* September 30, 2016…
The state of Illinois has abruptly changed the rules for providing vaccines to children from low-income families, putting tens of thousands of them at risk of potentially not getting their immunizations on time.
In late August the Illinois Department of Public Health told doctors that children covered by the state’s Children’s Health Insurance Plan for low-income families would no longer get their vaccines for free. Children covered by Medicaid can still get free vaccines, but for those 185,347 children covered by CHIP, doctors will have to privately order vaccines from suppliers and wait to be reimbursed by the state.
This new policy presents a sizable challenge for doctors and parents. And it goes into effect Oct. 1.
* IDPH downplayed the impact at the time…
Illinois is committed to every child being immunized. For parents or guardians of a child covered by Medicaid or by CHIP, their child’s eligibility for free vaccines has not changed. What has changed is the way doctors obtain and get paid for vaccines. Some providers may choose not to provide free vaccines to children covered by Medicaid or CHIP.
The change was required because, for years, many doctors had not been doing the necessary work of determining a child’s eligibility for a vaccine (e.g. do they qualify under the Vaccines For Children program or CHIP), and then submitting the proper paperwork to HFS (the entity that administers CHIP). Because many physicians were failing to provide this billing paperwork, HFS has not been able to channel the appropriate reimbursement for children in CHIP to the CDC. For good reason, the CDC has requested that Illinois, and many other states, alter their process to ensure that the proper reimbursement occurs. Without making such a change, IDPH runs the risk that the CDC will no longer continue to provide vaccines free of charge to the State for the VFC program.
Dozens of Illinois pediatricians are warning Gov. JB Pritzker about a potential health crisis from reduced access to vaccines for potentially thousands of children. […]
Local doctors say a particular group of Illinois kids is at risk of triggering an outbreak — those who are covered by the state-run Children’s Health Insurance Program, known as CHIP. There were about 324,000 children in Illinois enrolled in CHIP at some point in the 2017 fiscal year, the sixth highest amount in the nation, according to the nonprofit Kaiser Family Foundation, which tracks health care issues.
Doctors say this large group of kids is vulnerable to an outbreak because some physicians stopped vaccinating them after a major policy shift by the Rauner administration in 2016 made it too expensive. Doctors at the time were already grappling with not getting paid, or waiting for months, during the state’s epic budget battle. […]
It’s not clear how many Illinois children on CHIP haven’t been vaccinated or are getting shots later than doctors recommend. Physicians aren’t required to report it, according to Melaney Arnold, a spokeswoman for the Illinois Department of Public Health.
According to the article, the Pritzker administration says it’s working on changing the way doctors are paid for immunizations.
* A bit more history…
* July 13, 2017: What does $15 billion in overdue bills mean for the state’s doctors and hospitals?: Having a budget doesn’t put everyone at ease. Dr. Timothy Wall’s pediatric practice is one of the largest private providers of Medicaid managed care in DuPage County, and insurers owe it more than $1 million. He’s put off vaccinating children after their first birthdays because the insurers stopped paying for the expensive shots