Proposed State Budget Threatens Health Care for 180,000 Illinois Medicaid Recipients in Managed Care Plans

Main Category: Medicare / Medicaid / SCHIP
Article Date: 30 May 2005 - 0:00 PDT

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Doctors serving Illinois Medicaid recipients who participate in managed care plans today called on Governor Blagojevich and the General Assembly to reject a proposed provision in the pending State budget that would jeopardize health care for 180,000 citizens and throw the Cook County health system into chaos.

A single line proposed by the Illinois Department of Public Aid in its budget would eliminate all Medicaid managed care plans in Illinois -- despite a recent $300,000 report commissioned by the State recommending expansion of managed care programs as a means of saving tax dollars and providing improved care for Medicaid recipients.

The move is described by proponents as an effort to save money, when in fact it would only defer some state Medicaid spending obligations to the 2007 fiscal year.

"If the State eliminates Medicaid managed care, it would be a travesty for patients and for doctors serving those who need us the most," said Dr. Michelle Alexandre, a Melrose Park family physician. "I would be forced to fire my employees and close the doors of my practice. Our patients, who have come to depend on us, would be left without health care options because of the difficulty of finding doctors who will accept new Medicaid patients."

Dr. Alexandre's practice handles 20,000 Medicaid patient visits per year, and approximately 70 percent of her patients are enrolled in Medicaid managed care plans.

The elimination of Medicaid managed care plans would force current managed care participants into the State's "fee-for-service" Medicaid program, which currently reimburses doctors up to nine months after patients are actually treated. This payment delay discourages doctors from accepting new Medicaid patients, which in turn causes patients to "dial for doctors" --- or go to hospital emergency rooms --- in search of even routine medical care.

By contrast, Medicaid managed care providers are guaranteed payment on a monthly basis for each Medicaid managed care patient treated. A federal judge recently found that Illinois' fee-for-service system has failed Medicaid recipients -- especially children -- by limiting their access to vital services such as screenings and preventive care.

Dr. Alexander Zureikat is president of the Greater Chicago Medical Association, an organization that contracts Medicaid managed care services on behalf of 250 area physicians.

"The long reimbursement cycle under the State's fee-for-service is killing the doctors' ability to serve patients," Dr. Zureikat said. "Payments received through managed care are the only thing keeping many Medicaid doctors afloat. If they had to rely solely on the State for reimbursements, doctors would be forced out of business and thousands of Medicaid recipients would have to scramble to find health care for themselves and their families."

Medicaid managed care plans are similar to government- and employer- sponsored health care plans in that they provide each patient with a primary care physician who is familiar with the patients' medical history and can coordinate patient care accordingly.

Dr. Art Jones, CEO of Lawndale Christian Health Center, is an advocate for expanding Medicaid managed care in Illinois because of managed care's emphasis on preventive health care and use of primary care physicians.

"Medicaid patients in managed care plans receive a superior level of coordinated care, service and access to care than do the majority of Medicaid recipients who are left on their own to navigate the complex and often unfriendly fee-for-service system," Dr. Jones said. "Managed care patients have a 'medical home;' many others are essentially left 'homeless.'"

"Illinois should be taking steps forward to expand Medicaid managed care statewide. By eliminating managed care, the State is actually moving backwards and embracing a system that is costly and inefficient and that leaves many Medicaid patients lost and underserved," Dr. Jones said.

The proposal to eliminate Medicaid managed care follows an 18-month, $300,000 state-sponsored study that strongly recommends the expansion of Medicaid managed care throughout Illinois. The study's findings demonstrate how Illinois could improve health care access and quality for low-income citizens and eliminate $1.5 billion in federal and state spending over the next five years by implementing managed care for all Medicaid participants.

In stark contrast to the proposed Illinois budget, most other states have expanded Medicaid managed care - under both Republican and Democratic administrations - because of the tax savings and improved care.

Illinois Association of Medicaid Health Plans