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* GOP Rep. Patti Bellock and Sen. Dale Righter held a press conference yesterday to claim that Medicaid reform has turned into “un-reform.” From a press release…
Bellock and Righter said they feel an added sense of urgency because of recent meetings in which majority Democrats in the Senate and House of Representatives have been pushing for further unraveling of the agreed-to reforms.
“What we have seen since passage of the 2011 and 2012 laws is the ‘un-reform’ of the Medicaid system,” said Righter. “Where the reforms have been implemented, the state has experienced significant savings. However, these carefully negotiated reforms have consistently fallen short of projections and mandated goals because the Quinn administration and Democrat lawmakers refuse to implement the reforms as mandated in law and have quietly worked behind the scenes to undermine and disassemble the bipartisan reforms we enacted.”
In 2011, only 7% of Medicaid enrollees were in a managed care program, leaving the majority of Medicaid enrollees without a medical “home,” with many relying on more costly emergency room care. In response, the 2011 Medicaid reforms mandated that within four years, managed care enrollment was statutorily required to reach 50%. Well over three years later, and quickly approaching the end-of-year deadline, the number in managed care stands at an abysmal 16%.
The lawmakers stress this lagging enactment is indicative of the program’s overall implementation. Many provisions in the SMART Act have been ignored and program expansions have continued. Provisions limiting the number of prescriptions have not been enforced, and the third-party vendor hired to scrub the Medicaid rolls was relieved of its duties—despite saving the state more than $86 million after only reviewing 25% of total Medicaid cases.
* SJ-R…
Illinois Department of Healthcare and Family Services personnel were not available for comment Thursday, but department director Julie Hamos said in a statement that the state is on pace to meet the goals set out in the SMART Act.
“Since the implementation of that plan two years ago, we reduced Medicaid spending by $3.2 billion, and are now managing within that budget,” Hamos said.
She said the Act was passed with strong bipartisan support to put the state “on track to catch up with the nation’s other states by implementing coordinated care. As a result, we are on target to achieve the state’s 50 percent mandate by Jan. 1, 2015.”
She said the department’s goal is to provide better health care at a lower cost, “and we are doing that.”
The lag on managed care enrollment is indeed quite curious and deserves a much better response. Soon.
* However, Righter’s claim during the press conference that the effort to root out fraud was a “stunning success” caught my eye.
Bruce Rauner and many other Republicans have claimed that billions of dollars could be saved by kicking ineligible recipients off Medicaid. Yet, the outside contractor only found $86 million in savings? That’s not a “stunning success,” and it can’t even be easily projected out over the other 75 percent when you remember this crucial point by Doug Finke last December…
the ones that were checked first were mostly cases where the state already had suspicions. In other words, easy pickings. Once those are gone, it’s entirely possible the rate of fraud discovered will go down.
And what happens when the rate of fraud discovered goes down as most likely will be the case? Well, critics will contend it’s all Quinn’s fault.
posted by Rich Miller
Friday, May 9, 14 @ 10:36 am
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I get the impression that some people think Medicaid is like welfare, with the government cutting checks to enrollees.
The fraud is at the provider level. They’re the ones that get the money.
Comment by wordslinger Friday, May 9, 14 @ 10:50 am
The fraud issue has always been the “go to” reform. You had some dopes claiming there was billions of dollars in fraud. While any fraud is unacceptable and we certainly should do what we can to end it, the savings that was contended simply isn’t there.
And as an aside, I don’t think we should be limiting prescriptions. I know my grandma took all kinds of medicines. I’m sure there are waivers that are granted but I don’t think we should be telling somebody how many prescriptions they need.
Comment by Demoralized Friday, May 9, 14 @ 10:54 am
“and the third-party vendor hired to scrub the Medicaid rolls was relieved of its duties—despite saving the state more than $86 million after only reviewing 25% of total Medicaid cases.”
The third party contractor was not relieved of it’s duties, it was found by an arbitrator to be in violation of the collective bargaining agreement. Quinn fought to keep the third party contractor (Maximus).
Additionally, this attempt to clear the rolls of ineligible person has resulted in an extremely high number of persons being cancelled in error. Children and other seriously ill Illinois residents have found themselves without medical coverage. I have seen reports that the Maximus error rate is as high as 40%.
Comment by AFSCME Steward Friday, May 9, 14 @ 10:59 am
Righter and Bellock have no evidence, because none exists, that the state budget could be anywhere near balanced by cutting waste and fraud from the Medicaid program. It is a convenient untruth they perpetuate because they refuse to take responsibility for budget cuts, and they will not vote to extend the 5% income tax rate.
