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Sargent Shriver National Center on Poverty Law
- 1. Illinois Children’s Mental Health Policy Updates September 2019
- 2. The Shriver Center on Poverty Law fights for economic and racial justice. Over our 50-year history, we have secured hundreds of victories with and for people living in poverty in Illinois and across the country. Today, we litigate, shape policy, and train and convene multi-state networks of lawyers, community leaders, and activists nationwide. Together, we are building a future where all people have equal dignity, respect, and power under the law. Join the fight at povertylaw.org. ABOUT US
- 3. Federal Policy Updates • Public Charge Rule Finalized – Impact on Children • Proposed Change to Federal Poverty Level (FPL) • Texas v. US – Challenges to the ACA • Administrative Challenges – Sec. 1337 and Equal Access Rule • Uninsured Rate Rising including Children on Medicaid • Next Congress?
- 4. State Policy Update • Medicaid Omnibus Bill Passed and Signed • Behavioral Health Legislation • Behavioral Health $ Increases in the Budget • Behavioral Health Delivery System Changes • Foster Children and Managed Care Implementation • State Action on Public Charge - Messaging
- 5. Selected Legislative Highlights • Fair Tax on the 2020 Ballot • Children & Young Adult Mental Health Crisis Act HB 2154 • Medicaid Omnibus Bill SB1321 • Mental Health Action on Campus HB 2152 • School Code Mental Health Awareness SB 1731
- 6. Selected Budget Highlights • $39 million for addiction treatment and prevention and $43 million for mental health services to DHS. • $40 million appropriation to the Illinois Department of Healthcare and Family Services to expand access to psychiatric services and $7 million to HFS will be used to boost Medicaid reimbursement rates for mental health and addiction treatment. • Waiting on HFS Changes to MH Rates. • Mobile Crisis Response Certification See Provider Notice https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn 190830b.aspx
- 7. Integrated Health Homes (IHH) Implementation • Implementation on January 1, 2020 • Contracts with IHHs and MCOs beginning now • IAMHP Contact Form if interested in becoming IHH • Presentation on IHHs at HFS Working Group Slides Available on request • Coordination with N.B. Consent Decree, 1115 Waiver Pilots and Children and Young Adult MH Crisis Act
- 8. MCO Enrollment of Special Needs Children • HFS HealthChoice Illinois managed care expansion for the Special Needs Children population will begin on November 1, 2019. See Provider Notice: https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn190916a.aspx and ICOY MTAC Webinars with IlliniCare • Special Needs Children include children under the age of twenty-one (21) who meet any of the following criteria: • are eligible for Supplemental Security Income (SSI) under Title XVI; • receive Title V care coordination services through the Division of Specialized Care for Children (DSCC) (also known as the CORE Program); • qualify as disabled; • are under the legal custody or guardianship of the Illinois Department of Children and Family Services (DCFS); or • formerly were under the legal care of DCFS and are receiving assistance through Title IV-E.
- 9. Medicaid Omnibus Bill • A complete review of the Medicaid redetermination process within 90 days of the effective date in order to identify changes allowing for more Illinoisans to be automatically renewed (ex-parte). Within 90 days of the completed review, HFS is to seek written federal approval of the policy changes. • Streamline continuing eligibility by leveraging eligibility data from other public benefits programs, like SNAP. • Extend reasonable compatibility threshold for income. • Improve public reporting requirements that will enable stakeholders to better work with HFS, legislature to develop targeted policy and process solutions • Explore and implement opportunities for community stakeholders to assist in expediting eligibility determinations and renewals.
- 11. Impact of Applicant’s Family Members Receiving Benefits? • Benefits received or likely to be received by the applicant’s spouse, children, or other family members are not considered in determining whether the applicant is likely to become a public charge. • But the fact that the household qualifies for a designated public benefit program may indicate that the applicant has a low income. • Receipt of benefits by the sponsor on an affidavit of support will not be counted against the applicant. • However, the sponsor may not count any federal means-tested benefits as income (e.g., SNAP, SSI, Medicaid, TANF)
- 12. • **Medicaid • Supplemental Nutrition and Assistance Program (SNAP or food stamps) • Section 8 Housing Choice Voucher Program • Section 8 Project-Based Rental Assistance, and • Public Housing The 36-month period would not begin before October 15, 2019 for the five programs added by the new public charge rule. Receipt of any of these benefits before October 15, 2019 would not be considered. Public Benefits Added by the New Rule ** Exceptions on Next Slide.
