Durbin, Duckworth Urge Federal Approval of Illinois Application for Medicaid Section 1115 Waiver
Approving the waiver would allow the state to bolster public health programs aimed at addressing the opioid epidemic, violence prevention, homelessness, hunger, and more
WASHINGTON – U.S. Senate Majority Whip Dick Durbin (D-IL) and U.S. Senator Tammy Duckworth (D-IL) today sent a letter to U.S. Centers for Medicare and Medicaid Services (CMS) Director Chiquita Brooks-LaSure expressing their support for Illinois’ application for a Section 1115 Demonstration Waiver. If accepted, the waiver would accelerate efforts in Illinois to use the Medicaid program to address the opioid epidemic, maternal mortality, violence prevention, mental health challenges, homelessness, hunger, and additional interrelated public health challenges. In Illinois, approximately 3.5 million individuals receive health insurance coverage through Medicaid.
“The State’s 1115 application builds upon existing efforts to enhance the delivery of targeted services to the most vulnerable populations—which holds the promise of reducing health care costs and improving health care outcomes. The 1115 application also aligns with several legislative, regulatory, and funding efforts we have supported in Congress to address the root causes of health disparities and negative societal outcomes,” the Senators began their letter.
The Senators continued the letter by explaining how the 1115 application would help provide housing and wraparound care forIllinoisans experiencing homelessness as well as support the state in mitigating gun violence.
“We know that people experiencing homelessness have a disproportionately high rate of emergency department utilization—with the University of Illinois at Chicago recently identifying that 48 chronically homeless patients accounted for 776 emergency department visits. The State’s 1115 application seeks to address this challenge by furnishing housing support services to the most vulnerable patients and highest health care utilizers to provide stable housing and wraparound supports that also can reduce hospital expenditures,” the Senators wrote.
“To address the high and concentrated toll of gun violence across our communities, the State’s 1115 application seeks to utilize Medicaid funds for trauma-informed, community-based outreach initiatives that can prevent and mitigate community violence. Through street outreach and hospital-based violence recovery interventions, Illinois has built a nation-leading infrastructure to break the cycle of violence by utilizing trusted community leaders to address the trauma facing young people at risk of violence and furnishing mental health, job training, and other support services,” the letter continued.
If approved, the 1115 application would also impact hospital-based violence prevention programs and bolster support for hunger and nutrition programs across the state.
“Building upon [prior efforts]… to utilize Medicaid to promote hospital-based violence prevention programs, this requested authority holds significant promise to help young people who have witnessed violence or are likely to perpetrate violence to cope with their experiences and thrive in a healthy manner, thereby reducing health care costs from gunshot injuries and associated physical and mental health harms,” the Senators wrote.
“Similarly, one in 12 Illinoisans—including one in nine children—face hunger. Food insecurity and diet-related chronic disease are a significant burden on our health system, and imperil the academic success of young people. The 1115 application would support an array of evidence-based interventions to foster healthy eating habits to prevent chronic disease, including nutrition education and skill development, medically tailored meals, produce prescriptions, and assistance accessing benefits and nutritious food options for at-risk populations,” the letter continued.
The Senators concluded their letter by emphasizing the significant impact of approving Illinois’ Section 1115 Demonstration Waiver and encouraged Director Brooks-LaSure to swiftly approve it.
“An estimated 400,000 Illinoisans would benefit from the package of authorities and services that are proposed in the State of Illinois’ Section 1115 Demonstration. Through our collective efforts, Illinois has made remarkable progress in addressing the confluence of social determinants of health that fuel racial and ethnic health disparities and contribute to health care costs. To propel these efforts forward and harness innovative, community-driven solutions—involving stakeholders outside of the typical health care system—CMS can help Medicaid beneficiaries across Illinois improve health and wellbeing by approving the 1115 Demonstration,” the Senators wrote. “We appreciate your consideration and thorough review, and urge your approval of Illinois’ requested plan.”
