to all low-income adults in Illinois. Today’s action delivers on a major priority announced by Governor Quinn in his 2013 State of the State address and is part of his agenda to improve the health of the people of Illinois and increase access to quality health care.
“In the home state of President Obama, we believe access to quality health care is a fundamental right and we proudly embrace the Affordable Care Act,” Governor Quinn said. “This legislation will greatly improve the health of hundreds of thousands of people across Illinois, strengthen our health care system and create thousands of good jobs in the health care field. Thanks to this law and our shared commitment to increasing access to health care coverage in Illinois, the people of Illinois will be healthier and have a higher quality of life.”
Sponsored by State Senator Heather Steans (D-Chicago) and State Representative Sara Feigenholtz (D-Chicago), Senate Bill 26 will make Medicaid coverage available to adults with annual income below 138 percent of the federal poverty line, which is $15,860 for individuals and $21,408 for couples. The measure is expected to enroll 342,000 people by 2017. Currently, Medicaid is only available to children, their parents or guardians, adults with disabilities or seniors. Enrollment for the newly eligible population will begin Oct. 1 with coverage starting on Jan. 1.
Under the ACA, for the first three years, coverage of newly eligible adults will be 100 percent federally funded. The reimbursement rate will phase down to 90 percent by 2020. State officials estimate this will bring more than $12 billion in new federal funding to support the state’s health care system from 2014 to 2020.
“The Affordable Care Act gives Illinois the resources to provide critical health care services to a population that desperately needs it,” Illinois Department of Healthcare and Family Services Director Julie Hamos said. “Under Governor Quinn’s leadership, we are reforming our health care system so that it focuses on delivering coordinated care and keeping people healthy through better preventive care, not just paying the bills when they become sick.”
Under Governor Quinn's leadership, Illinois is also increasing access to health coverage through the Illinois Health Insurance Marketplace, another major feature of the ACA. The Marketplace, which also launches enrollment Oct. 1 with coverage starting Jan. 1, will be accessed through a user-friendly website where individuals, families and small businesses will be able to compare health care policies and premiums and purchase comprehensive health coverage. Those with income between 138 percent and 400 percent of the federal poverty level will receive subsidies on a sliding scale if they obtain coverage through the marketplace.
Governor Quinn has long championed access to decent health care for all people. In August 2001, he joined his then 78-year-old Doctor, Dr. Quentin Young, to walk 167 miles across Illinois to advocate for health care for all.
For more information about Illinois' implementation of the ACA, go to HealthCareReform.illinois.gov.
Related Documents
Senate Bill 26 and the Affordable Care Act (PDF)
(This post was taken directly from the Illinois Government News Network press release)
New Options for States: Facilitating Medicaid and CHIP Renewal & Enrollment in 2014
States must prepare themselves for an efficient enrollment period in order to capitalize on the upcoming changes to Medicaid eligibility under the Affordable Care Act. The Centers for Medicare & Medicaid Services (CMS)/Center for Medicaid & CHIP Services, recently released a letter that identifies enrollment strategies to help with the anticipated increase in applications. These optional strategies may facilitate enrollment while lessening administrative demands on individual states.
Here are the strategies for those states interested in adopting them:
1) Implementing the early adoption of Modified-Adjusted Gross Income, (MAGI)-based rules
Under the ACA, eligibility for all health insurance programs will be determined by MAGI methodology, which uses different income-counting procedures than current Medicaid programs. During the open enrollment period, which begins on October 1st, 2013, individuals applying for coverage in 2013 will determine their eligibility through MAGI methodology. However, individuals renewing and applying for Medicaid during that 4-month period will have their income reviewed by both current rule and MAGI methodology. States can opt to change how they determine eligibility starting October 1st in order to simplify this process.
2) Extending the Medicaid renewal period
Anyone who has a Medicaid renewal which falls in the first quarter of 2013 will also have to have their eligibility determined by both pre-MAGI and MAGI rules. Extending the renewal period will allow the states to use only the MAGI eligibility rules for simplicity.
3) Enrolling individuals into Medicaid based on Supplemental Nutrition Assistance Program, (SNAP), eligibility
The majority of non-elderly, non-disabled individuals who receive SNAP benefits are also eligible for Medicaid. Enrolling individuals in Medicaid who also receive SNAP benefits without a separate, MAGI-based income determination can help ease a state’s administrative burden. This enrollment opportunity can be implemented for a limited amount of time as states handle the demands of the increase in applications.
4) Enrolling parents into Medicaid based on their children’s Medicaid eligibility
A large number of parents with Medicaid-eligible children will also be eligible for Medicaid when changes go into effect. Enrolling parents based on their children’s eligibility can also serve as a temporary way to facilitate enrollment.
5) Adopting 12 month continuous-eligibility for parents and other adults
Many states already have 12-month continuous-eligibility for children, meaning that children are guaranteed their Medicaid coverage for a full year despite changes to their family’s income. Extending this guarantee to families will reduce the amount of “churning” between different plans, and ensure that entire families have more consistent coverage.
States that wish to implement any of these strategies must get authorization from the federal government. CMS also is encouraging states to propose any other creative strategy that will facilitate enrollment.
