Administration warned over huge Medicaid revamp
Wednesday, May 3, 2017 - Posted by Rich Miller
* From Crain’s…
Illinois Comptroller Susana Mendoza wants Gov. Bruce Rauner to hit the pause button on revamping the Medicaid managed care program.
In a state without a budget for two years, rebidding a program that could potentially award up to $9 billion a year over four years in contracts should have more scrutiny, Mendoza, a Democrat, said in a letter today to the Republican governor. She said the procurement could be the largest in the state’s history.
“We are effectively seeking to restructure the state’s largest budget item without a budget,” Mendoza wrote. “Why are we making this monumental change during this period of unprecedented upheaval?”
Rauner in February announced that he would overhaul the managed care program, a key Medicaid initiative that intends to rein in costs, but one that the governor says hasn’t saved enough money. It’s an unpopular program with doctors and hospitals alike. They complain about its heavy administrative burden.
* SJ-R…
In a letter sent to Gov. Bruce Rauner Tuesday – and also released publicly – Mendoza said the proposal calls for a 25 percent increase in Medicaid recipients using managed care while also greatly reducing the number of managed care providers.
“Similar initiatives in other states, advanced without appropriate questions being raised, have been met with unforeseen challenges, including reduced access to service and increased administrative costs,” Mendoza said.
The Democratic comptroller asked Rauner, a Republican with whom she has often been at odds, to delay implementation of the contract to give lawmakers and others more time to review the proposal. She is also asking legislative leaders to set up a forum for further discussion of the plan. […]
“The managed care reboot will improve healthcare delivery through a transparent process that was designed with significant stakeholder input to ensure integrity, competition and sustainable program costs for Illinois,” DHFS spokesman John Hoffman said in a statement.
* A lot could be at stake…
The board chairman of one of the largest private Medicaid health plans in Illinois fears the Rauner administration is locking the nonprofit out of a lucrative state contract.
If so, the health plan, Chicago-based Family Health Network, likely will dissolve, forcing its more than 200,000 members to find health insurance and doctors alike elsewhere, said Jose Sanchez. He’s board chairman of the plan, known as FHN, and CEO of Norwegian American Hospital, one of five hospitals that founded the plan 22 years ago.
A group of state lawmakers is taking it one step further, suggesting in a letter to Illinois Gov. Bruce Rauner that the hospitals would close without revenue generated from the health plan. Many of the facilities are anchors of impoverished neighborhoods.
“The healthcare delivery infrastructure for Latino and African-American communities are in grave danger of collapse,” the lawmakers wrote in the March 28 letter to Rauner.
The reason those hospitals could close is that they depend on the revenues from their stake in FHN to remain viable.
* A group of legislators held a press conference today to blast the plan and demand that it be delayed. They also warned that some safety net hospitals will close.
Their signage was more partisan than the presser, however…
- Langhorne - Wednesday, May 3, 17 @ 12:22 pm:
You had rauner at “contracts” and “consolidation”. Aka, picking winners and losers.
Just like vulture capitalism, except now its “Drivin’” results for taxpayers.
- Anonymous - Wednesday, May 3, 17 @ 12:32 pm:
Comptroller’s letter to Governor
https://illinoiscomptroller.gov/comptroller/assets/File/news_releases/MCOLetter050217FINAL%20(2).pdf
Comptroller MCO report
https://illinoiscomptroller.gov/comptroller/assets/File/news_releases/MCORFP_FINAL_050217%20(1).pdf
- Honeybear - Wednesday, May 3, 17 @ 12:33 pm:
I’m not sure people realize how cataclysmic this is for the poor disabled and elderly. The placard is totally accurate. It would destroy our main social safety net to transfer profit to private for profits. It will literally kill a lot of people.
I work with the approximately 52,000 poor disabled and elderly of my Metro East county. Every single day they struggle to find a doctor, get their prescription filled, get treatment. Good God folks it’s bad enough now.
I’ve got a million stories heart breaking stories of need. Especially the elderly and disabled are vulnerable.
True Medicare helps a lot with the elderly but not everything.
Don’t criminalize people because they are poor disabled and elderly.
In dozens of passages the bible tells us to care for those people
Let’s step up and not tear down
- Sir Reel - Wednesday, May 3, 17 @ 12:33 pm:
The statement from Hoffman at DHFS is pure agency jargon. Sounds good but says little.
Probably written by the consultant.
- So.... - Wednesday, May 3, 17 @ 12:35 pm:
So the English translation would be: “our record sucks and we will lose if forced to compete”
- wordslinger - Wednesday, May 3, 17 @ 12:36 pm:
Doesn’t matter who the governor is, this needs a thorough and complete airing before moving forward. It would be swell if the GA and media would do their jobs here and do them well. Ask all the questions and get real answers.
