Latest / Becker’s Healthcare Podcast / Erik Mikaitis on Medicaid Changes and Protecting the Safety Net

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Erik Mikaitis on Medicaid Changes and Protecting the Safety Net · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where they go to
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  - pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Laura Dierda with the Becker's Healthcare
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  - podcast. I'm thrilled today to be joined by
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  - doctor Eric Makaitis, chief executive officer at Cook
• 0:57
  - County Health. Doctor Makaitis, it's a pleasure to
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  - have you on the podcast today. Laura, thanks
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  - so much for having me. Absolutely. Now I'm
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  - excited for our conversation. I know we're gonna
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  - talk a bit about some of the Medicaid
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  - policy updates, things related to h r one,
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  - and all the things that you're doing at
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  - Cook County Health to start, preparing for those
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  - things and get ready for these changes. But
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  - before we dive in, can you tell us
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  - just a little bit more about yourself and
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  - and Cook County Health?
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  - Oh, sure. So, as you mentioned, I'm I
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  - currently have the privilege of serving, as the
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  - CEO of the Cook County Health System.
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  - I am an internist,
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  - by background and have worked in various,
• 1:31
  - clinical and administrative roles including palliative care and
• 1:34
  - and population health,
• 1:36
  - roles.
• 1:37
  - We as an organization,
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  - Cook County Health is is one of the
• 1:40
  - largest public safety net health systems in the
• 1:42
  - country,
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  - serving about 600,000 residents, in Cook County,
• 1:47
  - which, for those not in the Chicagoland area
• 1:49
  - is basically Chicago and its surrounding suburbs. So
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  - we serve about 600,000 people a year as
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  - a provider.
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  - We have two hospitals, and more than a
• 1:57
  - dozen community health centers across the county. We're
• 2:00
  - also responsible for the health care services at
• 2:02
  - the Cook County Jail.
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  - And what makes us very,
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  - unique, I think, is, that we're also responsible
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  - for the public health needs of our suburban
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  - Cook residents, about two and a half million
• 2:13
  - people, through our Cook County Department of Public
• 2:15
  - Health team.
• 2:16
  - And we're also a payer. We have CountyCare,
• 2:19
  - which, is the largest,
• 2:21
  - Medicaid health plan here in Cook County,
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  - and was also rated the highest, quality plan
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  - for two years running now in the state
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  - of Illinois.
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  - Absolutely. That's a huge organization enterprise that you're
• 2:32
  - running. And so, I'll be interested to hear
• 2:34
  - more and dig into some of the things
• 2:36
  - you're doing related to that Medicaid policy.
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  - I know the health system has a Medicaid
• 2:41
  - impact work group across, the community
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  - and, community efforts through a microsite as well,
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  - which is, getmedicaidfacts.com.
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  - And so could you talk a little bit
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  - about some of those specific Medicaid provisions in
• 2:53
  - HR one that concern you most for the
• 2:55
  - population in Cook County Health serves?
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  - Absolutely. And even before HR one, there have
• 3:00
  - been several policy shifts that,
• 3:03
  - are impacting coverage for our Medicaid patients.
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  - Even at the beginning of this year, there
• 3:08
  - were enhanced
• 3:10
  - tax subsidies that were outside of the HR
• 3:12
  - one policy changes, but those, were ended in
• 3:15
  - January.
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  - And we've already seen in Illinois over 90,000
• 3:18
  - people forgo their coverage because of increased out
• 3:20
  - of pocket expenses.
• 3:22
  - Now fast forward into kind of the HR
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  - one, policy changes,
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  - we have, a redefinition
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  - of the, qualifying immigrant population. So as of
• 3:31
  - October 1, victims of domestic violence and human
• 3:34
  - trafficking,
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  - and qualified asylum seekers, about 10,000 in Illinois
• 3:38
  - will no longer be eligible for Medicaid. In
• 3:40
  - fact, not just not eligible, they won't be
• 3:42
  - insurable.
• 3:43
  - And then come January,
• 3:44
  - is the really big, process changes, the policy
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  - changes where, work requirements will go into effect
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  - for the Affordable Care Act adults, the Obamacare
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  - adults. So that's nineteen to sixty four, with
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  - no dependents or disabilities,
• 3:58
  - who are covered under, Medicaid.
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  - So so they will now have to prove
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  - that they are working,
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  - volunteering, or in school eighty hours per month
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  - to maintain their Medicaid coverage.
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  - And the other piece is they they'll they'll
• 4:11
  - have to double the frequency with which they
• 4:13
  - prove up that they're still eligible. It's a
• 4:15
  - process called redetermination.
