* Dean Olsen has written a highly informative story about MCOs. Yes, it’s a complicated issue. Eyes tend to glaze over when you even mention Medicaid managed care. But try to take a little time to read his piece…
Years of finger-pointing by Illinois hospitals and managed-care organizations about what the hospitals said were high denial rates for Medicaid claims ended last month with legislation that both sides hope will reduce friction between the two and benefit low-income patients.
“This is a really good step forward,” said Jay Roszhart, president of Memorial Health System’s ambulatory group. “I’m fairly optimistic that the intent of the bill will resolve these issues.”
Samantha Olds Frey, executive director of the Illinois Association of Medicaid Health Plans, said Senate Bill 1321, if signed into law by Gov. J.B. Pritzker as expected, would lead to hospitals sharing more information with companies hired by the state to carry out the state’s Medicaid managed-care program, HealthChoice Illinois.
The legislation, Olds Frey said, would make sure hospitals and the managed-care organizations, or MCOs, “are talking to one another instead of at one another … to ensure cohesive care-coordination and discharge planning with a focus on the Medicaid members.”
Illinois’ managed-care system covers 2.1 million Medicaid beneficiaries, or more than two-thirds of the state’s 3.1 million population in Medicaid.
The folks who put that truce together did an excellent job.