600,000 Children in Cook County to Receive Better Access to Health Care
PRESS RELEASE
For more information, please contact:
John Bouman: (312) 368-2671
600,000 CHILDREN IN COOK COUNTY
TO RECEIVE BETTER ACCESS TO HEALTH CARE
June 24, 2005...Chicago, IL...In a settlement announced today and provisionally approved by
federal District Court Judge Charles Kocoras, the Blagojevich Administration and attorneys
representing low-income children in Cook County have agreed on a plan that will dramatically
affect children's access to health care under the Medicaid program in Illinois. The Blagojevich
Administration's effort to work with children's health advocates to resolve the 13-year old
lawsuit builds on its commitment to devoting significant resources to children's health care.
"We've been making great progress over the last two and a half years in giving more children
and their parents access to health coverage. In his first three budgets, Governor Blagojevich
provided funding to expand health care to more than 313,000 uninsured working families and
kids. With the agreement we presented to the court today, we'll not only resolve a legal
complaint that's been pending through three administrations, but also build on our recent success
by making sure kids who are at risk of missing out on important health services actually make it
to the doctor and back again for follow up visits," said Barry Maram, Director of the Illinois
Department of Public Aid, the lead state agency involved in the settlement.
The agreement announced today addresses concerns first raised in 1992 that children covered by
Medicaid in Cook County were not able to see doctors and receive recommended well-child
services. In provisionally approving the settlement, Judge Kocoras ordered that the affected
families receive notice of the provisions of the settlement, and he set a hearing date in early
November to hear any objections and to give the settlement final approval.
The agreement is designed to ensure children from low income families in Cook County have
access to regular, consistent physician care. The plan includes increases in pediatrician
reimbursement rates to help attract and retain more doctors in the Medicaid program, as well as
bonus payments to doctors who successfully keep their young patients from missing important
services and falling through the cracks. The rate increases and bonus payments have the
potential to more than double what pediatricians are currently paid by Medicaid for well-child
care (rather say how many more docs will come on board or how many more patients will be
served). In addition, dental providers will receive a major increase in reimbursement rates to the
levels paid by the State employee dental plan. The State will also contract with a third party
vendor to provide a referral network for families to assist them in getting necessary care and
services.
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Taking action to end poverty
"This settlement will begin to change the landscape for children receiving Medicaid by
attempting to put them on equal footing with children who are privately insured," said Stephanie
Altman, from Health & Disability Advocates (HDA), one of three organizations representing the
plaintiffs.
To remedy the problems with children's access to health care, the proposed settlement includes:
· Provider Incentives. The settlement will expand the pool of doctors available to serve
Medicaid recipients and improve the regularity by which patients are served. By
increasing provider rates, more physicians should be willing to participate in the
program. Additional incentives for physicians who achieve goals of providing regular,
consistent well-child care will improve the overall quality of care that these children
receive.
· Payments to Federally Qualified Health Centers (i.e., "clinics" in low-income
neighborhoods, which are known as FQHCs). Payments to FQHCs will be increased.
The adjustments are designed to encourage these centers to be proactive in providing
children with the full slate of well-child services, including immunizations and well-
child doctor visits.
· Notices. Informational notices will continue to be sent to recipients, including class
members with some enhancements for better communication.
· Reports/Monitoring. The State will create a series of quarterly reports, which it will
share with the plaintiffs, that will help identify the success of the new measures in
increasing the level of health care provided to children on Medicaid. The State will be in
a better position to identify which children are not receiving care so that the State can
make sure that children do not "fall through the cracks."
· Specialty Care. The State will fund a study on the access of children on Medicaid to
specialty care to to develop more information as to whether additional steps are needed to
increase access to those services.
· Enhanced physician referral system.
The settlement is an illustration of the Blagojevich administration's commitment to ensure that
children have access to quality and affordable health care in Cook County and throughout the
State.
