Illinois Medicaid Removes Chiropractic Care for Adults

Effective July 1, 2012 In an effort to reduce Medicaid expenditures for fiscal year 2013, the Illinois legislature approved changes anticipated to save the State of Illinois $1.6 billion dollars. In addition to removing chiropractic coverage for adults the passage of Senate Bill 2840 has made the following changes to the Medicaid program:

  • Adds eligibility verification for individuals, which is expected to remove an estimated 300,000 individuals who do not meet the current requirements.
  • Reduces hospital reimbursement by 3.5% - except for Critical Access and Safety Net Hospitals.
  • Changes the eligibility requirements for a family of four to $30,000
  • Imposes a $10.00 co-payment for emergency room visits
  • Requires a $3.60 co-payment on all services
  • Requires a $2.00 co-payment for generic medications
  • Limit prescription coverage to four prescriptions per month (will be extended with doctors certification of need)

Medicaid RAC Audits: Also included in SB 2840 is direction to implement Recovery Audit Contractor (RAC) payment recapture audits.  From authority given under the federal Affordable Care Act rules and 2011 Medicaid reform law, HFS will contract with Recovery Audit Contractors (RAC) to audit payments to medical providers. Focus will be on provider types not currently under close scrutiny.