Illinois should consider whether some or all of these options are optimal. Implementing these strategies could lessen the administrative burden on the state, maximize enrollment of uninsured populations, maximize eligibility for low income families, and increase federal financing for health care in the state.
Stephanie Altman & Kathryn Bailey
Health & Disability Advocates
Medicaid Expansion Passes Both Houses of the Illinois General Assembly
Earlier this week, the Illinois Legislature passed a bill (SB 26) to implement the Medicaid expansion option for adults without minor children on January 1, 2014. This expansion is a cornerstone of the Affordable Care Act and has the potential to cover over 600,000 low income adults in Illinois under the Medicaid program. The bill has overcome many hurdles along the way and now will be sent to the Governor's desk for his signature.
A year ago, the Supreme Court made the Medicaid expansion to adults an option that states did not have to take. However, the expansion is financially advantageous for states because the federal government pays all of the costs of the new Medicaid adult group for the first three years and thereafter, the state pays no more than 10% of the costs - making this the most lucrative Medicaid program in history for state governments. This coverage program will bring needed revenue to Illinois including to local entities such as Cook County and the City of Chicago as well as to hospitals and other safety net providers.
Illinois will begin accepting Medicaid applications for this new adult group on October 1, 2013, and coverage will begin on January 1, 2014. For residents of Cook County, they can enroll right now and begin getting coverage into the CountyCare program which is an early implementation of the Medicaid expansion. The passage of SB 26 ensures that CountyCare enrollees will be able to continue to be covered under Medicaid along with the rest of the state in 2014.
In addition, SB 26 makes other changes to the Medicaid program including "fixing" some of the SMART Act Medicaid cuts by partially restoring dental care to pregnant women. Some mental health advocates were opposed to an amendment added onto the bill, that allowed a new category of mental health facilities for short term crises. For any questions, you can contact me at saltman@hdadvocates.org.
Stephanie Altman
Programs & Policy Director
Health & Disability Advocates
New Study Builds Case for Expanding Medicaid
A new study in the New England Journal of Medicine confirms what consumer health advocates have known for decades: Medicaid is essential for keeping low-income households on stable financial footing. This should come as no surprise, since protecting families from unexpected and devastating medical costs is exactly what health insurance is meant to do. The study also proves that Medicaid coverage significantly improves beneficiaries’ mental health.
But opponents of Medicaid have distorted the study’s results; they claim it supports their agenda to block millions of low-income, uninsured families from accessing this vital coverage program. Their arguments are misinformed at best. The new study only strengthens the case for expanding Medicaid.
What the study tells us: Medicaid Works!
The researchers looked at the health and finances of low-income, uninsured Oregon residents who were given the opportunity to enroll in Medicaid through a one-time lottery, and compared it to their peers who remained uninsured.
The study shows that Medicaid virtually eliminated all catastrophic medical expenditures (medical expenses exceeding 30 percent of household income) for its beneficiaries. It also indicates that people with Medicaid coverage are significantly less likely to face any medical debt, borrow money to pay bills, or skip payments.
These results are extremely promising, especially in light of the fact that medical bills currently prompt more than 60 percent of U.S. bankruptcies. If we want to reduce the drag bankruptcies create on our economy and the ruin they leave behind in our communities, providing low-income families with Medicaid coverage is a good place to start.
The study also found that Medicaid is a powerful tool in combating mental illness. Medicaid beneficiaries in the study were 30 percent less likely to suffer from depression than those who remained uninsured. Given that suicide takes more lives in the US than any other form of injury and that depression accounts for more than $83 billion in the US between lost productivity and medical expenses, the impact of Medicaid on depression deserves attention and celebration.
File Under: Non sequitur
Instead of celebrating, opponents of Medicaid are arguing this study makes the case for withholding Medicaid coverage from millions of low-income, uninsured families. They base this on the study’s failure to detect statistically significant improvements in a handful chronic disease measures — blood pressure, cholesterol, or hemoglobin levels — in those with Medicaid compared to those without coverage.
That’s like saying because your blood pressure didn’t go down, we are going to prevent you from getting coverage for cancer treatment or a pap smear.
It’s certainly true that the U.S. health care system needs to be better at managing chronic conditions. We routinely lag behind other industrialized nations on measures of chronic care management, such as following medical guidelines for treating hypertension and diabetes. Plus, this study only looks at the impact of two years of coverage; significant improvements in these persistent chronic illnesses may take much longer to materialize.
This is hardly a reason to block millions of low-income families from gaining health coverage they need and deserve. We have no evidence that people with private insurance or Medicare fare any better than Medicaid beneficiaries on these measures, yet no one is suggesting we should all drop our health insurance.
Getting people covered is the first step in creating an effective health care system that works for everyone, but it is not the only step. The ACA contains numerous initiatives to improve the quality of health care.
File under: extremely relevant
Meanwhile, dozens of states are still trying to decide whether or not to take up the option to extend Medicaid coverage to millions of low-income, uninsured adults. This study confirms Medicaid can give beneficiaries peace of mind that they won’t go bankrupt when they experience that unexpected illness, and make staggering improvements in their mental health. It adds to the growing list of reasons why this decision should be a no-brainer for all 50 states.
Katherine Howitt, Senior Policy Analyst
Community Catalyst
(This blog was first published on the Community Catalyst Blog)