"This settlement helps move Illinois towards a reliable health care system for children receiving
Medicaid, which we hope will provide them with accessible, quality preventive medical and
dental services forming the foundation of a healthy childhood," said John Bouman, counsel from
the Sargent Shriver National Center on Poverty Law.
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Taking action to end poverty
"We are encouraged by the Blagojevich administration's agreement to address the problems that
it inherited from prior administrations," said Fred Cohen, counsel from Goldberg Kohn, a
Chicago law firm that took on the case on a pro bono basis. "The problems addressed in the
lawsuit, however, are difficult to solve, and this agreement is just one step along a path. The
team that represents these children is committed to continuing to work with the State to make
sure that we reach the end of that path."
The settlement comes after a decision by Federal Judge Joan Humphrey Lefkow was issued in
August 2004, finding that the Illinois Department of Public Aid and the Illinois Department of
Human Services were violating the rights of Medicaid-eligible children in Cook County to
receive health care under the Medicaid program. Specifically, the Court ruled that the State has
failed in its obligations to provide these children with access to care from doctors that is equal to
the access to care received by privately insured children, and to ensure that these children
receive the preventive health services required by the federal Medicaid program known as Early
and Periodic Screening, Diagnostic, and Treatment services (EPSDT).
In her opinion, Judge Lefkow explained the meaning of "equal access" to medical care contained
in Medicaid law: "[t]he [children] are entitled to access equal to that of children with private
insurance." The Court expressly concluded that: "the [children] have met their burden of
establishing that the defendants have violated their rights by failing to provide them with equal
access to medical services. Plaintiffs simply do not have access to medical services which is
equal to that of privately insured children."
In addition, Judge Lefkow ruled that the State has failed to establish "a Medicaid program
designed to provide all EPSDT services to all Medicaid-enrolled children on a timely basis."
Under the EPSDT program, the state is obligated to ensure that children receive well-child care,
including regular examinations and immunizations, and the state must *effectively' inform all
eligible individuals of the availability of these EPSDT services."
The Court also ruled that managed care organizations, which serve approximately 15% of
Medicaid-eligible children, have failed to provide requisite levels of preventive health care. The
rate at which children receiving Medicaid attain preventive health care screenings from
managed care organizations was lower than the rate for children on Medicaid who were not in
managed care.
The case was originally filed in 1992 by lawyers at the Legal Assistance Foundation of
Metropolitan Chicago who are now affiliated with two public interest organizations: Stephanie
Altman and Thomas Yates of Health & Disability Advocates and John Bouman of the Sargent
Shriver National Center on Poverty Law. In 2000, the Chicago law firm of Goldberg Kohn Bell
Black Rosenbloom & Moritz, Ltd. agreed to commit its expertise on a pro bono basis.
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Taking action to end poverty
The parties believe that this landmark agreement should help provide a real "medical home" for
children in the Medicaid program and ensure that these children receive timely and appropriate
preventive health care services to allow them to reach their full potential.
The plaintiffs have demonstrated a great desire to ensure that children have access to quality and
affordable health care in Cook County. The administration's willingness to work on a mutually
agreed upon settlement also demonstrates the Governor's commitment to focus significant
resources on children and their access to health care, rather than a lengthier court process. That
commitment has been demonstrated by the following:
The Blagojevich administration has met the State's budget crisis
without resorting to cuts in rates paid to doctors and other
health care providers.
The Blagojevich administration expanded eligibility for the
KidCare program from 185% to 200% of the Federal Poverty
Level as of 7/1/03. In calendar year 2003, Illinois added 60,000
children to its Medicaid programs and now delivers health
coverage to more than one million children across the State. In
all, Illinois has expanded health care coverage to 313,000 more
working families and their children.
In July 2004, the Kaiser Commission reported that Illinois was
second in the nation in the last six months of 2003 in the
number of children added to its KidCare or SCHIP program and
first in the nation in expanding coverage to working parents
through Family Care.
Outreach efforts have accomplished significant achievements.
In 2004, the Blagojevich administration streamlined the
KidCare application process, making it easier and faster to
apply.
