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What could possibly go wrong?

Wednesday, Sep 11, 2019

* Hannah Meisel

With less than two months until 17,100 youth in Illinois’ foster care system are supposed to be switched from their current fee-for-service Medicaid healthcare programs and into a Medicaid Managed Care Organization, critics said Tuesday the agency and the organization are nowhere near ready for that transition and plan to ask for a delay.

A marathon four-hour House hearing held in Chicago focused on issues with the state’s Department of Children and Family Services, which has been under fire for months.

In addition to 17,100 children and teens in state custody, 18,800 young adults younger than age 26 who were in state custody are also supposed to begin their healthcare coverage with IlliniCare, a part of HealthChoice Illinois, the state’s Medicaid Managed Care Program. The state’s Medicaid program has gradually been transitioning to largely managed care, which promises better healthcare outcomes — as well as savings through efficiencies — through caseworkers managing cases for Medicaid patients.

A law passed last year and signed by former Gov. Bruce Rauner was supposed to provide guidance for DCFS and whichever organization, known as a MCO, was selected as to the transition from fee-for-service to managed care.

The bill was pushed by the ACLU of Illinois, and passed the General Assembly unanimously in the Senate and overwhelmingly in the House last year. But since then, ACLU Illinois Director of Institutional Reform Heidi Dalenberg said DCFS hasn’t done enough to get ready for the transition, and that moving ahead anyway would spell danger, especially for the foster care population. Dalenberg told The Daily Line the transition is much more complicated than if an adult switched regular health insurers, which she noted is already stressful.

* Moving these kids into managed care was a Bruce Rauner idea, but it’s on Gov. Pritzker’s hands now. Governors own, as the saying goes. So, if they can’t make the November 1 deadline, then don’t do it

“I want to acknowledge that we’ve had some growing pains with managed care in Illinois,” Theresa Eagleson, director of the Department of Healthcare and Family Services, the agency that administers Illinois’ Medicaid program, told lawmakers during a hearing Tuesday in Chicago.

Eagleson, along with Leslie Naamon, president and CEO of IlliniCare Health, the company selected to run the program for DCFS children, tried to assure lawmakers they are trying to work out those issues before the new program launches. […]

Meanwhile, Dr. Edward Pont, a pediatrician who practices in DuPage County, urged state officials to delay the scheduled Nov. 1 start date for the new program. He said he was concerned that a managed care system could severely restrict those children’s access to certain kinds of health care because not all providers will be in the insurance company’s network.

“The decision to mandate that all wards (of the state) go into a single MCO will limit access,” Pont said. “Many providers now taking care of these wards may not be aware of the transition.”

* NPR Illinois

But people like State Rep. Mary Flowers (D, Chicago) say that plan is not soup yet.

“The road to hell was paved with good intentions, and I’m sure you have that,” she told a panel of healthcare officials at the hearing in Chicago. “But you are experimenting with my children’s lives, and I’m sick of it.“ […]

Rep. Jennifer Gong-Gershowitz said she’s worried kids who use IlliniCare exclusively may have fewer places they can go to receive care.

“If [a] provider is not a part of IlliniCare…then is it ultimately up to IllniCare to decide whether or not that child continues to receive those services?” she asked. “It seems to be little bit self-serving.”

* Kyle Hillman of the National Association of Social Workers on Twitter

In the short term at least, the MCO shift is looking like a total disaster. They don’t have the network, there are going to be a lot of kids losing care, and they don’t even know where some of these former kids are.

Which leads to my next thought - rather than just tell the committee we aren’t there yet - they literally lied about knowing where former youth in care are. When pressed, they sort of back tracked - but truth is they don’t know.

The testimony was full of buzz words and feel good statements but in the end the whole system is built on the false idea that these kids have proactive advocates. That just isn’t true

In a perfect world, their case worker would have small caseloads, their GALs would be fully trained and available, their medical professionals would have time to advocate and even their foster parent would have the training. We don’t live in a perfect world.

So knowing that these kids won’t have the advocates they need - it made Sen. @RobertJPeters question that more telling. In it he asked bluntly if the MCO planned to make a profit off of foster kids. After a moment of silence they said yes.

