September 18, 2014
A new law that restores certain Medicaid benefits previously cut due to budget pressures also adds a new service: kidney transplants for undocumented Illinois residents.
Public Act 98-0651, signed by Governor Pat Quinn on June 16, 2014, authorizes State funding of kidney transplants for low-income non-citizens beginning on October 1. Recipients must have end-stage renal disease and already be receiving renal dialysis services covered by Medicaid.
Immigrants’ rights experts said Illinois might be the only state to fund such transplants for undocumented residents. In Illinois and other states, advocacy groups have argued that public funding for transplants would be more cost effective in the long run than paying for years of dialysis and would provide a better quality of life for patients.
Medicaid, which is jointly financed by the federal and state governments, generally does not cover undocumented residents. Eligibility is limited to American citizens and certain lawfully present immigrants. Emergency care for undocumented immigrants is covered by Medicaid, however. Undocumented Illinois residents with end-stage renal disease can receive dialysis on a continuing basis without visiting the emergency room because they have an emergency condition.
States can choose to provide other medical services for the undocumented without receiving federal assistance. Illinois pays for medical care for undocumented children with family income up to 300% of the Federal Poverty Level (now $71,550 for a family of four), with premium payments required for families at the higher end of the income range. Similarly, the State will fund the newly authorized kidney transplants without federal support.
State officials estimated the cost of the new benefit at $7.5 million in FY2015, making it among the less costly items in Public Act 98-0651. As discussed here, the law as a whole is projected to cost the State’s general operating budget $221.5 million in FY2015. Of the total, additional payments to healthcare providers account for $169.0 million, or 76.3%, while additional medical benefits account for $52.5 million, or 23.7%. Most of the additional spending will be reimbursed by the federal government at a rate that will generally increase to 50.76% for the federal fiscal year that begins on October 1, 2014 from 50.0% in the previous federal fiscal year.
In addition to authorizing kidney transplants for non-citizens, the new law restored some of the benefits eliminated in 2012 under the Save Medicaid Access and Resources Together (SMART) Act. The new law brought back adult dental benefits that were provided before the SMART Act, which consisted of restorative services such as fillings and extractions but not preventive care such as cleanings. The new law also restored adult podiatry services and exempted psychotropic drugs from the limit of four prescriptions a month without prior authorization.
At a meeting of the Medicaid Advisory Committee on September 12, 2014, officials of the Illinois Department of Healthcare and Family Services (HFS) said that the agency expects only about 10 transplants a year to be provided under the new law. HFS Director Julie Hamos said the number could be higher in the short run. Director Hamos said she was told at a recent meeting with supporters of the law that there are 680 non-citizens who are receiving renal dialysis.
Dialysis reportedly cost about $75,000 per patient a year in 2011, while a transplant had a one-time cost of $100,000 at that time. Director Hamos said many of the potential recipients under the new law are young and would require years of dialysis if they did not receive a new kidney. Even after receiving transplants, patients still have some long-term costs, such as the drugs needed to prevent their bodies from rejecting the organs.