David Carvalho, Chair of the Board of the Cook County Health
& Hospitals System (HHS), and Dr. Ram Raju, Chief Executive Officer of HHS,
both expressed their great pleasure and relief that they were able to announce
that the HHS had received an 1115 Medicaid Waiver from the Federal Government
allowing them to enroll people now with incomes less than 133% of the poverty
level and receive the Medicaid portion from the Federal Government, which is 48
cents on the dollar billed. Currently,
HHS might not be receiving even that amount.
In 2014, when the Affordable Health Care Act goes into effect, HHS will
receive 100 cents on the dollar from the Federal Government for these people
for 3 years, when it will drop down to 90 cents on the dollar. (The State of Illinois is supposed to be
supplying the remaining portion, but given the State’s financial condition, HHS
is not expecting to receive any amount any time soon.)
As a result of this Waiver, HHS was presenting a balanced
budget to the Cook County Board, albeit with a continuing subsidy from the
County. HHS expects to net $99 million
over the costs of implementing the Waiver.
Absent the Waiver, HHS would have had a $99 million budget
shortfall. However, HHS has to do
several things to maintain the Waiver, including signing up 115,000 people
under the program. HHS already has
67,000 qualifying people in its system and there are another 47,000 people in
other federally qualified programs. HHS
estimates that there are 215,000 people in Cook County who would qualify under
the program, meaning there are another 100,000 or so people that HHS could
potentially sign up. Work is underway to
develop methods for reaching out to these people.
2013 Critical to
Transforming HHS
Dr. Raju said that the 2013 budget presented to the Board is
critical to transforming the health care system under the County to a
patient-centered model. When the
Affordable Care Act goes into effect in 2014, many of the patients Cook County
currently serves will now have health insurance and thus will have more options
for care. In order to keep patients with
insurance who can pay for the care HHS provides, it is critical that they view
HHS as an attractive option. Otherwise,
HHS will be left with only those patients who do not qualify to obtain
insurance.
While HHS continues to need significant dollars from the
County to balance the HHS budget, Dr. Raju pointed to improvements in the HHS
collecting fees from patients. Revenues
are up $100,000 more than in 2011, and physicians are at last billing for their
services, with $5.2 million collected already thus far in 2012, and $12 million
projected in 2013. In addition,
significant cost savings are being realized due to supply chain improvements.
Dr. Raju said that HHS needs to hire 444 people this year,
with 144 positions needing to be filled in the next 8 to 10 weeks, and a plan
to hire about 30 new people a month beyond that. Dr. Raju stressed that HHS actually needs
more people, but this budget reflects what can realistically be done during the
course of the year. He also stressed
that he has eliminated all positions that won’t be filled this year. (Often, departments maintain approved
positions, but carry them at a $1/year salary.
All such positions have been eliminated from this HHS budget.)
Mr. Carvahlo stressed that one problem facing HHS is that
the upper level salaries are not competitive enough to attract the talent
needed. HHS is working with Human
Resources and the Shakman Compliance Officer to streamline the hiring process.
Patients from
Outside Cook County
Based on a past survey, about 7% of the population being
served through HHS comes from outside of the County, which amounts to about $25
to $30 million in costs. In the past,
HHS has not done a good job of keeping track of these people, but expects to do
so in the future. A new Illinois law
prohibits a hospital that provides care from billing a patient whose income is
less than 200% of poverty, no matter where the patient lives. But a hospital is not obligated to provide
care, except in emergency situations to save the patient’s life. Currently, HHS provides all care. The HHS Board is starting to have discussions
as to whether there needs to be a change in policy for patients who come from
outside the County. Commissioner
Tobolski stressed that Cook County taxpayers cannot continue to be asked to pay
for care given to people from outside the County.
--Submitted by Priscilla Mims
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