Republicans like to accuse the poor of being irresponsible, but no one is more irresponsible than they who continue to peddle that which is demonstrably untrue.
And rather than being a breath of fresh air, Rauner is just a lot of hot air.
Comment by Truthteller Friday, May 9, 14 @ 11:02 am
= The fraud is at the provider level. They’re the ones that get the money. =
That is a very good point.
Why should some poor family go without medical care because a wealthy doctor fraudulently billed Medicaid for services allegedly provided to a dead person?
Absolutely we need to stamp out fraud, however the people who suffer from a refusal to extend Medicaid aren’t the people committing the fraud.
Comment by Bill White Friday, May 9, 14 @ 11:03 am
Almost ANY cut to Medicaid means that real people get hurt (by not receiving or being paid for services, prescriptions, etc. they had previously), and when these people complain/seek help from their legislators, it puts pressure on HFS to do something about it. Trying to balance the long-term good of the “system” against the immediate needs of real people pleading for help (regardless of whether the pleas are genuine or just scare tactics or manipulation) is not an easy task.
Comment by Secret Square Friday, May 9, 14 @ 11:15 am
I would think everyone would agree that Medicaid is and was in very serious need of reform and there exists a huge issue with accountability. Everyone should also agree on the importance of this safety net and what it provides. A Healthy Medicaid system (pardon the pun) would actually save money by eliminating wasteful spending AND providing a more cost effective preventative and ongoing health system that doesn’t rely on ERs which are the single most expensive place to administer healthcare.
The problem I continue to see is the willingness to throw the referees out of the ring every chance they get. Rep. Bellock (and Righter for that matter) are not so fiercely partisan as to not be able to lead an effort to reform this program. My Public Service Union and Democratic friends should be thrilled that they are the two moving this.
It ain’t fixed. Forget about the optics, there’s an effort to undue some of the good that has been done.
Comment by A guy... Friday, May 9, 14 @ 11:24 am
–I would think everyone would agree that Medicaid is and was in very serious need of reform –
What “reform” are you talking about?
Comment by wordslinger Friday, May 9, 14 @ 11:27 am
A Guy
“The problem I continue to see is the willingness to throw the referees out of the ring every chance they get”
And who might those referees be ?
Comment by AFSCME Steward Friday, May 9, 14 @ 11:42 am
There is also the issue of optional services vs. those required by the federal government under their regulations.
While it is not fraud to provide optional services it certainly makes the program much more expensive. Illinois has many additional services have been added over the years and these costs are up to 40% of the total budget. Some are quite realistic (like drugs) others may be more generous than what is required by law or what the state can afford.
In any case this issue is never examined or mentioned. It is not fraud by providers or recipients but it is costly. Although in any program this large there is undoubtedly fraud.
The FY13 budget went $2.3 billion over budget for Medicaid and that could very well be carried over to FY 14.
The Illinois Department of Healthcare and Family Services (HFS), the State’s main Medicaid agency, estimates that Illinois will have 513,000 new Medicaid recipients by 2017 as a result of the ACA. Of that total, an estimated 342,000 will be newly eligible under the ACA and 171,000 will be individuals who were previously eligible but had not enrolled in the program.
And remember the number of those in Medicaid has already risen from 1.4 Million in the year 2000 to 2.7 million today.
Again, there is a lot of rhetoric by both left and right on this issue but not much serious analysis and discussion.
Comment by Federalist Friday, May 9, 14 @ 11:46 am
C,mon Slinger, it’s among the most important and most expensive things a state is responsible for. It needs reform (and has been getting it) on cost containment, eligibility, prescription usage, administration of where care occurs, who provides, etc. We have a responsibility to maintain a strong Medicaid system, and a great responsibility to try and get fewer and fewer people to rely on it. There are a lot of solutions that become intertwined with Education and Business policy. It isn’t a safety net anymore if so many people fall into it that it breaks. Any and every social program paid for by the government should be under a perpetual cycle of reform to keep improving service, lowering cost and pushing more people toward a better life. How can we disagree on that?
Comment by A guy... Friday, May 9, 14 @ 11:46 am
The oher real issue with Medicaid reform was staffing. The state employee head count had been in rapid decline for quite a number of years. Consequently, there simply was no staff available to process medical redeterminations. They were literally piled up for months without being addressed. The Maximus contract was more costly than hiring sufficient staff. All the Maximus contract provided was some upgraded technology additional private employees, many of whom proved to be unreliable. The state could have contracted for additional technology and hired additional staff for less money than what they paid Maximus.
