Illinois’ All Kids Program
Illinois Department of
Healthcare and Family Services
Stephen E. Saunders, MD, MPH
State Coverage Initiatives National Workshop
State Innovations in Health Coverage
“Covering Kids”
January 26, 2007
About All Kids
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First state program in the nation to make sure
that every child in Illinois has access to
comprehensive and affordable healthcare
Allows most of the 253,000 uninsured children in
Illinois who need health coverage to get it
Helps children get to the doctor before they get
sick and before a simple problem becomes a
major illness
Provides health insurance and prescription
coverage at affordable rates
Began July 2006
Qualifications for All Kids
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18 and under
Illinois residents
No citizenship requirements
No income limit
Monthly premiums and co-payments
based on a sliding scale, based on
income
Current Illinois Medicaid Program
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Combined Medicaid and SCHIP Program
Income threshold 200% of poverty
Family Care 185% of poverty
Primarily Fee for Service
Implementing PCCM
Voluntary managed care in six counties
Over 2 million beneficiaries currently enrolled
Program Structure
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An extension of current Medicaid and SCHIP
program; Medicaid and SCHIP - now ALL KIDS
Same Medicaid benefit package (minus non
emergency transportation or waiver services)
No income limit or asset test, no deductibles
Co-pays, premiums and out-of-pocket limits
sliding scale
12-months continuous eligibility
No pre existing condition limitations
Includes dental
Provider reimbursement - same as Medicaid
All Kids Comprehensive
Health Benefits
Identical to KidCare except non-emergency
transportation and waiver services will not be covered
-Doctor services
Care at health clinics
-Hospital care (inpat/outpat)
-Prescription drugs
Dental care
-Vision and hearing
Lab and radiology
-Family Planning
Medical equip/supplies
-Mental Health/Sub Abuse
-Podiatry/Chiropractic
PT/OT/Speech therapy
-Home nursing care
Kidney dialysis
-Nursing home care
Hospice Care
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Eligibility Process
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One application for entire program
Application process:
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Mail-in
Web
Community-based Application Agent
At Department of Human Services local office, located
in each county
Outreach and PR campaign
One eligibility card for entire program
Crowd Out Provisions
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Must be uninsured for 12 months
Exceptions:
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Parent loses employer sponsored health
insurance
Newborn
Exhausted life time benefit
Child covered by COBRA
Crowd Out Provisions (continued)
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Exceptions (continued)
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Child was covered by Title XIX or Title XXI
and family income changes
Custodial parent cannot access non-custodial
parent’s insurance
Premium/Co-Pay Example
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200 – 300% poverty
Premium $40/child/month; $80/month - max
Co-pay
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$10 office visit
$7/$3 pharmacy
$30 ER
$100 hospitalization
5% rate for outpatient hospital
Yearly maximum - $500
No co-pay for preventive health care, e.g., well child
visits and immunizations
All Kids Monthly Premium
FPL
Per Child
Maximum Per
Month
200% - 300%
300% - 400%
400% - 500%
500% - 600%
600% - 700%
700% - 800%
Over 800%
$40
$70
$100
$150
$200
$250
$300
$80
$140
$200
No Max
No Max
No Max
No Max
Financing
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Governor’s key initiative passed General Assembly
November 2005
GRF funded – no waivers
Cost Savings through implementation of the:
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PCCM Program – FY 07 for most Medicaid/SCHIP
beneficiaries
Disease Management Program -July 1, 2006
 Disabled Adults
 Family Health Population with Persistent
Asthma
 Family Health Population – Frequent
Emergency Room users
Provider Buy-In
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Input into the planning process with
monthly Stakeholders’ meetings
30-day payment cycle for physician
services, starting July 1, 2006
Pediatrics rate increases for selected
preventive visit and E & M codes - January
1, 2006
Support by ICAAP and IAFP
Provider Payment
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Providers will be responsible for collecting
co-payments under All Kids (similar to
private insurance)
Providers may elect not to charge co-pays
Providers are not required to deliver
services when co-pays are not paid
Provider will be reimbursed under
established rates minus cost sharing copayments
Reimbursement Rates:
Select Examples
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CPT 99214 - E & M office visit,
established patient ($72.97)
CPT 99381 – Preventive office visit, initial
evaluation, healthy infant ($91.90)
CPT 99384 – Preventive office visit, initial
evaluation, adolescent ($104.96)
Challenges
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Major outreach resulted in significant volumes
of applications that require processing
Some provider resistance
Expectations of expanded population
sometimes different
Premium payment process issues
Making sure newborn is covered immediately
after birth
Building trust in program regarding
immigration issues
Number Enrolled
(as of December 15, 2006)
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Total All Kids Children 1.3 million
New since July 1, 2006 100,000
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64,000 Medicaid/SCHIP
36,000 Expansion
Conclusion
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Healthcare reform is possible with political
will and buy-in
Medicaid package of services comprehensive
and is a model benefit package
Medicaid structure provides an efficient
platform to build upon – has an established
payment, claims processing system and
provider enrollment processes
Conclusion (continued)
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Packaging the program to look like health
insurance should further eliminate “stigma”
of welfare
Sliding fee scale allows higher income
families who lack insurance for their
children to purchase affordable health care
with the benefit of a large risk pool
Outreach and simplified enrollment is key