Illinois Emergency Medicaid Waiver Approved, Improves Access to Care

During times of emergency, the federal government offers emergency Medicaid waivers (1135 waivers) which give states critically-needed flexibility to, among other things, quickly increase their health care workforces by relaxing licensing requirements and expanding their practice sites to serve more patients.

On March 23, the Center for Medicaid and Medicare Services (CMS) approved certain provisions of Illinois’ 1135 waiver application, recently submitted in response to the COVID-19 pandemic. CMS is still considering other requests made by the Illinois government. We will update this post as those requests are approved. 

The following is a brief summary of key changes to our state’s Medicaid system approved for the duration of the emergency period. Once the COVID-19 emergency is officially declared over, the following allowances will no longer be in effect.

Provider Participation:

  • Temporarily allow out-of-state Medicare and Medicaid health care providers to provide services regardless of having an Illinois license. This provision will increase the active health care workforce to prevent shortages of our most critical resource–medical providers.
  • Postpone all provider privileges that are about to expire and expedite any pending or new applications from providers in order to maintain robust provider capacity across the state.

Access to Care 

  • Temporarily suspend prior authorization requirements for medical, mental health, and equipment under Medicaid fee-for-service as a way to prevent the delay or disruption of necessary care for our state’s most medically complex individuals.
  • Extend already approved prior authorizations for services or treatments so that services to continue to be provided without a requirement for a new or renewed prior authorization.

Provision of Services in Alternative Settings:

  • Allows services to be covered that were provided in an “alternative setting” such as patient vehicles for drive through testing, mobile testing sites,  temporary shelters or other care facilities (such as commandeered hotel), and other places of temporary residence. This provision greatly increases the opportunities for individuals to receive care during the statewide shelter-in-place mandate.
  • Waive the requirement that Critical Access Hospitals limit the number of beds to 25, and that the length of stay be limited to 96 hours in order to accommodate additional patients during the crisis. 

Managed Care Appeals and Hearings:

  • Modify the timeframe for managed care entities (MCO) to resolve appeals before an enrollee may request a State fair hearing to no less than one day; this allows managed care enrollees to proceed almost immediately to a state fair hearing without having a managed care plan resolve the appeal first.
  • Extends the timeframe for managed care enrollees to request fair hearing by an additional 120 days, as long as the initial 120th day deadline for an enrollee occurred during the period of emergency.

The approved 1135 waiver helps to ensure access to health care and services during the emergency time period. However, remaining concerns such as providing temporary Medicaid for the over 100,000 individuals awaiting application approval, allowing Medicaid to cover up to 90 days of medications for all enrollees, and expanding fast-track eligibility so that individuals presenting at hospitals can get Medicaid quickly remain top priorities. 

Legal Council will continue to advocate for increased support and flexibility for Medicaid recipients and will provide any updates on the state’s progress to ensure that Illinoisans have increased access to meaningful high quality care.

RELATED READING: How Illinois Can Flatten the COVID-19 Curve