Comment by AFSCME Steward Friday, May 9, 14 @ 11:48 am
My daughter and I were on Medicaid for a couple of years and I could NOT wait to get off of it… it was really, really hard to find doctors willing to accept Medicaid patients (due to the long delays in payment and other hassles). Could that be part of the reason why Medicaid patients allegedly rely too much upon emergency room treatment — they have a hard time finding doctors? Do federally qualified health centers and low-cost/low income clinics fill the gap adequately?
Comment by Secret Square Friday, May 9, 14 @ 11:49 am
It is popular to attack Medicaid because of the misperception that it largely benefits “welfare queens.”
Let’s just call it like it is.
According to the Kaiser Family Foundation, 78 percent of Medicaid recipients are white in Illinois.
I do not know why legislators or Medicaid advocates have been so reluctant to discuss race openly when Republicans are clearly blowing the dog whistle here.
If you are defending, you are losing guys. If you aren’t sure how to knock The critics back on their heels, ask for help.
Comment by Yellow Dog Democrat Friday, May 9, 14 @ 11:54 am
===the Quinn administration and Democrat lawmakers refuse===
I don’t A guy, that sounds pretty partisan to me. Or maybe Righter failed high school english, you know, not understanding how to use nouns and adjectives.
You can’t say Righter’s not “fiercely partisan” when he insults my party in a press release.
Comment by 47th Ward Friday, May 9, 14 @ 11:55 am
47th, I think you’ll recover from Sen. Righter’s press release.
Comment by A guy... Friday, May 9, 14 @ 12:07 pm
I’m used to it. Just don’t pretend he’s not a partisan hack when there is evidence to the contrary right in front of you.
Comment by 47th Ward Friday, May 9, 14 @ 12:10 pm
Righter is no Coulson.
Comment by Yellow Dog Democrat Friday, May 9, 14 @ 12:40 pm
@A guy:
I don’t think pushing people off Medicaid is pushing them towards a better life.
Comment by Demoralized Friday, May 9, 14 @ 12:59 pm
==eliminating wasteful spending ==
Can we please stop using that “line” without providing some back-up as to what the “wasteful” spending is?
Comment by Demoralized Friday, May 9, 14 @ 1:01 pm
Yellow Dog’s Comment: “According to the Kaiser Family Foundation, 78 percent of Medicaid recipients are white in Illinois.
I do not know why legislators or Medicaid advocates have been so reluctant to discuss race openly when Republicans are clearly blowing the dog whistle here.”
reminded me of an interview with Douglas Blackmon, the author of Slavery by a Different Name. Blackmon said that large majorities of Americans supported the safety net of food stamps, welfare, Medicaid, etc. until the 60s when African Americans began to use these government services. It was then the whole “Welfare Queen” talk started and the public began to view the safety net in such a negative manner. I’m not sure if this is completely true but it is an interesting theory. The corollary to that theory would be, I guess, showing that 78% of the Medicaid recipients are white.
Comment by paddyrollingstone Friday, May 9, 14 @ 1:02 pm
@AFSCME Steward
“… Yet, the outside contractor only found $86 million in savings?…”
Especially, when the contractor cost $70 million. Gotta love pay back.
Comment by Rufus Friday, May 9, 14 @ 1:07 pm
Biggest cost share of Medicaid is for persons who are in nursing homes. Last data I saw was that this small population represented 2/3 of the cost of Medicaid. I also agree with AFSCME steward, Maximus has resulted in cases being cancelled, but many are still eligible and wind up getting back on Medicaid.
Also the state is enrolling people in Managed care programs on a fairly quick basis. They had to get contracts signed and reviewed and plans selected…Managed care does not happen with “I told you to do it, so it should be done yesterday” approach. Persons who I talk to that are on medicaid are happy with their new option…they know the doctor they see accepts Medicaid (so they don’t have to search for providers) and they have expanded resources through the Managed care provider which focus on wellness and reducing ER visits.
Comment by illinifan Friday, May 9, 14 @ 1:15 pm
==== Demoralized - Friday, May 9, 14 @ 12:59 pm:
@A guy:
I don’t think pushing people off Medicaid is pushing them towards a better life.====
Demo, it is if we push them towards a decent job with decent benefits.
