Mayor Brandon Johnson has advanced an ambitious agenda that has the potential to improve millions of lives across Chicagoland.
The new administration has a particularly valuable opportunity given the political alignment and partnerships among the city of Chicago, Cook County and the state of Illinois. To seize that opportunity, Chicago should deploy every tool to create a permanent, financially sustainable foundation for our medical, public health and social service infrastructure. That’s obvious. Less obvious is where the billions of dollars will come from to accomplish this vision.
There is one critical answer to this question: Illinois Medicaid. As soon as humanly possible, Johnson should establish a Mayor’s Office for Medicaid.
Why is this office essential? A million Chicagoans draw upon Medicaid for essential services; even more are eligible. The Chicago Department of Public Health, Chicago Public Schools and other agencies have done great work to enroll eligible Chicagoans. We must now build on that work. In areas ranging from hospital services, addiction and mental health care, prescription drugs, dental and disability services, Medicaid-financed services could be provided more effectively, with greater economy and humanity to more people who need them most. With the federal government providing 65 cents of every dollar spent on Medicaid in Illinois, Medicaid is uniquely positioned to provide a financial foundation for critical services, particularly as Chicago, Cook County and Illinois all face generational budget challenges.
Medicaid payments are essential to the financial health of our state’s health care and social service organizations. These payments are no less essential to the city of Chicago itself, which has often neglected Medicaid as a financial source. Many providers face serious financial challenges arising from small or delayed Medicaid payments and fragmented Medicaid services. Others lack the administrative infrastructure to properly bill Medicaid. Many city agencies do too. The Chicago Fire Department and CDPH’s community health clinics currently bill Medicaid for services rendered. Many other agency programs could likely bill Medicaid more effectively: home visiting programs and services for sexually transmitted infections, among others.
Chicago should build on the expertise of the agencies with experience interacting with Medicaid — including the Mayor’s Office for People with Disabilities, CPS, CFD and CDPH — using a unified structure facilitated by this new office to ensure that all of city government uses Medicaid effectively.
The office could also collaborate with state and county partners on the alphabet soup of federal Medicaid waivers to improve disability services, supportive housing and other services for those at risk of homelessness and reentry services for those leaving jail, and to support essential services delivered through community behavioral health clinics. Medicaid could play an especially vital role in new services to meet profound social needs — for example, team-based interventions such as community support teams — that serve Chicagoans with mental health and addiction disorders outside clinic walls.
Similarly, Medicaid could more intentionally support efforts such as Chicago’s new Crisis Assistance Response and Engagement program (CARE). There is now much interest in alternative crisis response. The federal government recently created opportunities for states to fund community-based mobile crisis intervention services with Medicaid. Medicaid is even more essential to bolster the prevention, social and follow-up services that surround such crises, which may prevent the need for that next 911 call.
A Mayor’s Office for Medicaid might also address another uncomfortable reality: glaring shortcomings of Illinois Medicaid that harm patients and providers alike. Medicaid provider payments are notoriously small and late. The program imposes huge bureaucratic burdens on patients and providers.
A team that includes our University of Chicago colleague Josh Gottlieb documents ways that Medicaid’s cumbersome administrative practices create problems across the nation, with some of the worst problems here in Illinois. Given these realities, it’s not surprising that marquee health systems — including our own employer — are unenthusiastic about treating Medicaid patients. Many providers perform “wallet biopsies” to identify and avoid Medicaid patients. Reimbursement problems impose even worse burdens on financially strapped social service organizations that provide such indispensable services to our loved ones in community, clinical and institutional settings.
A Mayor’s Office for Medicaid could be a champion for Medicaid patients while playing a mediating role with care providers and the state of Illinois. It could call out providers who spurn Medicaid patients. While requiring increased accountability and transparency, the office could work with policymakers in Springfield to ensure prompt payments and assuage administrative burdens that motivate such practices.
A Medicaid office could also provide greater accountability in promoting higher-quality disability services. Illinois recently ranked 44th in the nation in the benchmark quality ratings of intellectual disability services, with especially infuriating disparities in Medicaid-funded services between our wealthiest communities and those on Chicago’s South and West sides.
Many defects in Medicaid-funded services arise from poor oversight and coordination, particularly for home and community-based services. The office could provide other supports for patients and families, many of whom experience long delays and undignified experiences in their interactions with Illinois Medicaid.
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Finally, the office could provide vital supports for the City Council. Aldermen require greater access to Medicaid expertise in their legislative efforts to improve services, especially Medicaid-reimbursable services that require financial and administrative coordination with state and county partners.
Chicago has needed a Medicaid office for years. Johnson should seize this opportunity.
Harold Pollack is the Helen Ross professor at the Crown School of Social Work, Policy and Practice at the University of Chicago and is faculty co-director of the university’s Urban Health Lab. Jason Lerner, a social worker and an attorney, is senior director of the Health Lab’s 911 portfolio of projects.
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