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  - Right now, it's annual for everybody who's covered
• 4:19
  - under Medicaid. For that group, that cadence is
• 4:21
  - gonna double, so they'll have to be filling
• 4:22
  - out paperwork every six months to maintain their
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  - coverage.
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  - Wow. That's a a lot to have to
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  - handle and remember to do for a huge
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  - population that you
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  - serve. And so,
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  - could you talk a little bit about how
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  - you're navigating through that, what you have been
• 4:36
  - doing in order to,
• 4:38
  - make sure that the people within your community
• 4:42
  - are know that the change is coming and
• 4:44
  - are prepared to,
• 4:45
  - counter the redeterminations
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  - and and cover changes and those things. And
• 4:49
  - and just tell us about that effort in
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  - the work group?
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  - Absolutely. Yeah. So you mentioned the Medicaid impact
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  - work group. That was in September 2025. You
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  - know, we knew as the budget discussions were
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  - going on that that there would probably be
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  - some type of changes coming to Medicaid.
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  - And
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  - the the thinking there,
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  - was to really bring a broader group together.
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  - So, obviously, you know, we had
• 5:11
  - hospitals and clinics. We had insurers,
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  - you know, health insurers.
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  - We had public health departments. We partnered closely
• 5:18
  - with, our state Medicaid, agency,
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  - to ensure that we were, you know, supportive
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  - of their efforts and aligned in messaging. But
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  - we also invited business leadership, academic leaders,
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  - philanthropic organizations, and community groups into the discussion.
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  - As you mentioned, there's about 60, different organizations
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  - that joined the conversation.
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  - And the thinking there was, you know,
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  - what we saw, especially within health care and
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  - really especially within the safety net, was that
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  - people were, one, trying to kinda go it
• 5:46
  - alone and figure out messaging and how they
• 5:48
  - were going to kind of kinda meet the
• 5:50
  - moment here and and ensure that's that they
• 5:52
  - could minimize losses.
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  - But it was everyone kind of doing it
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  - on their own. And then two, a general
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  - lack of awareness. You mentioned, you know, the
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  - messaging and and the microsite already. But,
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  - there was a recent study published that shows
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  - fifty five percent of Medicaid enrollees don't realize
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  - that, the work requirements are coming into effect
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  - in January. Another 85%
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  - don't realize that the cadence of redetermination is
• 6:14
  - going to double. So there's a huge lack
• 6:16
  - of awareness right now in in terms of
• 6:18
  - all of the changes that are coming. So,
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  - really, an initial effort around
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  - bringing everyone together, unifying that message, and and
• 6:26
  - really engaging across sectors to make sure that
• 6:29
  - we, as much as possible, could make sure
• 6:30
  - that all eligible people maintain their Medicaid coverage.
• 6:33
  - There's early estimates right now that about four
• 6:35
  - hundred thousand people will lose their coverage just
• 6:37
  - in Illinois. And the numbers I've seen, out
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  - to, I think, it was 2030
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  - 2034,
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  - between eight and ten million Medicaid, enrollees will
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  - lose their coverage,
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  - across the country.
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  - Well, that's fascinating. And, you know, it's really
• 6:51
  - interesting to have that ability of the global
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  - view of,
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  - you know, how different organizations are approaching this,
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  - then I can imagine being able to come
• 7:00
  - together and unify in some ways.
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  - Hopefully, it makes things a little bit easier,
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  - at least being able to reach the huge
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  - population, as you mentioned, you know, millions of
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  - people.
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  - So how from your perspective,
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  - has this worked well? What what do you
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  - really see as being some of the ways
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  - that, you've been able to,
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  - work with this group and then get the
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  - message out effectively?
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  - So within the Medicaid impact work group, we've
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  - actually had three subgroups,
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  - kind of split off, to work in in
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  - specific areas. The first was communicate and educate,
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  - and that's where the microsite comes from. I'll
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  - come back to that group. We also we
• 7:35
  - also had coalition building,
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  - which, you know, I'm happy to say in
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  - our last, larger
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  - work group meeting, we had a 100, religious
• 7:43
  - leaders,
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  - from the Southland Of Chicago join the conversation
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  - to really, you know, start understanding what's gonna
• 7:49
  - happen and and help deliver that message to
• 7:51
  - their congregations.
• 7:53
  - And then there's an innovation group. That's our
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  - third group. They, right now, have been very
• 7:56
  - focused on partnering with the state, making sure
• 7:58
  - that, you know, data is flowing efficiently, that,
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  - you know, what providers are sending in terms
• 8:03
  - of claims and data into the state is
• 8:05
  - being received and that, you know, we're not
• 8:06
  - really dropping the ball anywhere.
