Illinois All Kids Program: A First in Universal Health Care
Under the Illinois All Kids Program, all children under the age of 19 are eligible for
health care coverage, regardless of family income.
In 2005, Illinois counted 253,000 children without health insurance. According to the governor, over half of these children came from working families who earned too much to qualify for assistance programs like SCHIP or Medicaid. These families were caught in the access gap so many Americans find themselves--earning too much to qualify for public assistance, but earning too little to buy private health insurance. The Illinois All Kids program was developed to address this gap. The governor asserted that uninsured children receive inadequate medical care and, therefore, are at higher risk for more severe illnesses and hospitalization. The governor stated that, by enacting the All Kids program, the state and insurance companies will save money by addressing medical problems on the front-end, rather than the back. The All Kids program was designed to build on Medicaid and SCHIP programs, exclusively using state funds. The program uses cost sharing based on family income to offset state costs. In 2005 the Illinois General Assembly passed legislation (HB 803) to enable this reform.
Financing the All Kids Program
The All Kids program went into effect July 1, 2006, and a report on the All Kids program progress was released by the Kaiser Family Foundation in August 2008. In the governor's original proposal, the estimated cost of the All Kids program was 34 million dollars, and these costs were to be offset with approximately 57 million dollars in savings through the Disease Management (DM) and Primary Care Case Management (PCCM) programs. The Kaiser report speculated that enrollment efforts in the DM and PCCM programs were less aggressive than those of All Kids, and participation in these programs was also lower than anticipated (a budgetary worry for Illinois and the All Kids program). According to an April 2008 press release, the governor's office estimated a 34 million dollar net savings from the DM and PCCM programs for fiscal year 2007. The press release suggests these savings are sufficient to fund the 22.8 million dollars in implementation costs for All Kids in fiscal year 2007.
All Kids Enrollment
By April 2007, nine months into the program, All Kids had already reached its one-year enrollment goal of 50,000 new children. Currently, Illinois insures over 1.3 million children under All Kids, through Medicaid, SCHIP and state only funded programming. About six months before the All Kids program began, the state initiated an aggressive outreach effort, including hiring an outside marketing firm, which they felt was necessary for All Kids' success. Outreach efforts included health fairs, back-to-school events, bus tours and media advertising. The state expanded its application agent program, allowing community-based organizations and individuals, like medical providers and insurance agents, to serve as application agents for All Kids. These agents received a $50 payment for each application submitted that resulted in new coverage. Kaiser reported that most of these outreach techniques have proven effective.
All Kids outreach efforts have increased enrollment of Medicaid and SCHIP eligible children who were previously uninsured. The Kaiser report states that about 50 percent of All Kids enrollees live in families with incomes below 200 percent of the federal poverty guidelines, and many of these enrollees are from the undocumented immigrant population. Controversy exists surrounding the use of state dollars to pay for or subsidize insurance coverage for this population. There have been at least two bills (SB 103 and SB 2468) and one resolution (SR 681) introduced in the 2008 session would limit eligibility for the All Kids program to U.S. citizens only. Another bill (SB 2464) would require parents to provide two pay stubs for All Kids enrollment. Currently self-declared income is allowed in certain cases, allowing children of immigrant workers to participate even if parents receive their pay in cash and are unable to provide a pay check stub. Low to moderate income groups account for most other All Kids enrollees. The report states that there have been fewer middle income enrollees than expected; this is surprising because it is the primary group the program was intended to serve. As anticipated, there was low enrollment among children from higher income families, because these enrollees often have other insurance options. Only about 100 children enrolled are from very high income families (with an income over $100,000 per year); Kaiser suggests that these higher income individuals could not enroll in private insurance due to preexisting health conditions.
Comprehensive Health Services for All Kids, Using Cost Sharing
The All Kids initiative covers all kids regardless of income or immigration status, providing the same benefit package across all covered groups. All Kids is a comprehensive program, offering the following services: doctor visits, vision and dental benefits, hospital services, and prescription drugs. Premiums are based on family income. For example, families earning between $40,000 and $59,999 per year pay monthly premiums of $40 per child, but do not pay more than $80 a month, no matter how many children they are insuring. There is no income cap for people wishing to enroll in the All Kids program; even families earning over $100,000 per year are eligible. In order to discourage employers and families with private insurance from dropping current insurance coverage, a one year waiting period for enrollment in All Kids was implemented. The waiting period is waived for families with income under 200 percent of the federal poverty line, children who lose coverage because of a parental job loss, or for children with limited insurance coverage services.
Noted Benefits of Health Insurance
According to All Kids' statistics, children with health insurance and reliable access to health services do better in school, are more likely to visit a doctor and have access to medication, and are therefore less likely to develop serious illnesses or need emergency room care or hospitalization. By allowing every child to see a doctor for a health problem, health conditions can be addressed before they become serious health problems, resulting in hospitalization or extensive medical treatment. Doctor visits and prescription drugs are far more cost effective than lengthy hospital stays, and the governor asserted that, by increasing access on the front-end of medical conditions, the state will save on more expensive treatments down the road. To encourage and emphasize preventative care services, All Kids does not require cost sharing at any income level for immunizations or regular medical and dental check-ups.
Click here for the Illinois All Kids webpage.
Click here for A Race to the Top: Illinois's All Kids Initiative report from the Kaiser Family Foundation.
Click here for the April 2006 State Health Notes newsletter article on All Kids.
 Children's Health Reform
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