 Over that same period, 752 truly needy Illinoisans have died on a waiting list
for lifesaving medical treatment. And with a large Obamacare bill due in less
than a month, policymakers should start working now to put the brakes on this
nightmare.
Thankfully, simple, tested and effective policy solutions exist to the
challenges facing the state. By freezing enrollment in its Medicaid expansion
program, Illinois can immediately begin protecting resources for its truly
vulnerable citizens and help Illinoisans currently trapped in welfare get back
on the path to independence. In addition, lawmakers would immediately provide
much-needed relief to overburdened state taxpayers.
Enrollment freezes are simple: Rather than pulling the plug on the expansion
program overnight, the state would allow current enrollees to stay for the time
being, but would stop enrolling new members. This allows lawmakers to gradually
wind down the program over time, but immediately free up resources for the truly
vulnerable.
And enrollment freezes are effective, largely because poverty is a short-term
situation for most individuals. Data from the U.S. Census Bureau indicate the
median time a person spends in poverty is just over six and a half months. So,
by closing the front door to the program, enrollees transition off of the
program as their incomes rise, just as they would anyway, but no new enrollees
are allowed on to the program to take their place. Other states have
successfully used this approach to wind down their Medicaid expansions
Arizona, Maine saw people drop out of Medicaid on their own after freezes
After expanding Medicaid to able-bodied, childless adults in 2000, Arizona’s
Medicaid expansion spiraled out of control and required the state to stop
enrollment. At the time the freeze went into effect, 230,000 adults were on the
program. But during first year of the freeze, enrollment dropped by more than
5.5 percent per month and, by the end of the first year, nearly 115,000 adults
(49 percent) had left the program. This natural attrition continued beyond the
first year, with nearly 155,000 adults (67 percent) transitioning out by the end
of the second year.
Additionally, in 2002, Maine expanded Medicaid eligibility to able-bodied,
childless adults below the federal poverty line. But in 2005, as costs and
enrollment began soaring to unsustainable levels, Maine froze enrollment in its
Medicaid expansion at more than 24,000 adults. Within the first six months,
nearly 8,000 adults (31 percent) had cycled off the expansion. By the end of the
first year, nearly 13,000 adults (52 percent) had left the program.
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Maine re-opened and capped enrollment in the Medicaid expansion at
various times over the next several years. Each time it froze
enrollment, it experienced similar rates of attrition. The state
imposed its last enrollment freeze in 2011, ultimately ending the
expansion altogether at the end of 2013.
Based on these experiences in Arizona and Maine, if an enrollment
freeze were implemented in Illinois, the state could expect 50 to 64
percent of enrollees to transition out of the program within the
first year. That means roughly 323,000 to 410,600 Illinoisans would
be freed from government dependency if the freeze was implemented,
based on the latest enrollment numbers from the state – and that’s
just within the first year.
And if the freeze is implemented at the beginning of the new fiscal
year (July 1, 2017), state taxpayers will save $23 million to $33
million in the first year. Over five years, state taxpayers would
save $555 million to $610 million.
Enrollment freezes are simple and effective ways to move able-bodied
adults out of welfare and back to independence. But, most
importantly, an enrollment freeze is a significant step towards
prioritizing the truly vulnerable – folks like Jake Chalkey and the
18,000 plus Illinoisans on the state’s urgent needs waiting list. As
the freeze is implemented and expansion enrollees transition back
into self-sufficiency, limited state resources will be freed up for
those who truly need help.
Congress is currently considering giving states the explicit
authority to implement enrollment freezes at any time, without
federal approval, as part of their Obamacare rollback plan.
Hopefully, Congress follows through with this policy change. But
regardless of where Congress lands, with 5 percent of expansion
costs falling on state taxpayers in January and rising thereafter,
the Rauner administration can and should begin working immediately
with the new presidential administration to obtain a freeze waiver.
This simple yet powerful step will start to reverse Illinois’
Medicaid crisis and make the vulnerable a priority once again.
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