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When a patient with suicidal thoughts sought care in an Illinois emergency department (ED), the hospital’s medical staff admitted the patient based on nationally recognized clinical guidelines. Yet, the patient’s Medicaid managed care organization (MCO) would only cover one of the patient’s five days in the hospital, despite the patient remaining suicidal two days after admission.

Prior authorization denials and delays are one of the top challenges to providing healthcare to Medicaid patients, whose access to needed care is unnecessarily bogged down by burdensome MCO administrative processes.

The Illinois Health and Hospital Association (IHA) urges lawmakers to support MCO prior authorization reforms, including permitting ED physicians to admit a patient in need of inpatient care without seeking MCO authorization, providing inpatient coverage for up to 72 hours.

Legislative reforms also address the time clinicians must put toward appeals, the majority of which are later overturned, pulling them away from patient care. IHA’s reforms would exempt physicians and hospitals with historically high prior authorization approvals from the prior authorization process for one year, like several states have adopted.

Vote YES on legislation that fixes harmful prior authorization practices and eliminates barriers to healthcare for Illinois’ most vulnerable populations. Support IHA’s MCO prior authorization reforms.