- 13. Medicaid Benefits specifically excluded from the new list of expanded public benefits: • Medicaid for children up to age 21 (including the All Kids program, EPSDT, CHIP) • Medicaid for pregnant women including for 60 days after the pregnancy ends (Moms & Babies program) • Emergency Medicaid • Medicaid for school-based services (including services provided under the Individuals with Disabilities Education Act)
- 14. Things to Keep in Mind ● The rule is not in effect yet. ○ Applies only to applications submitted on or after October 15, 2019. ○ Newly named benefits used prior to that date will not be considered. ● Not everyone is subject to the rule. ○ Many immigrants are exempt from the public charge inadmissibility ground. ○ Benefits used by family members will not be counted directly. ● Positive factors can be weighed against negative factors in this forward-looking test. ● Every situation is different. ○ You can consult with an immigration attorney if you have questions about your own case.
- 15. Conversations with Immigrants Do you or your family members already have green cards? The DHS public charge test does not apply to you. However, if you plan to leave the country for more than 6 months, it is a good idea to talk with an immigration attorney. *The public charge test is not part of a US Citizenship application. ● U.S. Citizenship ● Green card renewal ● DACA renewal ● TPS Do you have or have applied for one of the following statuses? ● U or T Visa ● Asylum or Refugee status ● Special Immigrant Juvenile Status The public charge test does not apply to the categories listed here. If you already have or are in the process of applying for one of these immigration statuses, you can continue to use any government programs that you qualify for because you will not be subject to the test.
- 16. Conversations with Immigrants Does your family plan to apply for a green card or visa from inside the United States? If you aren’t sure whether this policy applies to you, we recommend that you seek advice from an attorney who understands the new changes. If you are not subject to the public charge test, we recommend that you continue to get the assistance that you and your family needs. Does your family plan to apply for a green card or visa from outside the United States? U.S. consular offices abroad use different rules in making this decision You should talk with an expert for advice on your case before making any decisions.
- 17. Protecting Immigrant Families-Illinois (PIF-IL) Steering Committee Members: Convened By: ICIRR, Latino Policy Forum, Legal Council for Health Justice, Shriver Center on Poverty Law • AIDS Foundation of Chicago • Asian Human Services • Elevate Energy • Erie Family Health Center • Greater Chicago Food Depository • Health & Medicine Policy Research Group • Healthy Illinois Campaign • Housing Action Illinois • Illinois Coalition for Immigrant and Refugee Rights (ICIRR) • Illinois Chapter of the American Academy of Pediatrics • Legal Aid Society of Metropolitan Family Services • Legal Council for Health Justice • National Immigrant Justice Center • Shriver Center on Poverty Law • The DuPage Federation • The Latino Policy Forum • The Ounce of Prevention Fund • YMCA of Champaign 17 Grass tops, Provider-facing, and Community- facing education Webinars on Public Charge Growing and Formalizing the Coalition Press Briefing & legislator Briefing City of Chicago & Cook County Board Resolutions Organizing for robust comment volume Two Press Conferences, Vigil pifillinois@povertylaw.org
- 18. Litigation Updates • Cohen Updates on Medicaid Application Delays – ABE Newborn Partner Portal and Automated Phone Line for Delayed Applications See Provider Notice https://www.illinois.gov/hfs/MedicalProviders/notices/Pages /prn190906a.aspx • Public Charge Litigation – AG Case and Future Litigation • N.B. Consent Decree Update
- 20. Get in touch! Stephanie Altman, Director Healthcare Justice • 312-368-2675 • mnicolet@povertylaw.org
Editor's Notes
- The final rule states that the applicant is a public charge if he or she has received or is more likely than not to receive any of nine public benefit programs for more than 12 months in the aggregate within any 36-month period. The programs can be divided into two groups. The first group consists of four programs that were considered under the 1999 Interim Guidance and their receipt or potential receipt is not affected by the October 15, 2019 effective date. Cash benefits received or certified for receipt before this date will be considered a negative factor, as it is under the 1999 Interim Guidance, but not a heavily weighted negative factor. These programs are: The final regulation adds five new programs: non-emergency Medicaid; Supplemental Nutrition and Assistance Program (SNAP, formerly food stamps); Section 8 Housing Choice Voucher Program; Section 8 Project-Based Rental Assistance; and Public Housing. Only benefits received by the applicant are considered. Additional