Providers Lobby Against Proposal Requiring Medicaid Beneficiaries To Join HMOs

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice
Article Date: 28 Aug 2007 - 13:00 PDT

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Hospitals and physicians in Illinois are fighting "last-minute" legislation that would implement a pilot program in which Medicaid beneficiaries in two counties would be required to join HMOs, the Chicago Tribune reports. The program, which began in 1990, so far has been voluntary, and less than 160,000 beneficiaries have enrolled in HMOs.

Medicaid beneficiaries currently are required to sign up for a primary care physician. HMOs argue that restricting beneficiaries' choice of providers to their networks would provide more cost-effective care for fee-for-service Medicaid. HMOs also would offer disease management programs and assign PCPs to encourage preventive care and reduce the number of low-income individuals seeking care in emergency departments.

Physicians say that the proposal would limit access to care and that HMOs have no proof they offer more cost-effective care. Ken Robbins, president of the Illinois Hospital Association, said because "Illinois Medicaid payments are so low and the base rate has been frozen for the past dozen years, savings have already been squeezed out of the Medicaid program." The bill was approved by the state Senate, but its future in the state House is "uncertain," the Tribune reports (Japsen, Chicago Tribune, 8/23).

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