What happens if you're poor, don't have health insurance and don't qualify for Medicaid?
In Chicago, it means you often end up using Cook County's health system. And the county ends up paying--a whole lot. The Cook County Health and Hospital system is notorious for operating at a deficit. Last year's was $170 million.
But an early implementation of the Affordable Care Act could help the county pay those bills and provide stable health care for at least 100,000 low-income adults. It's called the Medicaid 1115 waiver, and it would allow the county to do now what the ACA promises to do in 2014: expand medicaid to cover childless adults that live under 133 percent of the poverty level. The county originally hoped that expansion could take place in June of this year, but it's August and the waiver has yet to be approved by the U.S. Department of Health and Human Services.
"We are hopeful to have more details about the 1115 waiver in September," said Marisa Kollias, a spokeswoman for the Cook County Health and Hospital System. "We have been having very positive conversations with [the U.S. Department of Health and Human Services' Centers on Medicaid and Medicare Services] and we are hopeful to hear more news in the coming weeks."
If approved, it would extend Medicaid benefits to some of the county's poorest residents. Critics have called the waiver too expensive, but advocates say it likely will save the county a lot of money.
According to estimates put forth by the Cook County Health and Hospital system, the federal match would save the county $198 million dollars by reimbursing money they are already spending on care for local residents who can't afford to pay.
"One of the reasons this is such a good idea is that Cook County is already spending the money on this population," said Margaret Stapleton, attorney at the Shriver Center on Poverty Law. "We might as well double the money that we have available."
In addition, Stapleton said, it will make implementation of the Affordable Care Act easier once 2014 rolls around.
"When the roll out of the new medicaid expansion in 2014 happens, it will mean some of them are already signed up," said Stapleton. "250,000 people will be newly eligible in 2014, and 125,000 will already connect to the county in some way."
If these patients establish relationships with the county's health system and make it their "medical home," the waiver, along with the medicaid expansion may help the county financially, by allowing it to retain medicaid reimbursements once the health care reform law takes effect.
Three other states and the District of Columbia have already had similar measures approved by the federal government to expand Medicaid in anticipation of the Affordable Care Act, according to Kaiser Family Foundation.
In the long term, reports the Chicago Tribune, the full Medicaid expansion might end up benefiting the county financially if they're able to keep Medicaid patients. The early implementation, said Stapleton, may allow patients to establish relationship with providers in the County's hospitals and clinics.
"The county wants people to establish a medical home, have follow through, have a relationship with providers," said Stapleton. "It will bring in a lot of federal funds and maybe even allow the county to hire additional staff."
Although it's unclear when or if the waiver will be approved and go into effect, Stapleton said the sooner the better. As of July, many Illinois residents who received help from the state paying for prescriptions or dental care were cut off.
"People need to be able to get medications and some primary care. They need medicine for diabetes, for heart problems," said Stapleton. "I think it's shocking that we could abandon them."
So what does Uncle Sam have to say about the waiver's progress?
"We continue to work with Illinois on their waiver request," said Alper Ozinal, spokesperson for the Center on Medicaid and Medicare Services.
For the sake of Cook County's poor and sick, let's hope there's more to say come September.
Photo credit: Tripp