Many enrolled in the state’s Medicaid program will soon be eligible to receive a host of non-medical services that could improve overall health – including housing and nutrition assistance, violence prevention services, and services to help them transition out of incarceration.

Under a new policy the Biden Administration launched last year, state Medicaid programs can now apply for federal waivers to cover what many people call “social determinants of health” – the conditions in which people live that can have a direct impact on their health care needs. 

The federal Centers for Medicare and Medicaid Services approved Illinois’ application for such a waiver July 2. It extends through June 30, 2029, and may be extended beyond that. At the same time, CMS also approved a five-year extension of another waiver originally approved in 2018 that allows coverage of substance use disorder treatment for individuals in mental institutions.

“You’ve heard the expression, ‘An ounce of prevention is worth a pound of cure.’ Well, that’s what this waiver means for Illinoisans all across our state,” Gov. JB Pritzker said at a recent news conference. 

Medicaid is a publicly funded health insurance program primarily for poor people that is jointly funded by states and the federal government. It was launched in 1965 alongside Medicare, the federally funded health care program for seniors.

For years, the federal government has allowed, and even encouraged, states to innovate with their Medicaid programs by granting them short-term waivers from standard Medicaid rules. This allows them to try out experimental, pilot or demonstration projects designed to better serve the health care needs of the Medicaid population.

The waivers are authorized under Section 1115 of the Social Security Act and thus are known as “1115 waivers.”

The new waiver adds three new categories of services that will be covered under the Illinois Medicaid program for individuals who qualify. But state officials estimate it will take at least a year to get the new services up and running.

The first and most far-reaching of those covers “health-related social needs,” or HRSN services. That includes such things as housing and food assistance for Medicaid enrollees who either have or are at risk of developing costly chronic health conditions and who have a documented need for such services.

A second new category covers violence prevention and intervention services for Medicaid recipients who either have been victims of violence in the past, are currently experiencing violence, or are at risk of experiencing violence in the future.

Finally, the new waiver authorizes Illinois to provide specific health-related services to incarcerated individuals for 90 days immediately before their expected release. That includes case management to assess their physical, behavioral, and health-related social needs. It also includes ensuring they have a 30-day supply of their prescription medications, along with any medical equipment or supplies they may need immediately upon their release.

As a condition of that waiver, Illinois will be required to provide Medicaid enrollment support for individuals entering a correctional facility, and it will only be allowed to suspend – not terminate – the Medicaid benefits of anyone already enrolled in the program once they enter the institution.

In 2021, according to CMS, Medicaid paid for about 41 percent of all childbirths in the United States. The National Institutes of Health estimates Medicaid pays for the care of about 62 percent of all nursing home residents.

In Illinois, Medicaid covers about 4 million individuals, with a total cost in the current fiscal year of nearly $27 billion, including both state and federal funds.

(Article courtesy of Capitol News Illinois)