Learn More About the Affordable Care Act and Implementation in Illinois

Today, for adults without dependent children, no matter how poor they are, they are not eligible for Medicaid. This gap in coverage is eliminated by the Affordable Care Act (ACA). The federal government is offering to pay 100% of the costs for the new category of Medicaid clients through 2016 (phased down to 90% by 2020).

The federal government, advocates and lawyers nationwide continue to debate the impact of the Supreme Court decision with respect to Medicaid. However, it is clear that in Illinois, the Illinois Public Aid Code and administrative rules delineate key aspects of Medicaid eligibility and services (for Medicaid and SCHIP – or All Kids). Therefore, to provide services to this “new Medicaid” group, General Assembly authorization and rule-making will be required.

• Governor Quinn Enacts Largest Increase in Health Care Coverage in State History Initiative Strengthens Health Care System and Brings More Than $12 Billion in New Federal Funding to Illinois
• Public Act 098-0104 (pdf)
• Senate Bill 26 and the Affordable Care Act (pdf)
• Enrolled SB26 (pdf)
• Summary of Senate Bill 26 by Article (pdf)

• Medicaid Financing for The Uninsured: How The Revenues and Costs Are Computed (pdf)
• New Medicaid Clients Under Affordable Care Act: Explanation of Enrollment Numbers (pdf)

Under the Affordable Care Act, the “new Medicaid” clients will be adults 19- 64 years of age, who will qualify on the basis of income – 133% of federal poverty level. (Please note: the federally required income level is actually 138% of federal poverty level, as there is a 5% universal income disregard, and this higher number will have to be included in any Illinois statute or rule.)

These “new Medicaid” clients will be low-income adults without dependent children, who cannot fit into one of the categories currently required for adults.  Current categories are seniors, persons with disabilities, parents/caretakers of dependent children, or pregnant women. 

In Illinois, about 200,000 “new Medicaid” clients are expected to enroll in 2014, with another 143,000 by 2017.  These numbers do not include those “old Medicaid” populations of adults and children who would be eligible under current rules, but who have not previously enrolled (estimated 170,000 by 2017).  Neither category of these additional enrollees would be allowed to purchase health insurance, even with tax subsidies, on the Health Insurance Exchange.

In addition, states must delineate a Benchmark Medicaid Plan for “new Medicaid” clients.  The Benchmark Medicaid Plan may be same as the full service package currently available to Medicaid clients, or something different. 

• Watch the video Health Insurance Changes Coming Your Way Under the Affordable Care Act to see what health insurance changes are coming under the Affordable Care

• Fact Sheet on Healthcare Reform Implementation Efforts in Illinois (pdf)

• Watch the in-depth explanation of the Health Insurance Marketplace, this is a 45 minute training video.

• For an Overview of the Health Insurance Marketplace see the Material in English and Spanish.

  • English Understanding the Health Insurance Marketplace (pdf)

  • English Understanding the Health Insurance Marketplace Presentation (pdf)

  • Video Training Understanding the Health Insurance Marketplace

  • Spanish Understanding the Health Insurance Marketplace (pdf)

  • Spanish Understanding the Health Insurance Marketplace Presentation (pdf)

• For information on the Marketplace Application Process and Marketplace Enrollment Process, visit the Centers for Medicare and Medicaid Services Website

• Video Determining Household for Medicaid and Premium Tax Credits

• Determining Household for Medicaid and Premium Tax Credits (pdf)

• Calculate how much financial help you could get on the Marketplace

• Introduction to Benchmark Medicaid
• Overview of Newly-Eligible Medicaid Expansion Population
• Listing of Current Mandatory and Optional Services for Medicaid
• Listing of Current Long-Term Services and Supports for Medicaid