The Illinois Department of Public Aid has redoubled outreach
efforts and partnered with some of the largest school districts in
the State to distribute informational flyers about KidCare and
the new income levels.
The Blagojevich administration has dramatically expanded
SCHIP eligibility for parents, under the theory that parents who
have health care are more likely to take care of their children's
health needs.
The Blagojevich administration believes in a pro-active
approach to the overall issue of children's health. One example
is the launch of the Illinois Healthy Women program, which
offers a full range of reproductive health care to 70,000 women
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Taking action to end poverty
coming off of Medicaid each year. The goal is to improve the
health of newborns by helping their mothers plan and space out
pregnancies.
###
Governor's press office: Becky Carroll: (312) 814-3940
Goldberg, Kohn, Bell, Black, Rosenbloom & Moritz, Ltd. is a commercial law firm located in
Chicago with principal concentrations in Litigation; Commercial Finance; Bankruptcy &
Creditors' Rights; Corporate, Securities & Tax; and Real Estate Finance, Leasing &
Development. Contact: Fred Cohen, (312) 201-3929, Frederick.cohen@goldbergkohn.com.
HDA is a national policy group that advocates on behalf of low-income people for access to
health care and disability related programs on the state and federal level. Since 1994, they have
played a leadership role on the national level in the design and implementation of changes in
federal Social Security disability programs. Contact: Tom Yates or Stephanie Altman, ( 312)
223-9600, tyates@hdadvocates.org or saltman@hdadvocates.org.
The Sargent Shriver National Center on Poverty Law, www.povertylaw.org, works in Illinois
and nationally to champion law and policy promoting equal opportunity and support for low-
income individuals, families, and communities so that they can escape poverty permanently.
Contact: John Bouman, Advocacy Director, (312) 368-2671, johnbouman@povertylaw.org.
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
For more information, please contact:
John Bouman: (312) 368-2671
600,000 CHILDREN IN COOK COUNTY
TO RECEIVE BETTER ACCESS TO HEALTH CARE
June 24, 2005...Chicago, IL...In a settlement announced today and provisionally approved by
federal District Court Judge Charles Kocoras, the Blagojevich Administration and attorneys
representing low-income children in Cook County have agreed on a plan that will dramatically
affect children's access to health care under the Medicaid program in Illinois. The Blagojevich
Administration's effort to work with children's health advocates to resolve the 13-year old
lawsuit builds on its commitment to devoting significant resources to children's health care.
"We've been making great progress over the last two and a half years in giving more children
and their parents access to health coverage. In his first three budgets, Governor Blagojevich
provided funding to expand health care to more than 313,000 uninsured working families and
kids. With the agreement we presented to the court today, we'll not only resolve a legal
complaint that's been pending through three administrations, but also build on our recent success
by making sure kids who are at risk of missing out on important health services actually make it
to the doctor and back again for follow up visits," said Barry Maram, Director of the Illinois
Department of Public Aid, the lead state agency involved in the settlement.
The agreement announced today addresses concerns first raised in 1992 that children covered by
Medicaid in Cook County were not able to see doctors and receive recommended well-child
services. In provisionally approving the settlement, Judge Kocoras ordered that the affected
families receive notice of the provisions of the settlement, and he set a hearing date in early
November to hear any objections and to give the settlement final approval.
The agreement is designed to ensure children from low income families in Cook County have
access to regular, consistent physician care. The plan includes increases in pediatrician
reimbursement rates to help attract and retain more doctors in the Medicaid program, as well as
bonus payments to doctors who successfully keep their young patients from missing important
services and falling through the cracks. The rate increases and bonus payments have the
potential to more than double what pediatricians are currently paid by Medicaid for well-child
care (rather say how many more docs will come on board or how many more patients will be
served). In addition, dental providers will receive a major increase in reimbursement rates to the
levels paid by the State employee dental plan. The State will also contract with a third party
vendor to provide a referral network for families to assist them in getting necessary care and
services.
