Good News: Senate Bill 26–Medicaid Expansion–Posted For Hearing in House Human Services Committeee

Update:  May 20, 2013–Senate Bill 26, which expands Medicaid coverage to many more persons with serious mental illnesses, has been posted for a hearing in the House Human Services  Committee for 9am on Tuesday, May 21, 2013 in Room C-1 in the Stratton Building.   Please contact members of that committee and voice your support.  You can also fill out a witness slip supporting the bill.  

January 17, 2013–President Obama has recognized that Medicaid expansion is vital to fixing our broken mental health system and made this an urgent priority in his recommendations on gun violence issued yesterday.  This is yet another reason to implement the Affordable Care Act in Illinois.

The Affordable Care Act is the most important piece of legislation effecting persons with mental illnesses since the enactment of Medicaid.  Serious mental illnesses, while highly treatable, are often incurable, They are most commonly diagnosed during adolescence of early adulthood.  Thus, they constitute “pre-existing conditions” which are used by health insurance companies to deny coverage.  The Affordable Care Act helps people with serious mental illnesses because: (1) it prohibits insurance companies from denying coverage based upon a pre-existing conditon; (2) it provides substantial financial incentives to states to expand Medicaid coverage to many people with serious mental illnesses; and (3) creates less expensive insurance for persons who are not eligible for Medicaid.  Persons with serious mental illnesses and all Illinois taxpayers will greatly benefit from full implementation of the ACA in Illinois.   Each state can decide whether it will implement the Affordable Care Act.  The passage of House Bill 106 or Senate Bill 26, which were  just introduced, will insure full implementation of the ACA.  The Summit urges all who care about mental health services to communicate to their state senator and state representative their support for passage of  these identical bills– full implementation of the ACA.

Click here for more information about this legislation.

Click here to locate your state legislators.

Summit Urges Passage of House Bill 2469–Carve out psychotropic medications from 4-drug limit

Representative Chapa LaVia has introduced House Bill 2469 to carve out  many psychotropic medications from the draconian 4-drug limit on Medicaid recipients imposed by last year’s SMART Act.  The SMART Act includes a provision requiring Medicaid recipients to get prior authorization from their doctor for any prescription medications over four per month.  This means each month Medicaid recipients who receive over four medications would be required to have each doctor for those additional prescriptions send paperwork to the Department of Healthcare and Family Services justifying those additional prescriptions.  Each month the prescription and doctor could be different depending on the order the prescriptions are sent to the pharmacy.  This creates a burden on the patient, as well as burdens on the doctor and the Department of Healthcare and Family Services.  Unfortunately many persons with mental illnesses and their doctors, when  faced with the burdensome prior authorization process, simply give up and then the person’s mental health condition deteriorates.  Over 200,000 Medicaid recipients take over four prescription medications.

The costs of this provision will outweigh any savings the legislature was hoping to gain.  The Summit is suggesting a number of possible changes to ease the burden o the Act in its current form.

  • Eliminate the four-drug limit entirely.
  • Amend the SMART Act to exempt from the four-drug limit persons who are on Medicaid due to a disability.
  • Amend the SMART Act to exempt psychotropic medications, or at least, exempt anti-psychotic and anti-depressant medications.
  • Improve the prior authorization process:
    • Create an electronic (email or web-based) submission process.
    • Increase transparency by publishing standards and procedures for prior authorization.

If you would like to help please contact the state legislators involved in the enactment of this Act (contact information for each provided in the links below): Senator Heather Steans (D), Senator Dale Righter (R), Representative Patti Bellock (R), and Representative Sara Feigenholtz (D).

For more information please see the links below.

Letter to personalize and send to your state legislators

Click key legislators names for contact information:

Senator Heather Steans (D)                       Senator Dale Righter (R)

Representative Patti Bellock (R)              Representative Sara Feigenholtz (D)

The SMART Act in its entirety; the 4 drug limit is in provision 305 ILCS 5/5-5.12 Pharmacy Payments

Summary of Driscoll and Fleeter research

Driscoll & Fleeter for NAMI Ohio research discussing the rise of costs under a prior authorization program

Exclusion of Antipsychotics from Four Drug Limit_Fact Sheet

CBHA report on the effect of the 4-drug limit so far (October, 2012)

The Illinois Department of Healthcare and Family Services Annual Report for FY11; this report was used by Thresholds in addition to the Driscoll & Fleeter research to apply it to Illinois

Report showing magnitude of co-occuring mental and physical illnesses