* GOP Rep. Patti Bellock and Sen. Dale Righter held a press conference yesterday to claim that Medicaid reform has turned into “un-reform.” From a press release…
Bellock and Righter said they feel an added sense of urgency because of recent meetings in which majority Democrats in the Senate and House of Representatives have been pushing for further unraveling of the agreed-to reforms.
“What we have seen since passage of the 2011 and 2012 laws is the ‘un-reform’ of the Medicaid system,” said Righter. “Where the reforms have been implemented, the state has experienced significant savings. However, these carefully negotiated reforms have consistently fallen short of projections and mandated goals because the Quinn administration and Democrat lawmakers refuse to implement the reforms as mandated in law and have quietly worked behind the scenes to undermine and disassemble the bipartisan reforms we enacted.”
In 2011, only 7% of Medicaid enrollees were in a managed care program, leaving the majority of Medicaid enrollees without a medical “home,” with many relying on more costly emergency room care. In response, the 2011 Medicaid reforms mandated that within four years, managed care enrollment was statutorily required to reach 50%. Well over three years later, and quickly approaching the end-of-year deadline, the number in managed care stands at an abysmal 16%.
The lawmakers stress this lagging enactment is indicative of the program’s overall implementation. Many provisions in the SMART Act have been ignored and program expansions have continued. Provisions limiting the number of prescriptions have not been enforced, and the third-party vendor hired to scrub the Medicaid rolls was relieved of its duties—despite saving the state more than $86 million after only reviewing 25% of total Medicaid cases.
Illinois Department of Healthcare and Family Services personnel were not available for comment Thursday, but department director Julie Hamos said in a statement that the state is on pace to meet the goals set out in the SMART Act.
“Since the implementation of that plan two years ago, we reduced Medicaid spending by $3.2 billion, and are now managing within that budget,” Hamos said.
She said the Act was passed with strong bipartisan support to put the state “on track to catch up with the nation’s other states by implementing coordinated care. As a result, we are on target to achieve the state’s 50 percent mandate by Jan. 1, 2015.”
She said the department’s goal is to provide better health care at a lower cost, “and we are doing that.”
The lag on managed care enrollment is indeed quite curious and deserves a much better response. Soon.
* However, Righter’s claim during the press conference that the effort to root out fraud was a “stunning success” caught my eye.
Bruce Rauner and many other Republicans have claimed that billions of dollars could be saved by kicking ineligible recipients off Medicaid. Yet, the outside contractor only found $86 million in savings? That’s not a “stunning success,” and it can’t even be easily projected out over the other 75 percent when you remember this crucial point by Doug Finke last December…
the ones that were checked first were mostly cases where the state already had suspicions. In other words, easy pickings. Once those are gone, it’s entirely possible the rate of fraud discovered will go down.
And what happens when the rate of fraud discovered goes down as most likely will be the case? Well, critics will contend it’s all Quinn’s fault.