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Taking action to end poverty
"This settlement will begin to change the landscape for children receiving Medicaid by
attempting to put them on equal footing with children who are privately insured," said Stephanie
Altman, from Health & Disability Advocates (HDA), one of three organizations representing the
plaintiffs.
To remedy the problems with children's access to health care, the proposed settlement includes:
· Provider Incentives. The settlement will expand the pool of doctors available to serve
Medicaid recipients and improve the regularity by which patients are served. By
increasing provider rates, more physicians should be willing to participate in the
program. Additional incentives for physicians who achieve goals of providing regular,
consistent well-child care will improve the overall quality of care that these children
receive.
· Payments to Federally Qualified Health Centers (i.e., "clinics" in low-income
neighborhoods, which are known as FQHCs). Payments to FQHCs will be increased.
The adjustments are designed to encourage these centers to be proactive in providing
children with the full slate of well-child services, including immunizations and well-
child doctor visits.
· Notices. Informational notices will continue to be sent to recipients, including class
members with some enhancements for better communication.
· Reports/Monitoring. The State will create a series of quarterly reports, which it will
share with the plaintiffs, that will help identify the success of the new measures in
increasing the level of health care provided to children on Medicaid. The State will be in
a better position to identify which children are not receiving care so that the State can
make sure that children do not "fall through the cracks."
· Specialty Care. The State will fund a study on the access of children on Medicaid to
specialty care to to develop more information as to whether additional steps are needed to
increase access to those services.
· Enhanced physician referral system.
The settlement is an illustration of the Blagojevich administration's commitment to ensure that
children have access to quality and affordable health care in Cook County and throughout the
State.
"This settlement helps move Illinois towards a reliable health care system for children receiving
Medicaid, which we hope will provide them with accessible, quality preventive medical and
dental services forming the foundation of a healthy childhood," said John Bouman, counsel from
the Sargent Shriver National Center on Poverty Law.
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Taking action to end poverty
"We are encouraged by the Blagojevich administration's agreement to address the problems that
it inherited from prior administrations," said Fred Cohen, counsel from Goldberg Kohn, a
Chicago law firm that took on the case on a pro bono basis. "The problems addressed in the
lawsuit, however, are difficult to solve, and this agreement is just one step along a path. The
team that represents these children is committed to continuing to work with the State to make
sure that we reach the end of that path."
The settlement comes after a decision by Federal Judge Joan Humphrey Lefkow was issued in
August 2004, finding that the Illinois Department of Public Aid and the Illinois Department of
Human Services were violating the rights of Medicaid-eligible children in Cook County to
receive health care under the Medicaid program. Specifically, the Court ruled that the State has
failed in its obligations to provide these children with access to care from doctors that is equal to
the access to care received by privately insured children, and to ensure that these children
receive the preventive health services required by the federal Medicaid program known as Early
and Periodic Screening, Diagnostic, and Treatment services (EPSDT).
In her opinion, Judge Lefkow explained the meaning of "equal access" to medical care contained
in Medicaid law: "[t]he [children] are entitled to access equal to that of children with private
insurance." The Court expressly concluded that: "the [children] have met their burden of
establishing that the defendants have violated their rights by failing to provide them with equal
access to medical services. Plaintiffs simply do not have access to medical services which is
equal to that of privately insured children."
In addition, Judge Lefkow ruled that the State has failed to establish "a Medicaid program
designed to provide all EPSDT services to all Medicaid-enrolled children on a timely basis."
Under the EPSDT program, the state is obligated to ensure that children receive well-child care,
including regular examinations and immunizations, and the state must *effectively' inform all
eligible individuals of the availability of these EPSDT services."
The Court also ruled that managed care organizations, which serve approximately 15% of
Medicaid-eligible children, have failed to provide requisite levels of preventive health care. The
rate at which children receiving Medicaid attain preventive health care screenings from
managed care organizations was lower than the rate for children on Medicaid who were not in
managed care.
