Monday, October 29, 2012
Crain's Chicago Business
by Greg Hinz

Cook County hit a $100 million jackpot over the weekend.

In a little noticed but crucial decision announced Friday night, the federal government signed off on a request by county board President Toni Preckwinkle to enroll 114,000 low-income people a year early in the Medicaid program.

For the county, the decision is worth as much as $100 million a year, since its network of hospitals and health clinics already is serving most of the patients free of charge. The tab now will be picked up by federal taxpayers under a provision of Obamacare, rather than by Cook County taxpayers alone.

"I am so pleased to see this result after many months of hard work," Ms. Preckwinkle said in a statement. Winning approval of the waiver plan first in Springfield and then in Washington was "the top legislative priority of my administration," she added.

County health CEO Ram Raju said the 144,000 now will get "a medical home," with preventive care, primary care physicians, case management and other actions designed to heal them and keep them healthy.

Under Obamacare, the 114,000 would have had to wait until 2014 to gain Medicaid eligibility. Moving them into the program now means the county will have to start covering a portion of the total cost a year earlier than otherwise. But it also means that, as soon as they are enrolled, the county no longer will have to provide uncompensated charity care on its own dime.

Winning the waiver is a key item in Ms. Preckwinkle's proposed fiscal 2013 budget. If it had been denied, she's conceded, the county had no fallback plan and would have had to scramble to patch a huge budget hole.