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The damage done

Tuesday, Apr 16, 2019

* 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.

* Now

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

- Posted by Rich Miller        

  1. - Huh? - Tuesday, Apr 16, 19 @ 11:43 am:

    There was a NPR story this morning about the measles. In 2000, the CDC declared the US had eliminated the disease from the US. This year there are 555 confirmed cases of measles. Another recent article said 1 person infected 22 people in Detroit after traveling overseas.

    This is a preventable disease. The vaccines are safe. The potential side effects of the disease are much worse than those of the shot.

  2. - lakeside - Tuesday, Apr 16, 19 @ 11:50 am:

    For the love of dog, float the cost, Illinois. Today.

    So torn between wanting to never see Bruce Rauner’s face again in this state and hauling him into hearings week after week to account for all this.

  3. - PJ - Tuesday, Apr 16, 19 @ 11:54 am:

    I’m somewhat sympathetic to doctors not ordering the vaccines when they already weren’t being paid during the budget battle. I’m less so now. Folks, you make 6 figures annually. You can’t front the cost of vaccines that you’ll be reimbursed for if you fill out the paperwork?

    It’s easy to blame IDPH, but I’m not sure this is their fault if the mandate comes from CDC. There’s also no looming crisis providing doctors just … do the paperwork.

  4. - wordslinger - Tuesday, Apr 16, 19 @ 11:55 am:

    –* 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.–

    Read those four sentences from the Rauner administration. Not only were those guys chronic liars, they were really bad at it.

    “Up is still up. But some who’ve fallen to the ground might view up as down.”

  5. - Anon221 - Tuesday, Apr 16, 19 @ 12:00 pm:

    Just one more way Rauner literally weaponized children in our State.

  6. - Union thug - Tuesday, Apr 16, 19 @ 12:21 pm:

    I was working the Medicaid hotline when this took effect. I am not surprised with the results.
    The way it usually went.
    Mom takes kid to Dr
    Dr tells mom allkids doesn’t cover vaccination anymore
    Mom calls hotline.
    Hotline inform mom theybsre still covered Dr doesn’t want to do new procedure.
    Refer mom to local health departments.
    Health department tells mom they can’t do it due to all kids.
    Mom calls hotline again
    If mom has names of people she talked to (Dr office and health department) an issue is sent.
    No idea who or what department since supervisors routed those.
    Mom call for a few weeks as no response on issue.
    At this poitn i fiqure either mom gave up or found another way to get child vaccinated.

  7. - DuPage Saint - Tuesday, Apr 16, 19 @ 1:03 pm:

    So if the vaccine is made mandatory as is being done in some places who can we go after Rainer? Bet his kid was vaccinated when she got into Walter Payton Prep

  8. - Perrid - Tuesday, Apr 16, 19 @ 1:19 pm:

    I’m still uncertain why this is a problem. Instead of being given the vaccine for free and get paid for administering the shot, the doc has to buy the vaccines themselves and then bill and get paid for both the vaccine and administering it. They get made whole, eventually. Is cash flow really that big of a deal? Are they that close to the edge? Or is the payment for the vaccine not enough to handle the cost of buying the vaccine?

    I also get that there is just some confusion about what gets paid for, and the process, so I don’t know how much of this is just confusion in docs and patients need to do, and how much is the process simply not working.

  9. - Cheryl44 - Tuesday, Apr 16, 19 @ 1:45 pm:

    I’m not saying why I know this, but some big name hospitals in Chicago are no longer allowing anyone under 18 to visit patients. My guess is this is part of the reason for the new rule.

  10. - Wensicia - Tuesday, Apr 16, 19 @ 3:05 pm:

    The list of Rauner victims continues to grow.

  11. - Union thug - Tuesday, Apr 16, 19 @ 7:01 pm:

    Let me put it this way. If you loan a guy $50 and he keeps coming back for $50. Know he will probably pay it eventually. How long do you keep handing him cash?

  12. - Pnut - Wednesday, Apr 17, 19 @ 7:50 am:

    So if this does go into effect until October 1,Maybe doctors should actively push to get all eligible kids in their care vaccinated before that date…

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