Medicaid
Illinois Medicaid ranks 48th of all states and Washington D.C., in spending per full-benefit enrollee. IHA advocates for adequate funding to care for Illinois' Medicaid customers.
The Impact of Medicaid in Illinois
Source: IHA COMPdata, 2024
- Advocacy
- Policy
IHA Summary: Medicaid Managed Care and Prior Authorization Reform Bills
This memo summarizes recent state legislation to reform clinical and reimbursement policies implemented by commercial health insurance issuers and Medicaid MCOs.
IHA Alert: Urge Your Legislators to Restore Medicaid Funding to Hospitals
Ask state legislators to urge their legislative leaders and state budgeteers to repeal the FY2013 SMART Act cuts to hospitals.
IHA Position Paper: Repeal FY2013 SMART Act Cuts, Restore Funding to Hospitals
Illinois hospitals have absorbed more than $800 million in reductions from 3.5% Medicaid rate cuts under the SMART Act passed in 2012.
IHA Alert: Urge Senators to Co-Sponsor Medicaid Managed Care/Prior Authorization Reform Legislation
IHA is strongly supporting legislation to reform the unfair policies and practices of the Medicaid Managed Care Organizations and state-regulated commercial health plans (Senate Bills 2006 and 177).
IHA Summary: Governor’s FY2022 Budget Proposal
This memo provides details on the Governor’s FY2022 budget proposal, which does not include any Medicaid eligibility, service or rate reductions.
Hospital and Healthcare Transformation – Update No. 4
On Jan. 13, 2021, the General Assembly overwhelmingly passed IHA supported legislation, Senate Bill 1510, to authorize the Hospital and Healthcare Transformation program. See IHA's memo.
Hospital and Healthcare Transformation Legislation Summary of SB 1510
On Jan. 13, 2021, the General Assembly passed IHA supported legislation, Senate Bill 1510 (House Amendment 3), to authorize the Hospital and Healthcare Transformation Program.
Hospital and Healthcare Transformation Update No. 3
On Nov. 16, IHA submitted comments to the Medicaid Legislative Work Group on the Hospital and Healthcare Transformation proposal released by the Dept. of Healthcare and Family Services on Nov. 13.
IHA Comments on HFS’ Hospital and Healthcare Transformation Proposal
IHA appreciates the opportunity to comment on the Hospital and Healthcare Transformation Plan proposed by the Dept. of Healthcare and Family Services and released to the public on November 13, 2020
Hospital and Healthcare Transformation Update No. 2: HFS Healthcare Transformation Proposal
On Nov. 6, 2020, the Illinois Dept. of Healthcare and Family Services released its Vision for Healthcare Transformation. This memo provides an initial summary of the proposal.
HFS Transformation Proposal – Presentation
See a Powerpoint presentation describing the Illinois Department of Healthcare and Family Services' (HFS) Nov. 6 Vision for Healthcare Transformation.
HFS Healthcare Transformation Proposal – Overview
On Nov. 6, 2020, the Illinois Department of Healthcare and Family Services (HFS) released its Vision for Healthcare Transformation. See an overview of its proposal.
Hospital and Healthcare Transformation – Fall Legislative Preview
See an update on the discussions taking place in the Illinois General Assembly on the process and criteria to be used under the Hospital and Healthcare Transformation program to allocate funds.
IHA Position Paper: Hospital and Healthcare Transformation Program – Investing for Health Equity
Illinois should invest in systemic hospital and healthcare transformation to eliminate health disparities and achieve health equity. IHA shares its principles for legislation.
Hospital Transformation: Opportunity & Challenge
IHA made this presentation to the Medicaid Legislative Work Group on August 19.
IHA Memo re: Medicaid Reimbursement for Inpatient Days Beyond Medical Necessity
This memo summarizes IHA’s concerns about proposed rules on a new methodology for hospitals inpatient days beyond medical necessity.
IHA Letter re: HFS Proposed Rules on Reimbursement for Days beyond Medical Necessity
IHA raises concerns about proposed rules on a new reimbursement methodology for hospital inpatient days beyond medical necessity.
IHA Comment Letter on Medicaid Fiscal Accountability Regulation
IHA formally commented on the proposed Medicaid Fiscal Accountability Regulation. The proposed rule will threaten access to quality healthcare for the 2.9 million Illinoisans on Medicaid.
IHA Infographic on MFAR: Protect Healthcare for Children, Seniors and People with Disabilities
IHA provides facts on Illinois' Medicaid program, which is the state's healthcare safety net for 43% of all Illinois children and 461,584 Illinois seniors or persons with disabilities.
IHA's Medicaid Managed Care Legislation & Advocacy Strategy
Today, a comprehensive legislative package of Medicaid managed care reform bills developed and strongly backed by IHA was introduced in the Illinois General Assembly.
Support Medicaid Managed Care Organization Fairness and Accountability
Senate Bill 1697/House Bill 2715 is a comprehensive approach to needed managed care reforms for fairness and accountability.
Support Safety Net and Critical Access Hospital MCO Reforms
Senate Bill 1807/House Bill 2814 is a comprehensive approach to needed Safety Net and Critical Access Hospital managed care reforms.
Support the Right to a Fair Review of Improper Medicaid MCO Denials
Senate Bill 1703/House Bill 2730 will help assure access to care for Medicaid beneficiaries by providing a fair process to review and correct improper Medicaid MCO payment denials.
Tip Sheet: Thank Your Legislators Who Voted Yes on Hospital Assessment Program
IHA urges members to publicly thank their local legislators who voted "Yes" on Senate Bills 1773 and 1573 to continue the Hospital Assessment Program.