$9B a year in contracts? TII. Proceed accordingly, given our colorful history.
- Anonymous - Wednesday, May 3, 17 @ 12:36 pm:
And has anyone pointed out Felicia Norwood’s connections to Aetna, which would likely win a big piece of the RFP pie?
- hisgirlfriday - Wednesday, May 3, 17 @ 12:49 pm:
Just as a non-partisan practical matter how does it make sense for the Republican governor to make major Medicaid program changes before we know whether more changes are coming through the Republican Congress and president?
- Anon1234 - Wednesday, May 3, 17 @ 12:53 pm:
Anon 12:36 - is this Norwood person behind Aetna taking over all the state employee health plans? I just found out yesterday that Cigna will no longer be managing my plan as it is being switched to Aetna.
- Anon - Wednesday, May 3, 17 @ 12:55 pm:
Josh Lyman’s plan, not Toby Zeigler. http://westwing.wikia.com/wiki/Celestial_Navigation
- Anonymous - Wednesday, May 3, 17 @ 12:57 pm:
Cigna is suing over the Aetna shift.
- Anon1234 - Wednesday, May 3, 17 @ 12:59 pm:
On first glance, it looks like Felicia Norwood would not be the one who selected state employee health insurance, but putting on my tinfoil hat, it makes me wonder if there is some connection between the administration and Aetna.
- LTSW - Wednesday, May 3, 17 @ 1:23 pm:
What you are hearing is the IHA talking via Mendoza and legislators. Hospitals are treated very well in Illinois’ current Medicaid structure.
- Irish1 - Wednesday, May 3, 17 @ 1:32 pm:
@Anon 12:32pm the links do not work, I would love to see the comptroller’s MCO report.
- Anonymous - Wednesday, May 3, 17 @ 1:36 pm:
Budget? Who needs a budget? All the legislators, lackeys and departments are getting paid…we have judges telling us who we can pay — all is wonderful. So go ahead - revamp it — what could possibly go wrong?
- Anon1234 - Wednesday, May 3, 17 @ 1:39 pm:
http://www.courthousenews.com/illinois-accused
Here’s a summary of the Cigna claims about Aetna being improperly awarded the contract. Aetna is charging higher costs, so it makes me more suspicious that someone making the decisions has a connection with Aetna. Why wouldn’t the state release the Aetna bid for review? This will probably cost the state even more money.
- Mr. K - Wednesday, May 3, 17 @ 1:41 pm:
@Irish1 — copy the whole link — don’t click on it. Then paste it in your browser.
It works.
- Anonymous - Wednesday, May 3, 17 @ 1:44 pm:
This links to the letter and if you scroll to the bottom of the page you can open the report. http://bit.ly/2pG1fa4
- zatoichi - Wednesday, May 3, 17 @ 2:46 pm:
Yes, let’s move to managed care. It has such a good track record. Gosh, I wonder why Molina just dropped their managed care contracts in many counties througout central Illinois. Could not possibly be a lack of profit? Wells Center in Jacksonville just closed. One of their problems was managed care companies who only know the word ‘No’. The managed care project in the collar counties around Chicago, not exactly a raging success according to providers in that project. Most rural counties have not had managed care services. It’s the next hot thing that consultants say will solve all money issues.
- Anonymous - Wednesday, May 3, 17 @ 2:48 pm:
FHN can’t expand out of Chicago, and the contract is for the whole State (Cook CountyCare was exempted, and can cover cook only). So by “locked out” they mean they can’t fulfill the request, and want special treatment. The timeline for the new rollout is insane, but the idea of having fewer plans is a good one- less headache for providers. Though a lot of providers that don’t have to deal with managed care now will have to figure out how to do so, since the new plan is statewide and not the 30ish counties now. So there are potential problems but I don’t think it’s quite as doom and gloom aaa FHN et al is trying to make seem
- McGruff - Wednesday, May 3, 17 @ 5:47 pm:
After selling the legislature a bill of goods, the MCO’s failed to deliver. Instead of saving the State money and providing so -called care coordination , they are costing the state close to a billion dollars in administrative fees! And does that billion dollars stay in Illinois? No, it travels out of our bankrupt state to the shareholders of said Insurance companies. And ‘care-coordination’ is MCO speak for ‘Claims Denied’. The govenor and Norwood admitted the program is failing. However, rather than stopping enrollment and doing an audit of the current mess, the Govenor doubles down! Yes , so now let a concentrated few insurance companies divvy up billions in contracts! And the legislature is willingly ceding all control. Wake up people! The insurance companies, including the director’s former employer Aetna, are laughing all the way to the bank.