Regional News/Midwest: Illinois seeks waiver to find housing for Medicaid enrollees, and other news

Illinois plans to ask the CMS for permission to spend $60 million in Medicaid funding to help vulnerable enrollees find and maintain stable housing.

With the waiver, Illinois would join New York and counties in Minnesota and California in recent efforts to add housing to the list of healthcare services offered to chronically ill Medicaid patients.

Proponents of the efforts say the potential health benefits of stable housing could reduce avoidable emergency room visits and hospital stays.

The evidence of savings from these initiatives is limited. This year's expansion of Medicaid under the Patient Protection and Affordable Care Act, though, has increased pressure on state officials and providers to find ways to curb healthcare spending.

Under the waiver, Illinois would offer incentive payments to managed-care plans for enrollees with mental illness or substance-abuse disorders who successfully find temporary or permanent stable housing, consultants for the state told Illinois lawmakers.

The housing provision would allow Medicaid health plans to tailor services to what patients need to maintain their health, said Steven Glass, executive director for managed care for the Cook County Health and Hospitals System in Chicago.

The system's Medicaid managed-care plan won federal approval to begin early enrollment for adults who gained access to Medicaid under the Affordable Care Act. Enrollment began last year and the 72,000 enrollees include more homeless and chronically ill adults than before.

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Missouri's regulations for outreach workers who help individuals sign up for healthcare coverage through the federal insurance exchange have been thrown out by a federal judge. The ruling could have implications for other states that also have attempted to regulate training and activities of outreach workers, a healthcare law expert said.

U.S. District Judge Ortrie Smith issued a preliminary injunction Jan. 23 prohibiting enforcement of a Missouri law that requires outreach workers to register with the state and limits their activities. Outreach workers include navigators, in-person assisters and certified application counselors.

Missouri is among 36 states relying on the federal exchange to provide access to insurance products. That decision, Smith ruled, precludes the state from interfering with implementation of the Patient Protection and Affordable Care Act. States had the option of creating their own exchanges or using the federal marketplace.

“Missouri has opted not to be in the health insurance exchange business,” Smith wrote in his opinion. “Having made the choice to leave the operation of the exchange to the federal government, Missouri cannot choose to impose additional requirements or limitations on the exchange.”

At least 17 other states that are relying on the federal exchange to sign up residents for healthcare coverage have laws regulating the behavior of outreach workers, according to data collected by researchers at Georgetown University's Health Policy Institute. Many of these laws are being pushed by insurance brokers, who view the outreach efforts as state-sanctioned competition. The Missouri ruling could have significant implications for those other states, according to Timothy Jost, a healthcare expert at Washington and Lee University's School of Law.

Regulation of outreach workers also has generated complaints in states such as Indiana, Ohio, Tennessee, Texas and Wisconsin. In general, these states are controlled by Republican lawmakers hostile to the ACA.

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The Cleveland Clinic said that nearly 700 employees accepted early retirement offers, which are part of the health system's ongoing effort announced last September to trim $330 million from its budget.

In addition, the clinic, which boasts annual operating revenue of about $6 billion, said it eliminated “several hundred” open positions, which allowed the organization to keep layoffs to a minimum. The health system did not disclose the number of layoffs. When the budget reductions were announced in September, the clinic said it would offer early retirement plans to 3,000 eligible employees.

“These are always difficult decisions and we regret the loss of any jobs,” according to a written statement from the clinic. “We will continue to evaluate our services and the way we work moving forward, just as healthcare systems across the country will need to do. At the same time, we will continue to hire for positions that are critical, and we will continue to grow to ensure our future is strong, to protect jobs and to provide the best care to our patients.”

The clinic's budget reductions were attributed, in part, to declining reimbursements from government and commercial payers. In addition, there continues to be a veil of uncertainty in the healthcare industry as the Affordable Care Act takes hold.

According to Crain's research, the clinic employs more than 33,000 full-time-equivalent employees in a 15-county area in Northeast Ohio, making it by far the region's largest employer.

Crain's Cleveland Business