The Current State of Medicaid in Illinois

By Beverly George

ACE Leader

 

Illinois expanded its Medicaid program in 2013. Governor Bruce Rauner (R) stated in 2014 that had he been in office then, “he would not have approved the expansion, but that he would not push for an end to its expansion.”[2] Medicaid expansion has provided affordable health care to a greater number of the most economically strapped Americans, allowing them to spend more money on food, housing and other necessities.[2] It has also expanded the number of health care jobs, giving back more to the states in tax revenues and disposable income in circulation from these workers.

Illinois currently has about 3.2 million Medicaid patients, and on January 1, 2018, about two-thirds of them will be enrolled in Medicaid managed care. That’s an increase of 500,000 over the number covered in the plan today.[3]

Managed care is a health system that enables and requires doctors to treat patients with a consistent, ongoing delivery of care via regular office visits and any prescriptions needed to manage chronic conditions. This, in turn, yields better patient outcomes and lowers costs by avoiding emergent crises that propel a patient to more expensive emergency room treatment or even more costly hospitalization.

The Illinois state legislature passed a budget July 6, 2017 after a two-year impasse. Over that time, the state had fallen so far behind in its reimbursements to Medicaid providers, many had stopped offering Medicaid services. (The University of Chicago Medicine recently pulled out of Medicaid insurer IlliniCare.[3]) But with the new budget and by the end of July, the Illinois comptroller announced it had paid $740M to Medicaid managed care organizations. However, the bill wasn’t paid in full; there is still $3.5 billion outstanding.[5]

Governor Bruce Rauner wants to economize the state’s Medicaid expenses further with his plan, which includes the following.

  • The former 12 health care providers contracted to deliver Medicare managed care to Illinois enrollees has been cut to six providers (BlueCross-BlueShield of Illinois, Harmony Health Plan, IlliniCare Health, Meridian Health Plan, Molina Healthcare, and CountyCare Health Plan). The smaller number of insurers is expected to bring “enhanced care coordination and stronger quality controls to fulfill the promises of managed care to Medicaid beneficiaries,” according to Felicia Norwood, director of the state healthcare and family services department. [3]
  • Another predicted efficiency is a universal credentialing system for doctors who want to be in the six insurers’ networks. Previously the credentialing systems used by the 12 providers were not necessarily the same.[4]
  • In 2016, about 60% of Illinois Medicaid patients were enrolled in managed care. Governor Rauner wants to increase that to 66% in 2018, and to 80% the following year. Illinois spends about $10.5B now, and that sum is expected to climb to between $12.8B and $13.5B as the number of enrollees increases by five hundred thousand next year. [3]

Advocates of the changes believe the administration by fewer providers will be smoother and more efficient for the patients, at the same time saving between $200M and $300M per year, according to the Department of Healthcare and Family Services. The savings is due, in part, to providers having agreed to be paid less per beneficiary, according to spokesman John Hoffman. [3]

Opponents of the governor’s plan point out significant hurdles to come, such as the following points.

  • Medicaid managed care providers have found it very difficult to track down their patients. Many are homeless or don’t have a permanent address or a telephone number, while others don’t want to be bothered. They have to focus on having sufficient food or clothing, which puts healthcare a distant third or fourth in priorities.These Illinoisans can meet a health crisis with a costly ER visit or hospitalization instead of consistent care through their assigned provider. And providers are paid per patient, even when they don’t have regular contact with them.[1]
  • As more new enrollees integrate into managed care next year, health plans will focus on the sickest, most expensive patients first, possibly leaving those in better health now to fall through the cracks later. [1]
  • The patients who will have to find a new provider as a result of the 12-condensing-to-6 scheme, will no doubt find it confusing, and many may not receive the smooth, ongoing delivery of healthcare that is a critical desired outcome in the governor’s plan. [3]

Delivering consistent, quality, compassionate healthcare to Medicaid patients for the most favorable health outcomes, and doing it with efficiency, thoroughness, and through a fiscally sound system is a challenge for every state. For Illinois it is paramount as the state tries to move forward to a stronger, healthier, and more promising future for all Illinoisans.

 

 

Sources 

  1. Crain’s Chicago Business; “The problem in Illinois no one is talking about” by Kristen Schorsch and Sabrina Gasulla. July 8, 2017.
  2. BALLOTPEDIA: The Encyclopedia of American Politics; “Medicaid spending in Illinois.” https://ballotpedia.org/Medicaid_spending_in_Illinois .
  3. Chicago Tribune; “Illinois names 6 insurers to take part in overhauled Medicaid managed care” by Lisa Schencker. August 11, 2017.
  4. Modern Healthcare; “Rauner names winners in Illinois Medicaid overhaul” by Kristen Schorsch. August 14, 2017.
  5. Chicago Tribune; “State pays out Medicaid money, still has billions in outstanding bills” by Lisa Schencker. July 27, 2017.

Along with being the leader of ACE, Beverly George also is a member of Indivisible, the Naperville League of Women Voters, and the Citizens Climate Lobby. She also volunteers with her parish PADS group. A former chemist, George worked in clinical chemistry and hematology research at the Centers for Disease Control for six years and taught chemistry and freshman science at Naperville North High School for 20 years.