Dear Governor Blagojevich,

On April 15, 2008, the Circuit Court in this action issued a preliminary injunction enjoining your Medicaid FamilyCare program for failing to meet certain statutory prerequisites. The other constitutional and non-constitutional objections to what your Administration have yet to be addressed. As a result, at the present the approximately 25,000 persons and families enrolled in the program are now without health insurance coverage they paid for and the doctors, clinics, hospitals that provided medical services in reliance on their getting paid under the Mediciaid FamilyCare Health Insurance Program either won’t be getting paid ever, or, if you are successful in your appeal, for many months or years to come. This is tragic for many people who relied on you and your Administration that they were covered under the new Mediciaid FamilyCare Health Insurance Program and that you could create such a program on your own authority without getting prior authorization from the Legislature to establish the program under Medicaid.

In addition, in court proceedings held on April 23, 2008, your attorneys admitted that the Department of Health and Family Services (“HFS”) could not identify the charges that are not to be paid and separate them from other payments that can lawfully be made under other programs to doctors, hospitals and clinics. This was confirmed by the attorney for the Comptroller. The Comptroller’s attorney said that because HFS is unable to identify the enjoined payments, all HFS payments for medical services are being held in abeyance until HFS can certify which ones can be paid, and which ones may not be paid under the preliminary injunction! This may cause great hardship for the doctors, hospitals, clinics and other medical providers who are relying on being paid and need to be paid in a reasonable period of time.

To minimize the adverse harm of your Administration’s decision to terminate FamilyCare under the federal Children’s Health Insurance Program and, instead, to create it as a new Medicaid program without first obtaining the approval of the Legislature, I suggest that you do the following:

1. Order HFS to submit the CHIP Waiver to re-establish that FamilyCare Program. HFS didn’t do that prior to the prior Waiver’s expiration on September 30, 2007.

2. Direct HFS to increase those covered under CHIP FamilyCare to families whose incomes do not exceed 200% of the federal poverty level. Previously HFS had set the limit at 185% of the federal poverty level even though the State CHIP Act allowed the cap to be 200% of the federal poverty level. HFS could have increased it to the 200% level.

3. Request the federal Department of Health and Human Services to approve the new Waiver retroactively to October 1, 2007. That will allow the State to recover 65% of its costs for providing FamilyCare Health Insurance coverage to persons and families whose incomes are above 133% of the federal poverty level and not more than 200% of the federal poverty level. Right now under your Medicaid FamilyCare Health Insurance Program, the federal Government is reimbursing the State for 0% for those whose incomes are 133% to 400% of the federal poverty level and for the medical charges incurred by those persons and families, payments by the State has been enjoined. By switching back to the CHIP FamilyCare Health Insurance Program you’ll be helping a lot of people, doctors, hospitals, clinics and other medical services providers who are otherwise being “left out in the cold.” Those persons and familieis covered by regular Medicaid are unaffected and the State will continue to be reimbursed for 50% of its traditional Medicaid costs.

4. As for those families with incomes above 200% of the federal poverty level, and the doctors, hospitals and clinics and other medical providers who assisted those family members who don’t qualify for the federal CHIP FamilyCare Program, immediately terminate the medicaid FamilyCare program and try to get the Legislature to approve payment for services that were rendered prior to April 15, 2008, and join the current ongoing effort of the many other States to get the federal Government to expand the class of CHIP FamilyCare eligible families to those whose incomes are higher than 250% of the federal poverty level and not in excess of 400% of the federal poverty level.

5. If the Legislature doesn’t appropriate money to pay for services rendered under the Medicaid FamilyCare program , perhaps you can use your considerable re-election funds, or raise money from your many supporters, to both pay for those charges and reimburse the State for any monies determined to have been expended unlawfully or unconstitutionally without the required legislative authorization.

These efforts will demonstrate that you are sincere in your desire to help the citizens of the State to obtain health insurance at a reasonable cost rather than that you were just politically motivated for self-advancement reasons. Perhaps the Legislature will approve amending the State CHIP Act to allow Illinois to pursue the federal Government’s allowing families with incomes above the 250% federal poverty level current cap and the State’s going along with any such expansion. That will be a difficult task in light of the current State deficit and your promise not to raise taxes but, if there is a way, I’m sure you’ll find it. If you do, Illinois will truly become a model for all other states to emulate.

Yours truly,

Richard Caro