The case was originally filed in 1992 by lawyers at the Legal Assistance Foundation of
Metropolitan Chicago who are now affiliated with two public interest organizations: Stephanie
Altman and Thomas Yates of Health & Disability Advocates and John Bouman of the Sargent
Shriver National Center on Poverty Law. In 2000, the Chicago law firm of Goldberg Kohn Bell
Black Rosenbloom & Moritz, Ltd. agreed to commit its expertise on a pro bono basis.
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Taking action to end poverty
The parties believe that this landmark agreement should help provide a real "medical home" for
children in the Medicaid program and ensure that these children receive timely and appropriate
preventive health care services to allow them to reach their full potential.
The plaintiffs have demonstrated a great desire to ensure that children have access to quality and
affordable health care in Cook County. The administration's willingness to work on a mutually
agreed upon settlement also demonstrates the Governor's commitment to focus significant
resources on children and their access to health care, rather than a lengthier court process. That
commitment has been demonstrated by the following:
The Blagojevich administration has met the State's budget crisis
without resorting to cuts in rates paid to doctors and other
health care providers.
The Blagojevich administration expanded eligibility for the
KidCare program from 185% to 200% of the Federal Poverty
Level as of 7/1/03. In calendar year 2003, Illinois added 60,000
children to its Medicaid programs and now delivers health
coverage to more than one million children across the State. In
all, Illinois has expanded health care coverage to 313,000 more
working families and their children.
In July 2004, the Kaiser Commission reported that Illinois was
second in the nation in the last six months of 2003 in the
number of children added to its KidCare or SCHIP program and
first in the nation in expanding coverage to working parents
through Family Care.
Outreach efforts have accomplished significant achievements.
In 2004, the Blagojevich administration streamlined the
KidCare application process, making it easier and faster to
apply.
The Illinois Department of Public Aid has redoubled outreach
efforts and partnered with some of the largest school districts in
the State to distribute informational flyers about KidCare and
the new income levels.
The Blagojevich administration has dramatically expanded
SCHIP eligibility for parents, under the theory that parents who
have health care are more likely to take care of their children's
health needs.
The Blagojevich administration believes in a pro-active
approach to the overall issue of children's health. One example
is the launch of the Illinois Healthy Women program, which
offers a full range of reproductive health care to 70,000 women
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Taking action to end poverty
coming off of Medicaid each year. The goal is to improve the
health of newborns by helping their mothers plan and space out
pregnancies.
###
Governor's press office: Becky Carroll: (312) 814-3940
Goldberg, Kohn, Bell, Black, Rosenbloom & Moritz, Ltd. is a commercial law firm located in
Chicago with principal concentrations in Litigation; Commercial Finance; Bankruptcy &
Creditors' Rights; Corporate, Securities & Tax; and Real Estate Finance, Leasing &
Development. Contact: Fred Cohen, (312) 201-3929, Frederick.cohen@goldbergkohn.com.
HDA is a national policy group that advocates on behalf of low-income people for access to
health care and disability related programs on the state and federal level. Since 1994, they have
played a leadership role on the national level in the design and implementation of changes in
federal Social Security disability programs. Contact: Tom Yates or Stephanie Altman, ( 312)
223-9600, tyates@hdadvocates.org or saltman@hdadvocates.org.
The Sargent Shriver National Center on Poverty Law, www.povertylaw.org, works in Illinois
and nationally to champion law and policy promoting equal opportunity and support for low-
income individuals, families, and communities so that they can escape poverty permanently.
Contact: John Bouman, Advocacy Director, (312) 368-2671, johnbouman@povertylaw.org.
Sargent Shriver National Center on Poverty Law
50 E. Washington Street, Suite 500, Chicago, Illinois 60602 312.263.3830 Fax: 312.263.3846 www.povertylaw.org
Feeds: Atom
© Copyright 1996-2008 Sargent Shriver National Center on Poverty Law
50 East Washington Street, Suite 500, Chicago, Illinois, 60602;
(312) 263-3830 (voice); (312) 263-3846 (fax).