Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Nick Shields, Chief External Affairs Officer for Cook County Health, and Chief Medical Officer, Dr. Lauren Smith, about Medicaid changes. Thank you both for being here today.

Lauren Smith, MD, MBA: Thank you for having us.

Nick Shields: Maggie, thanks so much for having us.

Host: To help set the stage, Nick, can you explain what Medicaid is, who it serves, and why it's such an important source of health coverage for millions of Illinois residents?

Nick Shields: Absolutely, Maggie. Thank you again so much for the opportunity. Medicaid is a public health insurance program funded jointly by federal and state governments, right? it provides access to doctor visits, hospital care, prescription drugs, dental care, vision care, and even preventative services. It serves children, pregnant people, seniors, people with disabilities, and adults with limited incomes.

Approximately one in five people in the United States are covered by Medicaid right now, including 3.4 million folks in Illinois. So, for many families, Medicaid is really the difference between getting regular care and, quite frankly, going without treatment.

Host: Well, that is crucial. Nick, we've been hearing that changes to Medicaid are coming. What are the key changes Medicaid enrollees should know about, and when are they going to take effect?

Nick Shields: Yeah. So, the majority of the changes start January 1st 2027. Some eligibility changes begin as early as October '26 for some immigrants. ACA adults will either need to provide they meet the new work, education, or community service requirements, or claim an allowable exemption, based on circumstance or condition in order to continue to receive coverage.

Generally, this requirement applies to adults 19 to 64 who are not on Medicaid. But exemptions can include people with serious health conditions, disabilities, substance abuse disorders, SSI or SSDI recipients, certain caregivers, veterans with total disability, ratings, and individuals recently released from incarceration.

Now, some enrollees will need to renew their coverage every six months rather than annually, right? And the goal right now is for members to stay informed and keep their contact information up to date so they can keep themselves on the rolls.

Host: It sounds like a lot to know and a lot of new things in place. So for people who are subject to the new requirements, what activities will count toward maintaining coverage?

Nick Shields: Yeah. So, individuals subject to work requirements can satisfy those requirements in multiple ways, all right? So, first is through employment. A minimum of 80 hours of work per month is what will be required, or a monthly income of at least $580 per month.

Volunteer or community service training program will also allow folks to stay on the rolls. But that is also a minimum of 80 hours per month. And folks can also do an educational program. So for that, you have to be enrolled at least half the time in either higher education or have a career or have some sort of technical education program that you are currently enrolled in. And any combination of these activities totaling 80 hours a month can also satisfy those work requirements.

Host: Dr. Smith, Nick mentioned immigrants. How will these changes affect immigrant Medicaid enrollees? And what should affected families know as the implementation date approaches?

Lauren Smith, MD, MBA: Different from what Nick mentioned regarding the January changes, we do expect that the immigration-related eligibility changes will go into effect in October 2026. Currently, the groups that under-qualified immigrant status will be changing. So, that definition will change and will no longer include refugees, those seeking asylum or temporary protected status, as well as victims of domestic violence and trafficking. And this is a big change.

For the last 30 years, we have had these qualified immigrant status. And so, unfortunately, in October 2026, we will see those changes. So, it is very important that families check out the HFS website to get the true definitions. There will be some groups that remain eligible.

If you are a lawful permanent resident that meets the criteria ffor residency requirements, you will be allowed to stay. But again, you really need to check the HFS websites and recommendations. And those changes are expected in October 2026.

Host: What can Medicaid enrollees do today to prepare for these changes and avoid an interruption in their health coverage?

Nick Shields: Yeah, Maggie, I appreciate you asking that question. It starts with updating their contact information with HFS. So, to create or maintain an ABE Manage My Case account, that website is ABE, ABE.illinois.gov. They can open and respond promptly to mail and notices from HFS, attend community redetermination events if assistance is needed, right?

And all of these events are on the website that we created, getmedicaidfacts.com, www.getmedicaidfacts.com. They can also stay connected with healthcare providers and health plans. But I really want to add this too. We really want to make sure folks are aware of scams, right? There's so many scams happening today. So, please keep in mind that Illinois will never, and I mean never, charge people to apply for or renew Medicaid coverage.

Host: That's good to know and to highlight because, you know, scammers are so talented these days. It looks so official, you know, in certain areas. So, good to know. And Dr. Smith, what are you seeing in the emergency department today that highlights why access to health insurance matters?

Lauren Smith, MD, MBA: I think what we're seeing, one, we're starting to see a trend up in volumes. I think some folks think that the eligibility criteria have already changed and don't realize that they actually still qualify for Medicaid. So, we want to make sure that everyone that is enrolled stays enrolled.

And what we see is when you don't have that insurance, you don't have access to preventative care, and we'll see in the emergency department presentations of gaps in care, patients who have experienced gaps in their care. And so, whether they run out of their medication and then their diabetes is no longer managed well or their hypertension, and they're presenting with a catastrophic event as a consequence of having one of those chronic conditions.

