Gov. Pritzker Announces Federal Approval of 1115 Waiver, Expanded Medicaid Coverage

CHICAGO- On July 2, 2024, the State of Illinois received federal approval of its proposed Healthcare Transformation 1115 Demonstration waiver that will allow the Illinois Department of Healthcare and Family Services (HFS) to begin nation-leading work to expand Medicaid coverage. Assistance will soon address root causes of health disparities, such as housing and food insecurity, and help individuals transitioning from incarceration.

“Here in Illinois, the 1115 waiver is the cornerstone of our broader strategy to address health-related social needs,” said Governor JB Pritzker. “We are using it to direct Medicaid resources toward initiatives that address the root causes of health inequalities such as housing, food insecurity, unemployment, violence prevention, re-entry from prison settings, substance use treatment, and more. Illinois is leading the way in this work and once again setting the nationwide standard for what equitable, effective, and people-centric healthcare should look like.”

“This is a transformational moment for our state, enabling us to continue to fulfill our vision to increase access to more equitable healthcare,” said HFS Director Elizabeth Whitehorn. “By covering health related social needs services under Medicaid just like we cover traditional healthcare, we hope to improve overall health for some of the most vulnerable populations in our state. We applaud the Biden-Harris Administration for recognizing the connection between social determinants of health and healthcare.”

“Illinois’s public health grows stronger when the State can invest in improving both the medical care and the social needs of our residents,” said IDPH Director Dr. Sameer Vohra. “IDPH is thrilled that Illinois has received federal approval of this 1115 waiver, and we will support HFS, our other sister state agencies, and our community partners to use this new opportunity to better address disparities and improve the health of our residents.”

The federal Centers for Medicare & Medicaid Services (CMS) approved Illinois’ application to amend and extend for five years an existing 1115 waiver to include services newly-eligible for federal Medicaid match. These programs were designed to specifically address health-related social needs and improve health outcomes statewide, with a focus on housing support, medical respite and food and nutrition.

Coverage for pre-release services for individuals leaving carceral settings is also included, reflecting a major policy shift in the Medicaid program, as well as highly-innovative services to address community firearm violence. Expanded home- and community-based services, including non-medical transportation and expanded employment services will also be covered.

Services additionally include substance use disorder (SUD) assistance as well as coverage of Violence Prevention and Intervention services for Medicaid beneficiaries impacted by violence.

Originally approved by federal CMS in 2018, HFS requested to extend and amend its existing Behavioral Health Transformation 1115 waiver in the summer of 2023 to take advantage of new federal flexibilities offered to states. Waivers authorized under Section 1115 of the Social Security Act allow states to test new services and care delivery models and determine their efficacy and efficiency while remaining eligible to receive federal Medicaid matching funds.

Some other items contained in the extension application continue to be under review. The state prioritized health-related social needs and reentry for initial approval and will continue discussions with the federal authorities on other components of its request.

Illinois was one of five states to receive federal approval for pre-release services for individuals to prepare for transition from incarceration. Illinois will cover a set of pre-release benefits for certain individuals who are inmates residing in a state or local jail, prison, or youth correctional facility. Incarcerated individuals who are Medicaid-eligible will be able to receive case management to assess and address physical and behavioral health needs and health-related social needs, medication-assisted treatment (MAT), services for substance use disorder, prescription medications, medical supplies and more.

HFS will be engaging with other state agencies and external stakeholders on a variety of implementation-related tasks, including the development of operational protocols, which are subject to federal review and approval. The Department recognizes that there are numerous community-based organizations, social service and health care providers already working in the health-related social needs space and looks forward to partnering with housing and food security providers to enhance these opportunities.

"Demonstrations like Illinois' strengthen health care coverage for American families. Illinois joins a growing roster of states that recognize a simple truth: health care can – and should – mean care for the whole person,” said U.S. CMS Administrator Chiquita Brooks-LaSure. “We applaud Illinois for using every tool available to improve quality and access, reduce health disparities, and improve health equity, for those who need it most. We look forward to more states following your example.”

“The approval of this federal Medicaid waiver is historic for Illinois and will continue to establish our state as a leader in expanding access to health care for millions of patients from Chicago to Carbondale,” said U.S. Sen. Dick Durbin (D-IL). “I was pleased to support the federal approval of this important health program, which expands upon the work of my Chicago HEAL Initiative to break the cycle of violence through trauma recovery programs. This Medicaid initiative requested by the Governor recognizes the role of community investments to improve health care, including by addressing hunger, housing, and opioid treatment barriers.”

“As a member of the Medicaid Working Group, I fully understand that we cannot advocate for people to live strong, healthy lives without addressing social determinants of health and the inequitable outcomes they result in,” said Senate Majority Caucus Chair Omar Aquino (D-Chicago). “With a focus on quality, innovation and equity, I’m excited this waiver will allow our state to tackle interconnected issues like housing, health and food security, fostering a more holistic care system where everyone can get the treatment they need.”

"The CMS approval of most of our 1115 waiver request will allow us to integrate the social determinants of health with the medical needs of our most vulnerable Medicaid clients," said House Majority Leader Robyn Gabel, D-Evanston. "It will provide additional fiscal support and give our departments a broader reach in providing substance abuse treatment, housing supports and other social services."

"As the Chair of the House Appropriations-Health and Human Services Committee, I am excited that the governor is moving so quickly in making sure that Illinoisans are aware of the Healthcare Transformation 1115 Demonstration waiver, a measure that will give our most vulnerable populations hope as they navigate health disparities such as access to healthcare, addiction, homelessness, and their transition from incarceration,” said Rep. Camille Lilly (D-Chicago). “In addressing the importance of quality of life, we must continue to support our communities and maintain the resources that will ultimately allow them to lead healthier and better lives.”

“Cook County is an innovator nationally among county governments when it comes to partnering with state Medicaid agencies to meet the health care needs of our residents," said Cook County Board President Toni Preckwinkle. "I am grateful for the partnership of leaders at the US Department of Health and Human Services and State of Illinois in advancing this proposal that will support the reimbursement of essential services including re-entry care for justice-involved individuals and access to food and housing that will result in improved and more equitable health outcomes for members.”

“The Greater Chicago Food Depository believes that a healthy community starts with food. The 1115 waiver represents a significant acknowledgment that health-related social needs such as food and housing are important aspects of improving health outcomes," said Kate Maehr, Executive Director and CEO of the Greater Chicago Food Depository. "It will reinforce our prepared meals program so that fewer families at-risk of food insecurity have to make the difficult choice between paying for food or paying for medicine for medical care. We are extremely grateful to Governor Pritzker and the State of Illinois for securing federal approval of the waiver, embracing a holistic approach to healthcare, and for supporting our work to create a hunger-free community.”

“Medical Respite exists because it improves patient outcomes, reduces hospital readmissions, and connects patients experiencing homelessness with ongoing primary care,” said Lynda Schueler, CEO of Housing Forward, a suburban Cook County nonprofit that works to transition people from housing crisis to housing stability. “Everyone deserves to have access to affordable, quality healthcare, regardless of their living situation or income level. The revenue stream provided by the expansion of the 1115 waiver will expedite and expand our ability to address the substantial and unmet health, service and housing needs for the unhoused community.”

The full approval document is available on the CMS website: Illinois Healthcare Transformation | Medicaid

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