Gov. Pritzker Announces Efforts to Expand and Expedite Medicaid Coverage for Uninsured and Insured Illinois Residents

As the state continues to build on its robust response to the COVID-19 pandemic and prepare for increased demand across the state’s health care system, Governor JB Pritzker announced the “Care Comes First” action plan, a series of efforts led by the Illinois Department of Healthcare and Family Services to expand medical coverage for residents across the state. The state has submitted two federal waivers requesting increased flexibilities around Medicaid coverage. If approved, the flexibilities will ensure that individuals, whether uninsured or insured, can receive Medicaid coverage for treatment if they have been diagnosed with COVID-19.

Illinois has also taken steps to request from the federal government the authority to make Medicaid available to cover the costs to treat COVID-19 for every uninsured resident, regardless of income. An additional request seeks authority for Medicaid to help cover out-of-pocket expenses for insured residents, as a secondary payer for COVID-19 treatment costs. In an effort to fast track Medicaid enrollment, the state has also requested approval from the federal government to remove time-consuming verification processes, such as numerous co-payments, spend-downs, and asset verifications. The state is also streamlining processes, such as more phone assistance to help residents obtain information and complete applications as quickly as possible.

The state is also working to simplify Medicaid enrollment for providers to expand access, including a request to allow any medical provider licensed in Illinois to bill Medicaid. Site visits to join and revalidation to remain in the program are suspended by the state, as well as minimum staffing levels for most facilities. Quicker and expanded access to treatment and medications has remained a priority for Illinois, as a result prior authorization rules are suspended, and existing authorizations remain for most services. The state is seeking authority from the federal government to allow Illinois to expand telehealth and alternate settings for a range of services, including allowing prescribers not enrolled in Medicaid to write prescriptions.

Lastly, to promote social distancing and observance of stay-at-home orders, the state is seeking authority to provide home-delivered meals and temporary housing for those experiencing homelessness through Medicaid coverage.