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Medicaid, SCHIP, & Federal Authority

  • HIFA waiver – In 2002, Illinois received approval from the Centers for Medicare and Medicaid Services (CMS) for a Health Insurance Flexibility and Accountability (HIFA) waiver to provide FamilyCare coverage to parents and caregiver relatives of children eligible for the State Children’s Health Insurance Program (SCHIP) with incomes up to 185 percent of the federal poverty level (FPL). FamilyCare was fully phased-in over the course of several years, with the final HIFA waiver authorized expansion to 185 percent of the FPL taking effect January 1, 2006. Illinois also operated a premium assistance program, entitled All Kids/FamilyCare Rebate, under the HIFA waiver. This program allowed eligible children with family incomes between 134 percent and 200 percent of the FPL and parents or caregiver relatives with incomes between 134 percent and 185 percent of the FPL to enroll in employer-sponsored or private insurance and receive a monthly rebate ($75) from the State. The HIFA waiver expired in September 2007; Illinois no longer receives federal financial participation for these programs previously implemented under waiver authority.

    All-Kids – In October 2005, Illinois renamed its children’s coverage program and the program known as KidCare became All Kids. Effective July 1, 2006, All Kids coverage expanded to include children who need health insurance, regardless of family income or immigration status. Cost-sharing in the form of monthly premiums and co-pays is determined by family income. Illinois continues to draw federal matching funds for children at and below 200 percent of the FPL who meet immigration requirements. The State pays for higher income children and children who do not meet immigration requirements with State-only funds. 
    FamilyCare- Effective December 2007, Illinois expanded coverage to parents and caretaker relatives of children who live them to 400 percent of the FPL*. Cost sharing in the form of monthly premiums is based on income. Parents and caretaker relatives also pay copays for services.

High-Risk Pools

  • Illinois’ high risk pool, the Illinois Comprehensive Health Insurance Plan (ICHIP), became operational in 1989. Total enrollment in ICHIP was approximately 16,550 as of January, 2007. In 2006, premiums were set between 125 and 150 percent of the average charged for comparable coverage. ICHIP operates two programs:

    • The traditional ICHIP covers the medically uninsurable and is funded by premiums paid by participants and state general funds. Enrollment in traditional ICHIP was approximately 5,800 in January of 2007.
    • HIPAA-CHIP covers Health Insurance Portability and Accountability Act (HIPAA) and Health Coverage Tax Credit (HCTC) qualified individuals and is funded through member premiums and an assessment on the insurance industry. From 2004 through 2006, federal grant funds helped offset premium.   Premiums are set at 135 percent of the average charges for comparable services. At the beginning of January 2007, approximately 10,750 persons were enrolled in this portion of ICHIP.

Dependent Coverage

  • Parents in Illinois have the option of keeping dependents on their health insurance coverage until age 26. Additionally, dependents who are veterans can maintain their parent's coverage until age 30. (Public Act 095-0958)

State Specific Strategies

  • Three-Share – Illinois has several “three-share” models, designed by local community groups, that combine contributions from the employer, the employee, and some community subsidy to create a lower-cost product traditionally aimed at small business.  Illinois had an active program in Winnebago (Rockford) County.  The program suspended operation in October 2006 until a more stable community subsidy could be developed.  Other programs in Macoupin and Sangamon counties will be able to begin enrollment once a stable community subsidy is in place.

    Funded by a Health Resources and Services Administration (HRSA) State Planning Grant pilot grant, the Illinois Division of Insurance assisted with the development of two pilot community “three-share” programs for St. Clair County and a program for Jackson, Franklin and Williamson Counties. The product is designed for low-wage, small businesses (2-50 employees) that currently do not offer insurance.  These programs will begin enrollment once a stable community subsidy is in place.
    *Because of pending litigation and court orders, the Department is currently unable to enroll parents up to 400%