August 14, 2018
To the Honorable Members of
The Illinois House of Representatives,
100th General Assembly:
Today I return House Bill 4771 from the 100th
General Assembly with specific recommendations for change.
It is essential for Illinois to support people
with disabilities and seniors who require nursing level care but do not have
the resources needed to provide for that care. While I support a myriad of
programs to help people remain in the community according to their needs and
their choices, Medicaid funded nursing home care remains an important piece of
our social safety net.
For many years, Illinois has struggled to
process Medicaid applications for long term care quickly. For most Medicaid
bills, the state pays for half of the cost and the federal government
reimburses the state for the other half. Under this bill, the state would be on
the hook for 100% of the costs of nursing home stays while an application is
under review.
While I empathize with the desire to speed
payments for clients who qualify for Medicaid long term care services, this
bill as written would expose the state to unnecessary expenses. These include
costs for individuals who do not qualify for Medicaid, costs over and above the
amount individuals qualify to have covered by Medicaid such as “spend down” or
“penalty period” amounts, and costs that would have been matched by the federal
government if presumptive eligibility were not in place. In addition, this
bill would incent applicants to prolong the review of their applications,
exacerbating the current backlog, and inviting the filing of fraudulent
applications.
This amendatory veto is intended to cure
several issues with the legislation as it was initially approved. Specifically:
- It clarifies that the provisional
eligibility applies strictly to long term care Medicaid cases.
- It clarifies that provisional eligibility
only lasts until the state makes an eligibility determination. The
original bill required payments for people even after they were found to
be ineligible. This change will save the state millions in unnecessary expenses
when compared to the original legislation. It also aligns the incentives
for applicants to remain cooperative during the entirety of the review of
their applications.
- It includes a sunset that is intended to
repeal this law once the state has made significant progress eliminating
the backlog of long term care applications.
- It includes a “claw back” provision so
the state can recoup payments for those who are determined not to be
eligible for the benefit. This change will save the state millions in
unnecessary expenses when compared to the original legislation and will
discourage those to seek to profit at public expense.
My administration is committed to eliminating
the backlog of long term care applications. Over the last year, we have added
nearly fifty percent more state staff assigned to processing applications and
are in the process of a procurement to further expand our capacity to attack
the backlog. The Departments of Human Services and Healthcare and Family
Services have undergone a modernization process to identify and eliminate
bottlenecks in the application process. They are implementing solutions
internally and reaching out to external stakeholders to improve the rate at
which complete applications are submitted. In addition, we have implemented a
policy change to make it faster and easier to approve benefits for those
applicants with the clearest need, and are exploring additional policy changes
to further streamline the process.
Earlier this month, I signed two bills that
will expedite long term care application processing. SB 2385 will make it
easier and faster for applicants to provide the state with the financial
records necessary to determine eligibility. SB 2913 enacts a number of reforms
to improve the way the state processes long term care applications and
communicates with stakeholders. These two bills combined with our other
improvements to date and those coming soon will eliminate the long term care
backlog.
In order to ensure further progress on this
issue, I have directed the Departments of Human Services and Healthcare and
Family Services to coordinate with each other to achieve the following
objectives:
·
They
will collaborate with each other and external stakeholders to develop clear,
easy-to-follow instructions, trainings, and checklists for applicants for long
term care and those who assist them with Manage My Case and the Application for
Benefits Eligibility.
·
They
will work to improve communication with applicants and providers by holding
quarterly meetings with provider organizations and sending important notices to
providers with applicants’ permission. The Department of Healthcare and Family
Services will coordinate with the Centers for Medicare and Medicaid Services to
determine when ex parte redeterminations are appropriate in long term
care settings.
·
They
will explore ways to streamline processing of income adjustments for clients
already enrolled in long term care.
The current improvements to processing long
term care applications combined with the efforts we are putting in place now
will eliminate the backlog. I urge the legislature to adopt HB 4771 as amended
by this amendatory veto to avoid the significant unnecessary expenses the
original bill would impose on the people of Illinois.
Therefore, pursuant to Section 9(e) of Article
IV of the Illinois Constitution of 1970, I hereby return House Bill 4771,
entitled “AN ACT concerning public aid”, with the following specific
recommendations for change:
On page 10, by
deleting lines 2 and 3; and
On page 10, by
replacing line 4 with: “(h) Beginning upon the effective date of this
amendatory Act of the 100th General Assembly, provisional
eligibility, in”; and
On page 10, by
replacing line 7 with: “benefits, must be issued to any applicant who, due
to delay by the State, has not received”; and
On page 10, by
replacing line 8 with: “an eligibility determination on his or her
application for”; and
On page 10, by
replacing line 9 with: “Medicaid long-term care benefits or a notice of an”;
and
On page 10, by replacing
line 13 with: “enrollment status until an eligibility determination is made.”;
and
On page 10, by
deleting line 14; and
On page 10, by
replacing line 15 with: “The Department or the managed care”; and
On page 10, by
replacing line 25 with: “fee-for-service system until the State makes a”;
and
On page 10, by
replacing line 26 with: “determination on the applicant's Medicaid”; and
On page 11, by
replacing line 1 with: “long-term care application.”; and
On page 11, by
deleting lines 2 through 12; and
On page 11, immediately
after line 12, by inserting the following:
“(3) Provisional
Eligibility as enacted in this amendatory Act of the 100th General
Assembly shall be repealed when the combined backlog of long term care
applications and admissions has been reduced by 80 percent or more from its
2018 peak. When that mark is reached, the Director of the Illinois Department
of Healthcare and Family Services shall send a letter to the Governor and the
leaders of the four legislative caucuses indicating that the backlog has been
reduced by at least 80 percent. Provisional eligibility as enacted in this
amendatory Act of the 100th General Assembly shall be repealed upon
the date these letters are sent.
(4) The
Department shall recover all amounts paid to a provider for any individual
while provisionally eligible if the individual’s application is not approved.
The Department shall recover money pursuant to this section either by set off,
crediting against future billings, by requiring direct repayment to the
Department, or by any process permitted by law.”.
With these changes, House Bill 4771 will have
my approval. I respectfully request your concurrence.
Sincerely,
Bruce Rauner
GOVERNOR
Translate
