Illinois’ All Kids Program
Illinois Department of
Healthcare and Family Services
Stephen E. Saunders, MD, MPH
Child Health Services Research Meeting
June 24, 2006
About All Kids
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First and only 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
Begins 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
Voluntary managed care in six counties
Over 2 million beneficiaries currently enrolled
One year continuous eligibility
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
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 since January 1, 2006,
or 12 months after December 31, 2006
Exceptions:
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Parent looses 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
Affordable health insurance definition
applies at redetermination
Premium/Co-Pay
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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)
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