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  - One of the one of the pieces,
• 8:11
  - that gets people off of that double return
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  - redetermination process and the work requirements is if
• 8:16
  - they're medically frail.
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  - So working with the state and and taking
• 8:19
  - their guidance really and and how they're gonna
• 8:21
  - define that and making sure that we, as
• 8:23
  - a provider community, can communicate that effectively to
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  - the state. So that's where the innovation group
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  - has been looking,
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  - most recently. And as that solidifies and we
• 8:31
  - start seeing the impact of the changes, their
• 8:32
  - shift their their their focus is gonna shift
• 8:34
  - to how we can innovate care for those
• 8:37
  - who lose coverage anyway.
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  - So how we can how we maintain access
• 8:41
  - and ensure that there's good prevention
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  - there. The shifting back to communications, that's, where
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  - you mentioned the get Medicaid facts microsite.
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  - That really has been
• 8:50
  - focused at addressing
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  - the knowledge gaps that I mentioned earlier, 55%
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  - of people not knowing, about work requirements and
• 8:57
  - 85 not knowing about, the redetermination
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  - process doubling.
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  - So
• 9:02
  - we launched the microsite, and there's really two
• 9:04
  - areas of focus there. The first is for
• 9:06
  - the community members who are covered by Medicaid.
• 9:09
  - A few a few areas of focus there,
• 9:11
  - for them,
• 9:13
  - a link out to
• 9:14
  - key websites. For example, HFS is our Medicaid,
• 9:18
  - administrator in Illinois. It's, a link out directly
• 9:21
  - to where, individuals can check their
• 9:24
  - addresses, their contact information, and if it's wrong,
• 9:26
  - they can update it. That's one of those
• 9:27
  - administrative,
• 9:28
  - areas where we see people falling off where
• 9:30
  - they might move, and the state doesn't get
• 9:32
  - that update. And the paperwork doesn't get where
• 9:34
  - it needs to go, and they end up
• 9:35
  - dropping off the rolls. So making sure that
• 9:37
  - we're staying tight there. And then there's a
• 9:39
  - a link out to a calendar of events
• 9:41
  - in terms of for, for redetermination events. So
• 9:43
  - just through county care, we do about twenty,
• 9:46
  - twenty five events a month,
• 9:48
  - to offer people one on one assistance, and
• 9:50
  - they don't have to be county care members
• 9:52
  - as anybody, and anyone covered by Medicaid to
• 9:54
  - keep them enrolled and ensure that they're you
• 9:56
  - know, any questions they have on paperwork or
• 9:58
  - any help that they might need to stay
• 9:59
  - enrolled, that they're able to engage there. So
• 10:01
  - there's that information,
• 10:02
  - on on a calendar, and then there's a
• 10:04
  - very robust FAQ,
• 10:06
  - that answers kind of the policy change questions
• 10:08
  - and how that's gonna impact them.
• 10:10
  - So that's kind of the patient facing,
• 10:12
  - part of the website. There's also a resource
• 10:15
  - for our community members, these folks who've joined
• 10:17
  - the Medicaid impact work group and more broadly,
• 10:19
  - in the communities, anybody who's interacting with our
• 10:21
  - Medicaid population.
• 10:22
  - There's toolkits that people can download. And we've
• 10:25
  - intentionally it's it's free to download. It's open
• 10:27
  - source,
• 10:28
  - and they're not branded. So we've encouraged our
• 10:30
  - community partners to actually brand the materials to
• 10:32
  - their organization.
• 10:34
  - We think that adds a layer of trust
• 10:36
  - when people receive it from, you know, from
• 10:38
  - their church, if they're a congregation member, from
• 10:40
  - their place of employment, if it's their employer,
• 10:42
  - you know, whoever would choose to use this,
• 10:44
  - we think that adds adds some connectivity there,
• 10:46
  - to the community.
• 10:48
  - And then again, you know, free to download,
• 10:49
  - and there for anybody who wants to use
• 10:51
  - it.
• 10:53
  - That wow. What a a great resource to
• 10:54
  - have and especially with so many changes coming
• 10:57
  - down the pipe. So I wanted to ask
• 10:59
  - you a little bit about the mechanics there
• 11:01
  - as well. How was the GetMedicaid
• 11:03
  - fax microsite designed to reach enrollees who are
• 11:06
  - the hardest to inform, including some that are
• 11:08
  - non English speakers as well in immigrant communities?
• 11:12
  - Yeah. So, again, that's where the community comes
• 11:14
  - in. We've really partnered,
• 11:16
  - across the board. I'm happy to say we
• 11:18
  - started with about 60 people, in that first
• 11:20
  - meeting in September. We hit about 200 a
• 11:22
  - couple of months ago in our last, big
• 11:24
  - meeting where we came together. So there's definitely
• 11:26
  - growing interest.