Fact Sheet on SB 1773 and SB 1573: Hospital Assessment Program
IHA urges the General Assembly to approve SB 1773 and SB 1573, bipartisan legislation to redesign Illinois’ Hospital Assessment Program and enhance Medicaid managed care performance transparency.
IHA Summary of Governor's FY2019 Budget Proposal
Many of the Governor's proposed savings would require legislative action or changes to employee contracts.
Illinois is Getting Shortchanged
Illinois receives less federal funding per Medicaid beneficiary than any other state and has one of the lowest Medicaid matching rates in the country.
State DSH Allotment Reductions
IHA in a letter outlined strong concerns with a proposed rule establishing new policies to implement Medicaid state disproportionate share allotment reductions.
Litigation Update 6
Federal District Court Judge Joan Lefkow ordered the State to make Medicaid payments on a more timely basis to ensure access to care for Medicaid beneficiaries.
AHA Transformation Strategy Brief
The AHA Task Force on Ensuring Access in Vulnerable Communities examined ways in which the access to and delivery of care could be improved.
Pass-Through Payments
In a letter to the Centers for Medicare & Medicaid Services (CMS), IHA expressed concern that a proposed rule would further constrain many states’ transition of their Medicaid programs.
DSH Payments Third-Party Payers
IHA asked CMS for clarification on a proposed rule on Medicaid disproportionate share hospital payments and the treatment of third-party payers in calculating uncompensated care.
Litigation Update 5
The House's Revenue Committee heard testimony on the Rauner Administration's plans to issue Medicaid payments in compliance with several consent decrees.
Litigation Update 4
The Rauner Administration has decided that all Medicaid providers statewide should be paid for services provided to all Medicaid beneficiaries—children and adults—during the budget impasse.
Litigation Update 3
During the state budget impasse, the Department of Healthcare and Family Services will make payments to providers serving Medicaid beneficiaries who are children.
Litigation Update 2
The state must continue to make all Medicaid payments for all healthcare services provided to Medicaid beneficiaries who reside in Cook County, according to an agreed-upon court order.
Medicaid Add-on Payment for LAI Antipsychotic Drugs
Illinois HFS issued a Provider Notice informing hospitals of a new add-on payment to psychiatric inpatient claims for certain long-acting injectable antipsychotic drugs.
HFS Healthcare Transformation Section 1115 Demonstration
On May 12, 2023, HFS issued a Public Notice announcing the Department is seeking a five-year 1115 Demonstration extension to secure additional Medicaid resources and spending flexibilities.
IHA Comments on HFS 1115 Demonstration Waiver Proposal
On June 12, IHA submitted a comment letter on the Dept. of Healthcare and Family Service’s (HFS) 1115 demonstration waiver proposal.
Hospital Compliance Reminder: LTC Facility Admissions
On Sept. 16, the Illinois Dept. of Healthcare and Family Services (HFS) issued a Provider Notice reminding hospitals of the mandatory preadmission assessment processes for long term care facilities.
April 18 PASRR Implementation Phase 2
On Monday, April 18, the Illinois Department of Healthcare and Family Services (HFS) will launch Phase Two of the state's Pre-admission Screening and Resident Review (PASRR) system redesign.
March 7 Statewide Hospital Webinar: PASRR Process Redesign
A March 7 webinar will address the statewide transition of the federally mandated Pre-admission Screening and Resident Review process to a new web-based management system.
HFS Announces Statewide March 14 PASRR Process Redesign
The Dept. of Healthcare and Family Services (HFS) has a new vendor, Maximus, to transition the Pre-admission Screening and Resident Review (PASRR) process to a new web-based management system.
Telehealth Policy and Payment Updates
An IHA memo covers changes to the Medicaid COVID-19 Fee Schedule primarily impacting virtual check-ins and e-visits and a correction to the Medicare Physician Fee Schedule.
Integrated Health Homes – Comments Requested
IHA is seeking comments on the Illinois Dept. of Healthcare and Family Services Public Notice proposing to begin Medicaid coverage for Integrated Health Home services on Apr. 1.
Medicaid Releases Psychiatric Rate Add-ons
The Dept. of Healthcare and Family Services updated its Practitioner Fee Schedule with psychiatric service add-on payments, which were delayed. See IHA's memo on eligible procedure codes.
DCFS & HFS Managed Care Transition Plan for DCFS Youth Member Assistance Requested
HFS and DCFS have delayed full implementation of mandatory managed care for Youth in Care of DCFS, Former Youth in Care, and other Special Needs Children from Nov. 1, 2019 to Feb. 1, 2020.
Medicaid Newborn Case Add-ons: Corrections and Open Cases
IHA worked with HFS to establish a standard process for hospitals to resolve long-standing newborn enrollment issues. See our memo (password required) for instructions on submitting data to HFS.
Integrated Health Homes-Update #1
This memo summarizes the latest information on Integrated Health Homes as shared by the Dept. of Healthcare and Family Services.
Telehealth Recommendations Requested by HFS
IHA recommendations on Medicaid telehealth practice and reimbursement promote broad telehealth expansion. Our recommendations came at the request of the Department of Healthcare and Family Services.
Telehealth Coalition
IHA and a diverse group of stakeholders sent a letter to the Governor's office outlining Medicaid regulations that are limiting quality care and cost savings through telehealth.
Medicaid 1115 Demonstration Waiver Proposal
With a Medicaid section 1115 waiver, the state would use federal funds to shift behavioral health patients from institutional to community care settings and enhance community-based services.
1115 Waiver Proposal Summary
Several IHA-backed initiatives, including integrating behavioral health and physical health, are in the State's draft of its federal health transformation Medicaid section 1115 waiver proposal.
HHS Transformation Medicaid Waiver
State officials are working to transform how health and supportive services are provided to people with behavioral health conditions. Their plan will likely include a Medicaid 1115 waiver proposal.