Forget Pensions And Salaries: Medicaid Biggest Piece Of Rauner’s Budget Pie

Illinois governor Bruce Rauner has been criticizing state workers' high salaries and benefits ahead of his State of the State address Wednesday. But the biggest payout the state makes has nothing to do with labor contracts.

Actually, Illinois spends more on its Medicaid program than on anything else. The state has set aside $20 billion dollars this year for its healthcare program for the elderly, disabled and the poor. 

As part of the federal Affordable Care Act, more low-income people are on Medicaid than ever before. The increase is beyond what the state had planned for. A Chicago Tribune analysis shows growth three times original estimates.

For the next two years, that won't be a problem; the federal government is footing the bill until 20-17.

But when Illinois does start picking up the check, Springfield will have to grapple with its biggest payment ever..

Rauner had been a critic of Medicaid expansion on the campaign trail, but says now that it's here, it can't be taken away. So what can the state do to reduce the program's cost?

"Our current structure of our Medicaid program has a lot of fraud and waste and abuse in it and that's not fair to the honest recipients who need the help and it's not fair to our taxpayers," Rauner told reporters last week.

That's as specific as the governor would get when asked about it. 

Lawmakers *could* temper that payment by restricting eligibilty for Medicaid  like former Governor Jim Edgar did by removing childless adults from the program. The state has also experimented with eliminating specific programs, such as adult dental care.

But Medicaid advocates warn that will lead to more cost to individuals and the state down the road