The MCO makes money off of “efficiencies” which often looks more like denial of claims and referral of cheaper less effective treatments. It saves the state money by denying foster kids care. Yay us!

When you don’t have the providers in your network around specialized care or in some rural areas - the foster youth can’t get costly needed services = $

When they don’t know where the former foster youth is they can’t get healthcare = $$

When the MCO denies claims and the kids don’t have proper advocates to fight for the care they need = $$$

- Posted by Rich Miller        

10 Comments »
  1. - tobor - Wednesday, Sep 11, 19 @ 9:54 am:

    The plan boils down to, wait for it, $$$$


  2. - Juvenal - Wednesday, Sep 11, 19 @ 10:03 am:

    The best way to reduce medical costs for kids in foster care is to prevent children from being abused and neglected so severely that they end up in foster care in the first place.

    Is DCFS doing that?

    No, they are not.

    Kyle Hillman raises a good point: the MCO should not be paid a penny for kids they cannot locate and who have not had atleast an annual check-up.

    Is that in the contract?


  3. - Cassandra - Wednesday, Sep 11, 19 @ 10:13 am:

    If it’s that bad, why would anybody want to be in a managed care system.

    In any case, seems to me that back in the early aughts, when the Democrats took the governor’s office, there was a lot of public discussion about missing DCFS wards, blamed on the outgoing Republicans, of course.

    So, is this another plus ca change moment.


  4. - R A T - Wednesday, Sep 11, 19 @ 10:52 am:

    You all know I am not for increased gov funding but DCFS sure does seem like the exception. These children are so let down by so many, the state needs to do all they can for them. We need to support those that support them.


  5. - Earnest - Wednesday, Sep 11, 19 @ 11:04 am:

    When I hear a phrase like “growing pains” I think back to this post: https://capitolfax.com/2017/11/27/medicaid-managed-care-contract-cost-skyrockets-more-than-50-percent/

    The purpose of managed care is to save the state money and hand a nice contract to a large corporation. Given our already-disastrously-low Medicaid rates, the way to accomplish that is to fund fewer services for people. I’d rather see the work being done by cost-effective Tier II state employees who live and pay taxes in our neighborhoods and pay into the pension system than send jobs and profits out of state.


  6. - GADawg - Wednesday, Sep 11, 19 @ 11:49 am:

    Ask the providers who are in the networks for already present MCOs how that is working out for them.


  7. - Someday - Wednesday, Sep 11, 19 @ 11:49 am:

    Someday the truth will come out about Managed Care Organizations, MCO. Hint, it’s not saving any money, it’s actually costing the state more.


  8. - Almost retired - Wednesday, Sep 11, 19 @ 2:30 pm:

    Here are the rankings for 2018 of the Illinois Medicaid MCOs or Health Plans for those on Medicaid. Look at IliniCare’s
    https://www.illinois.gov/hfs/healthchoice/reportcard/Pages/statewide_sc.aspx


  9. - revvedup - Wednesday, Sep 11, 19 @ 3:29 pm:

    As an adult victim of repeated Medicaid blunders, the thought of these kids being the newest pawns of the State depresses me. I was MCO’d for a month (literally before getting Medicare for being disabled), and found few doctors willing to even deal with Medicaid or IlliniCare in my part of Cook County(!). My primary care doctor said it’s not worth the headaches and low reimbursement rates. Same issue for kid’s care, yet the State pretends they’ve got it all figured out….


  10. - zatoichi - Wednesday, Sep 11, 19 @ 4:23 pm:

    When the original five MCOs came to our area they required five similar but slightly different operations which mean hiring more staff to track all the billing variations. Local hospitals and physician groups only signed with selected groups which meant traveling out of the area to find a willing provider or getting the person to change to a different MCO that had local agreements if they could. Talk to mental health centers on how well the process has worked. MCOs get paid a piece of the available budget dollars which means fewer dollars for providers. MCOs may save the State money by denials, but providers get hit with fewer dollars for already low rates.


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