The full text of the letter is available below:
February 13, 2024
Dear Administrator Brooks-LaSure:
We write in strong support of the State of Illinois’ application to the Centers for Medicare and Medicaid Services (CMS) for a Section 1115 Demonstration Waiver to enhance the delivery of behavioral health services for Medicaid beneficiaries across Illinois. Given the shared federal responsibility for the Medicaid program, we urge CMS to swiftly approve the State’s 1115 application. This will accelerate efforts in Illinois to address the opioid epidemic, maternal mortality, violence prevention, mental health challenges, homelessness, hunger, and many other interrelated public health challenges facing our constituents.
The State’s 1115 application builds upon existing efforts to enhance the delivery of targeted services to the most vulnerable populations—which holds the promise of reducing health care costs and improving health care outcomes. The 1115 application also aligns with several legislative, regulatory, and funding efforts we have supported in Congress to address the root causes of health disparities and negative societal outcomes.
For example, we know that people experiencing homelessness have a disproportionately high rate of emergency department utilization—with the University of Illinois at Chicago recently identifying that 48 chronically homeless patients accounted for 776 emergency department visits. The State’s 1115 application seeks to address this challenge by furnishing housing support services to the most vulnerable patients and highest health care utilizers to provide stable housing and wraparound supports that also can reduce hospital expenditures.
To address the high and concentrated toll of gun violence across our communities, the State’s 1115 application seeks to utilize Medicaid funds for trauma-informed, community-based outreach initiatives that can prevent and mitigate community violence. Through street outreach and hospital-based violence recovery interventions, Illinois has built a nation-leading infrastructure to break the cycle of violence by utilizing trusted community leaders to address the trauma facing young people at risk of violence and furnishing mental health, job training, and other support services.
Building upon the guidance CMS provided to states on the April 27, 2021, call regarding strategies to utilize Medicaid to promote hospital-based violence prevention programs, this requested authority holds significant promise to help young people who have witnessed violence or are likely to perpetrate violence to cope with their experiences and thrive in a healthy manner, thereby reducing health care costs from gunshot injuries and associated physical and mental health harms. For example, compared to the national five-year re-injury rate for firearm injury of nearly 50 percent, hospital-based programs in Illinois that furnish interventions as patients transition into the community have successfully reduced retaliation and reinjury rates.
Similarly, one in 12 Illinoisans—including one in nine children—face hunger. Food insecurity and diet-related chronic disease are a significant burden on our health system, and imperil the academic success of young people. The 1115 application would support an array of evidence-based interventions to foster healthy eating habits to prevent chronic disease, including nutrition education and skill development, medically tailored meals, produce prescriptions, and assistance accessing benefits and nutritious food options for at-risk populations.
The 1115 application proposes several additional authorities which we also strongly support, including, among others, to: fund transformative collaborations across hospitals, federally qualified health centers, and other community providers to coordinate care through preventive services, including annual dental visits for those with substance use disorder; augment the training and certification forcommunity health workers; bolster the continuum of care licensure forproviders serving individuals with intellectual/developmental disabilities; permit Medicaid enrollment for eligible individuals 90 days prior to release from incarceration to promote a healthy and successful reentry; and allow coverage for clinically appropriate substance use treatment services in Institutions for Mental Diseases.
An estimated 400,000 Illinoisans would benefit from the package of authorities and services that are proposed in the State of Illinois’ Section 1115 Demonstration. Through our collective efforts, Illinois has made remarkable progress in addressing the confluence of social determinants of health that fuel racial and ethnic health disparities and contribute to health care costs. To propel these efforts forward and harness innovative, community-driven solutions—involving stakeholders outside of the typical health care system—CMS can help Medicaid beneficiaries across Illinois improve health and wellbeing by approving the 1115 Demonstration.
We appreciate your consideration and thorough review, and urge your approval of Illinois’ requested plan.
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