• 11:28
  - But, you know, again, we're we're trying to
• 11:30
  - engage the communities to use those toolkits.
• 11:32
  - But then we've also translated the the website
• 11:35
  - and the materials into 14 languages, including fact
• 11:38
  - sheets and social media graphics.
• 11:40
  - And and really the goal there is to
• 11:42
  - create clear and easy to use materials
• 11:44
  - so that we can educate folks about these
• 11:46
  - changes. So it's really kind of a a
• 11:49
  - community ground game, making sure that we've got
• 11:51
  - the unified message. You know, I I mentioned
• 11:52
  - everyone trying to go it alone. That was
• 11:54
  - another piece that that was, I think, one
• 11:57
  - of the nice outputs with Get Medicaid facts
• 11:58
  - and the broader work group is that we
• 12:00
  - had individual offices. We had, you know, hospitals
• 12:03
  - and health systems all trying to figure out
• 12:05
  - how to message this on their own. This
• 12:07
  - is partnership with the state, unified messaging. We're
• 12:10
  - able to kinda keep things updated and timely,
• 12:13
  - through the website, and then it's kind of
• 12:15
  - a all hands on deck community push to
• 12:17
  - to make sure everybody's aware.
• 12:19
  - That makes a ton of sense. And cool
• 12:21
  - that you've gotten that type of unity around,
• 12:24
  - so many different organizations within the community and
• 12:26
  - and having,
• 12:28
  - singular message out there,
• 12:30
  - certainly makes a difference. Now looking ahead, what
• 12:33
  - would success look like for the Medicaid impact
• 12:35
  - work group a year from now given the
• 12:37
  - enrollment deadlines in 2027 and, everything else that's
• 12:40
  - happening in health care right now?
• 12:42
  - Yeah. I think, keeping as many people eligible
• 12:45
  - and enrolled as possible
• 12:47
  - and ensuring that we've seen the the 400,000
• 12:51
  - number for Illinois,
• 12:53
  - shared in terms of anticipated losses. And I
• 12:55
  - think if we can cut into that,
• 12:58
  - hopefully significantly, then then I would I would
• 13:00
  - count that as a as a success.
• 13:02
  - I would also say behind that for people
• 13:05
  - who are losing,
• 13:06
  - their insurance, how we keep them engaged in
• 13:08
  - preventative care. That's been another big worry, especially
• 13:11
  - when you think about, you know, the broader
• 13:13
  - safety net and some of the stressors at
• 13:15
  - least here in Chicagoland that we're seeing. We've
• 13:17
  - had two hospitals close in the last year,
• 13:19
  - and we know several more are struggling in
• 13:21
  - the safety net space.
• 13:23
  - As these pressures mount and create additional financial
• 13:26
  - burden, you know, it's it's a question
• 13:28
  - of what does the safety net look like
• 13:30
  - a year or two from now. So trying
• 13:31
  - to, you know, not just keep people,
• 13:33
  - insured, but keep them healthy. So, you know,
• 13:36
  - shifting to kind of the the patient view,
• 13:38
  - what ends up happening when people lose their
• 13:40
  - insurance, they don't engage in preventative care as
• 13:42
  - meaningfully.
• 13:43
  - So they may ration meds, they may skip
• 13:44
  - doctor's visits.
• 13:45
  - And
• 13:47
  - what tends to happen is instead of managing
• 13:49
  - high blood pressure and diabetes in an office,
• 13:51
  - you end up down the line seeing people
• 13:53
  - showing up in the emergency room with strokes
• 13:55
  - or heart attacks, which
• 13:56
  - much more burdensome for the patient, the family,
• 13:58
  - the community they come from, but it's also
• 14:00
  - a much higher cost to treat patients,
• 14:02
  - in that way. So, you know, as they
• 14:04
  - come in without insurance in that state, it
• 14:06
  - creates additional burdens on on an already struggling
• 14:09
  - safety net. So maintaining some stability within the
• 14:12
  - safety net while also trying to
• 14:15
  - maintain,
• 14:16
  - a higher level of of of health and
• 14:18
  - better outcomes and and avoiding preventable illness.
• 14:22
  - That would be a huge win
• 14:24
  - I love it. Thank you so much for
• 14:25
  - joining us the on the podcast today, doctor
• 14:27
  - Macaitis. This has been a really fun conversation
• 14:30
  - inspiring to hear what you're doing in Chicago,
• 14:32
  - and I look forward to connecting with you
• 14:34
  - again soon. Laura, thank you so much for
• 14:36
  - having me.