Pritzker Expands Medicaid Coverage for Uninsured Coronavirus Patients

Illinois Gov. J.B. Pritzker has announced “Care Comes First,” an action plan to ensure an expansion of medical coverage across the state.

The action plan, a series of activities that expands and expedites Medicaid coverage for the duration of the coronavirus outbreak, is led by the Illinois Department of Healthcare and Family Services. Medicaid is a government-funded health insurance program for the poor and disabled.

“We’re doing everything in our power to make sure all our residents can access the healthcare they need in these trying times. This is especially true for our Medicaid population — more than 3 million in Illinois — and those who suddenly find themselves in need of health coverage. We’ve put in every waiver we can with the federal government to expand health care availability during this period,” Pritzker announced.

Application for federal waivers

As part of the action plans, Pritzker applied for federal waivers to further expand Medicaid. Pritzker’s plan is to open up Medicaid to uninsured people diagnosed with the coronavirus, regardless of their income, and also help cover out-of-pocket costs related to the virus for insured residents, with Medicaid serving as a secondary payer.

Pritzker explained that the state was working with insurance companies while Medicaid works with the federal government to “try and make sure everything around COVID-19 is covered. So that nobody has to go without treatment for a [coronavirus]-related illness.”

The governor said they had suspended prior authorization and streamlined the enrollment system on the provider side. In addition, the state is studying how it can allow any medical provider in Illinois to bill Medicaid.

It was reported that the state had requested federal approval to remove time-consuming verification processes, such as numerous co-payments, spend-downs and asset verifications. Meanwhile, Illinois is streamlining processes, such as offering more telephone assistance to help residents obtain information and complete applications as quickly as possible.

To ensure that more people are covered, Illinois has suspended Medicaid terminations, following guidance in new federal legislation.

Crain’s Chicago Business reported that Illinois is among those states approved for another federal waiver that removes bureaucratic barriers to testing and treatment for Medicaid patients. The waiver temporarily suspends the requirements that doctors obtain prior authorization from insurers before providing medical care and allows out-of-state clinicians to treat Illinois’ Medicaid beneficiaries.

In addition, in order to promote social distancing and the observance of stay-at-home orders, Illinois is seeking the authority to provide home-delivered meals and temporary housing for those experiencing homelessness. This will be covered through Medicaid.

Expanding access to treatment

In the wake of the coronavirus, Illinois has been working on providing quicker and expanded access to treatment and medications.

The federal government has approved Illinois’ request for a federal major disaster declaration, which will provide emergency funding to increase hospital and housing capacity.

Recently, Pritzker issued an executive order relaxing rules on telehealth for Medicaid and private insurers in an effort to help those affected by the novel coronavirus pandemic. The new measures say telehealth services would be fully reimbursed by insurers just as if the patient had visited a doctor’s office. The expansion of telehealth services will not be limited to the coronavirus pandemic only, but will include other health care services such as mental health and substance abuse treatment.

On its end, the federal government announced that it is expanding Medicare telehealth coverage during the coronavirus crisis so that beneficiaries can receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility.

As of April 1, there were 5,994 confirmed cases statewide, with 99 deaths recorded.

In an effort to curb the spread of the virus, Pritzker announced that he was extending his stay at home order through to the end of April. Under the terms of the order schools, nonessential businesses and many city departments will remain closed until the end of the month. Pritzker’s initial order was due to expire on April 7.