SPRINGFIELD — —
A plan to expand Medicaid coverage for low-income adults without children squeaked through an Illinois House committee Tuesday despite scrutiny over a last-minute amendment that would give more flexibility to mental health institutions.
The Human Services Committee voted 8-6 in favor of the expansion, which is part of President Barack Obama's health care law. The measure now moves the House floor; the state Senate has already approved it and Gov. Pat Quinn is in favor.
Up to half a million uninsured Illinoisans would be newly eligible for coverage, with the federal government footing the bill for three years. Roughly 340,000 people are to enroll by 2017 and the expansion would cover those making up to 138 percent of the federal poverty level, or just under $16,000 annually.
Democratic State Rep. Sara Feigenholtz, a sponsor, called the complicated measure a "game changer."
"We are finally going to be able to insure people, childless adults specifically, for the first time in as long as I can remember," she told the committee.
But those who voted against the bill, including Republican Rep. Patti Bellock, were concerned about future costs. She and other Republicans have questioned whether the federal government will put more of the financial burden than expected on states. Last year's U.S. Supreme Court decision made the expansion optional and more than a dozen Republican-led states have declined.
"The problems that a lot of us had is not about serving more people, it's about the fiscal conditions of the state and whether we can take on this expansion at this time," Bellock said.
Much of the testimony at Tuesday's nearly three-hour hearing centered on an amendment filed Monday that would, among other things, allow some existing mental health facilities to be repurposed as triage centers, easing the burden on emergency rooms. Illinois has about two dozen such nursing homes.
Proponent Terry Sullivan, the executive director of Alliance for Living, estimated the savings to the state at $100 million a year.
Opponents agreed that the services are needed, but said the facilities disproportionately serve the Chicago area, have lax regulations and don't have a good track record.
Illinois has historically relied on nursing homes to house the mentally ill, particularly after it began shutting down state-run mental hospitals in the 1970s. The care provided in the homes came into question after lawsuits were filed that claimed Illinois violates the civil rights of the mentally ill by needlessly segregating them in the specialized nursing homes. A 2010 federal class action settlement allowed people living in those institutions to move into apartments and smaller homes. The nursing homes rely on state money.
Opponents claimed that the proposed amendment was a way for those facilities, called institutions for mental disease, to reclaim money lost after the settlement.
"Giving them new customers and new people when they have done such a terrible job ... seems to be not a good idea," said Wendy Meltzer, executive director Illinois Citizens for Better Care.
Proponents dismissed the claim, but two state representatives said the opposition raised important questions and they wanted further discussion on the matter. Feigenholtz said the specifics were still in the works.
House Democrats who had pushed for the Medicaid expansion said the failure to pass the bill would lead to unintended consequences. Those include putting a Cook County pilot project that expanded Medicaid early at risk. More than 50,000 people applied for the CountyCare program, which is set to expire at the end of the year.
Feigenholtz said the bill would address those concerns, along with changing the model for mental health care in Illinois.