Medicare & Medicaid

Why is this important to family physicians?

More Americans depend on family physicians than on any other medical specialty, and are the main source of primary health care for the Medicare population while also caring for a large proportion of new Medicaid beneficiaries: 91% participate in Medicare, 82% accept new Medicare patients, 86% see Medicaid patients, and 70% accept new Medicaid patients (click here).

What can be done?

Here are some proven principles and suggested solutions for Medicaid Managed Care in Illinois:

  • Enhanced payments for primary care will lead to increased primary care physician participation in Medicaid and improved beneficiary access;

  • Payment for primary care services should be at least equal to Medicare. Restore the increase of Evaluation and Management (E/M) and immunization management codes to Medicare rates as provided in 2013 and 2014. Neighboring states such as Indiana, Iowa and Michigan are among 19 states that pay at or above Medicare rates.

  • Blended payments that include monthly care management payments and robust quality rewards can help reduce inpatient and emergency department costs and utilization.

Federally, advocacy help for Medicaid rate increases may also be done by clicking on the following links to contact your U.S. Senator and U.S. Representative, see also AAFP Medicaid Access & Medicaid Parity Guidance.

What is happening with Medicaid programming in Illinois?

New Behavioral Health Funding

Beyond reappropriation of behavioral health programming at various agencies through the state budget, see Public Act 102-698, the state legislature also added and increased funding to several mental health programs through Medical omnibus legislation, see House Bill 4343:

  • Authorizes mental health wellness checks in schools;

  • Increases psychiatric Medicaid outpatient add-ons (note: general acute hospitals w/ 500+ qualifying services); and

  • Creates a behavioral health collaborative program between the Department of Healthcare and Family Services and associations representing behavioral health providers.

Other Medicaid Omnibus Items

The state’s Medicaid omnibus also increases maternal health rates for prenatal and postpartum visits to be at or above “adult well visits,” and creates new continuity of care protections.

Medicaid Redeterminations

Separate from state legislation, the Department of Healthcare and Family Services confirmed a July end date to the suspension of Medicaid redeterminations from the federal public health emergency related to COVID. Of note, states must restart redeterminations 14 months after the initial notifications.

Coverage for Undocumented

Additionally, the state will expand Medicaid coverage for undocumented adults ages 42 to 54 beginning on July 1st, which was included in the House Bill 4343 Medicaid omnibus. Coverage was previously expanded to undocumented adults 55 to 64 years old, which went into effect in March 2022 after being approved by the state legislature in 2021 (note: undocumented adults ages 42 to 54 years old is expected to take less than a year due to the platform already being in place for undocumented adults 55 to 64 years old).