Exceptions: Active duty military and families, kids eligible under the Child Citizenship Act Medicaid covered by the rule is any Medicaid program operated under Title 19 for which a state seeks federal reimbursement (unless state-only authority at no expense to the Federal Government). State funded health coverage is not listed in the Rule. The I-944 instructions confirm that applicants do not need to report the receipt of state-only funded coverage (which sometimes has the same name as federally funded coverage). Immigrants won’t be penalized for receiving state-funded coverage. But: Health consideration: looks at whether a person has been diagnosed with a medical condition likely to require extensive treatment or institutionalization, or that will interfere with a person’s ability to go to school, work or care for oneself. Having such a condition is weighed heavily negative if the person is uninsured, and has no prospect of getting private health insurance or the financial resources to pay for reasonably foreseeable medical costs. Although this wouldn’t include state-funded coverage, it would include subsidized ACA coverage. Access to private unsubsidized insurance – heavily positive if appropriate for expected period of admission. This would not include subsidized ACA coverage. Tanya Broder: Medicaid/SNAP: A subset of people granted parole, withholding of removal, or Cuban/Haitian entrants who seek lawful permanent residence through a pathway (such as a family-based petition) that subjects them to public charge. SNAP: In addition to the groups listed above, some members of the Hmong and Lao communities that helped the U.S. during the Vietnam War may be subject to a public charge test if they seek status through, e.g. a family-based visa petition. Public Housing or Section 8: Some people granted parole or withholding of removal are eligible for housing programs and may be subject to public charge if they seek lawful permanent resident status through, e.g. a family-based visa petition. Citizens of Micronesia, Marshall Islands or Palau could be subject to public charge determinations if they leave the U.S. and attempt to reenter, or if they seek a green card through a family-based visa petition or another pathway where public charge is applied. Eligibility for the state/local cash assistance varies by state and locality (some people seeking LPR status may be eligible); for TANF, it’s the returning LPRs and subset of those granted parole, withholding, C/H entrants if they seek LPR status through a pathway that subjects them to public charge; eligibility for SSI is even more restrictive. We already advise LPRs who are receiving SSI or state cash assistance programs to consult with an attorney before leaving the country for over 6 months.
- These exceptions cover almost all the non-citizens who are currently eligible to receive Medicaid benefits and who may be subject to a public charge determination. Similarly, most adjustment applicants are not eligible for other designated federal benefit programs, such as SSI, TANF, SNAP, or Public Housing/Section 8. The Department of Housing and Urban Development has proposed eliminating housing benefits for households that include an ineligible non-citizen family member NOTE: The final rule does NOT list Medicare LIS. However, in listing Medicaid, the final rule does NOT carve out the Medicare Savings Programs (QI-1, SLIB) which help eligible folks with their Medicare Premiums and co-pays. But I need to think about this a little more, because I understand that these programs are state funded and state funded programs are excluded from the rule (by virtue of not being listed explicitly and also being excluded from the I-944). I need to do some more digging on this point. State funded health coverage is not listed in the Rule. The I-944 instructions confirm that applicants do not need to report the receipt of state-only funded coverage (which sometimes has the same name as federally funded coverage). Immigrants won’t be penalized for receiving state-funded coverage. But: Health consideration: looks at whether a person has been diagnosed with a medical condition likely to require extensive treatment or institutionalization, or that will interfere with a person’s ability to go to school, work or care for oneself. Having such a condition is weighed heavily negative if the person is uninsured, and has no prospect of getting private health insurance or the financial resources to pay for reasonably foreseeable medical costs. Although this wouldn’t include state-funded coverage, it would include subsidized ACA coverage. Access to private unsubsidized insurance – heavily positive if appropriate for expected period of admission. This would not include subsidized ACA coverage.
- At least four lawsuits have already been filed! Stay tuned for updates
- We already advise LPRs who are receiving SSI or state cash assistance programs to consult with an attorney before leaving the country for over 6 months.