And we also see patients when you miss that preventative care, you actually may not be diagnosed with diabetes, for months, and you may have had it for a while, or same with high blood pressure or hypertension. So, you don't actually even know that you have it until you show up in the emergency room. So, you know, when you present in the ER, we're really experiencing those gaps in care that the patients may be presenting with. So, it is very important to maintain your insurance while you can and to continue with that, continuity of care with your primary care physician or provider.

Host: Wow. Well, so what does happen when people delay care because they're unsure whether they have coverage?

Lauren Smith, MD, MBA: Yeah, I think what we see is things that could be pretty minor end up being a major event, right? And so if you have a patient that's been told that they were pre-diabetic and then they lose their insurance, they're not able to get follow-up and maintenance to know when they become diabetic, if they are to become diabetic.

And so, when you are presenting in those presentations, obviously, we see worse health outcomes. We see patients that present, and then they're also getting higher costs because an emergency room visit is much more expensive than a visit to your primary care physician. And then, ultimately, we see an overburdened healthcare system.

Host: And Nick, from a health system perspective, why is it important that people understand these Medicaid changes well before they take effect, because October is just around the corner.

Nick Shields: Right, isn't it? Understanding the changes can help prevent avoidable coverage losses. Patients are more likely to maintain coverage for their care when they know what actions they need to take, right? Early communication gives families time to prepare. Education and outreach can reduce confusion and misinformation. And of course, healthcare systems, community organizations, and public agencies, all benefit when patients stay covered and are connected to care.

Host: Is there somewhere people can go to, like a website or call to get help?

Nick Shields: Yeah, absolutely. For starters, we want folks to come to our website, right? Cookcountyhealth.org. I would recommend that folks come here to learn more about the services that we provide, and to learn more about the offerings that we have to serve our residents.

Host: And I would love to ask both of you this. Beyond individual enrollees, what impact could these Medicaid eligibility changes have on hospitals, community health centers, and the broader healthcare landscape in Cook County and across the country? Let's start with you, Dr. Smith.

Lauren Smith, MD, MBA: You know, I think we just see a burden on the whole healthcare system as an entirety. So, emergency department volumes will trend up. We see pressures on the primary care doctors and providers, trying to care for these patients as they, again, will experience gaps in care without having this insurance.

So, it's really important that we cannot emphasize enough how important it is to maintain your coverage so you can continue the preventative care, you can get diagnosed earlier. So that way, you also have a better health outcome in the end.

Nick Shields: I'll jump in there too and say we are just very concerned. Safety net providers could see more uninsured patients as a whole, right? Community health centers and hospitals may face, increased care costs. Outreach and enrollment support will become increasingly important. And strong partnerships, just in general, across the healthcare. And community organizations, healthcare landscape and community organizations will just be absolutely critical in these times.

We've been connecting on a daily basis with organizations, to stay plugged into what's happening at the grassroots level. And in addition to that, we have started a group bringing in the philanthropic community, businesses, organizations, grassroots and grasstop leaders, just to make sure we are all on the same page as these changes come into effect.

Host: And if listeners remember only one thing from today's conversation, what would you want them to know about staying informed and keeping their Medicaid coverage, Nick?

Nick Shields: Make sure HFS has your current address, phone number, and email. That's going to be critical to stay on the rolls. Watch for official notices and respond promptly. Seek help if you have any questions, and please please, please stay connected to trusted resources and your healthcare providers.

Lauren Smith, MD, MBA: I would just add don't panic. You know, there is a lot of change going on. And we, you know, experience it on the healthcare side as well, as a system, as a provider. So one, just don't panic. As Nick mentioned, stay connected and really don't fall behind on your preventative care. So, stay in touch with your doctor's office. Make sure you're doing all the general maintenance so that you are at your healthiest self and that we're not experiencing those gaps in care so we can provide great care, you can live a long, healthy life.

Host: Well, thank you both for sharing your expertise today with us. This has been so informative and important. I mean, it is crucial information. And you've given us a lot to think about and a lot of good resources to find out more. So, we appreciate your time today.

Nick Shields: Maggie, thank you.

Lauren Smith, MD, MBA: Thank you.

Host: Again, that's Nick Shields and Dr. Lauren Smith. Before we wrap up another insightful episode of Total Health Talks, remember, the most important thing you can do today is make sure your contact information is up to date and stay informed. Visit getmedicaidfacts.com for the latest information about upcoming Medicaid changes, answers to frequently asked questions, resources in multiple languages, and guidance on how to keep your coverage. You can also contact the Illinois Department of Healthcare and Family Services, HFS, if you need to update your address, phone number, or other information. Staying informed and responding to official notices is the best way to protect your healthcare coverage. This is Maggie McKay signing off from Total Health Talks. Stay well.