Comment by A guy... Friday, May 9, 14 @ 1:24 pm
==it is if we push them towards a decent job with decent benefits.==
So long as they have a decent job with decent benefits before we push them.
Comment by Demoralized Friday, May 9, 14 @ 1:27 pm
=== illinifan - Friday, May 9, 14 @ 1:15 pm:
Biggest cost share of Medicaid is for persons who are in nursing homes. Last data I saw was that this small population represented 2/3 of the cost of Medicaid.====
I know this to be true I Fan. This population was in big part who this whole system was designed to protect.
Comment by A guy... Friday, May 9, 14 @ 1:28 pm
“So long as they have a decent job with decent benefits” Yeah! Lower the minimum wage so that Walmart will hire more part-time workers who will then be eligible for … umm .. and … hmmm … oh well, nevermind.
And of course that also assumes that the person on Medicaid is physically capable of going to work at a job that offers decent benfist.
Comment by Skeptic Friday, May 9, 14 @ 1:39 pm
Keeping people out of nursing homes is a key component for holding down Medicaid costs.
Adequate funding for programs such as Meals on Wheels would be very helpful, here.
Lower costs for taxpayers and better quality of life for the senior citizens makes it a “Win-Win”
Comment by Bill White Friday, May 9, 14 @ 1:48 pm
==it is if we push them towards a decent job with decent benefits.==
If 2/3rds of the cost of Medicaid is spent on nursing homes, how many of those receiving benefits can be expected to hold down a job?
Comment by Bill White Friday, May 9, 14 @ 1:50 pm
So the Republicans think Julie Hamos isn’t cutting enough, and the Black Caucus thinks she is cutting too much. That probably means she is cutting just about right.
Comment by Just Me Friday, May 9, 14 @ 1:53 pm
Here is a useful link to help frame the issues faced by the IL Medicaid system
https://www2.illinois.gov/hfs/agency/Documents/Medicaid101.pdf
Comment by Bill White Friday, May 9, 14 @ 2:01 pm
@Yellowdog,
Please provide the site in which the figure for those on Medicaid was 78% White. Would appreciate it.
According to the data I found the figures from the Kaiser Foundation were 43% white, 22% Black, and 29% Hispanic for Illinois as of 2010. However, this figure included only the non-elderly.
Additional Comments:
The state spent $16,239 per person for those age 65+. This according to an FOI release from HFS. Most recent data I have. Probably due to nursing homes but I can not confirm any further breakdown. (Wonder if they spend that much per person for state retirees age 65+ even if they are not Medicare eligible. would be interesting to know)
According to State Audit conducted by William Holland in 2010 the state had enrolled over 54,000 ‘undocumented immigrants’ in the ALLKids program that is part of Medicaid. That was 74% of the enrollment. This figure would probably be higher if the children who were born in the U.S. but whose parents are here illegally were counted as ‘undocumented’
Lot to think about. And again, see how much of the data I presented makes its way from Springfield or the MSM.
Comment by Federalist Friday, May 9, 14 @ 2:13 pm
I didn’t work on this, but I’m under the impression that a good number of the people who were found to be ineligible were within the eligibility limits for Obamacare. So the State made the (to me) reasonable decision not to kick them off for a few months and then go through the whole (expensive) rigamarole of re-enrolling. Does anybody know if this is accurate?
Comment by Soccermom Friday, May 9, 14 @ 3:16 pm
My own daughter who is an adult with mental illness is on the Medicaid program. I respect the right of the state to examine her financial records, but I don’t respect the state for losing documentation. My daughter was given the re-enrollment form and was required to submit to the State proves of her total net worth and all documentation related to her special needs trust fund with is legally exempt for the asset limitations. The state lost all of these records which were mailed to them and also sent to them as attached files.
We had no idea that this had happened and then we got a letter telling her that all of her Medicaid benefits had ended because she was non-compliant with the financial audit requirements. We then had to meet with a case worker and hand over the documents for a third time to her to have benefits restored, it should be noted that when the state notified my daughter of the reenrollment requirement the letter required her to submit the documentation by mail and or email as attached files.
The case worker said because of the volume it was possible the documentation was not able to be processed as having been received prior to the cutoff date for submission. By the way it was sent to the state two weeks prior to the cutoff date. I asked why the state would cut people off Medicaid if they knew there was a backload of unprocessed financial forms. The case worker could not answer that question. Believe me people are getting cut off Medicaid and the review process is on-going.
My daughter is now in the managed care program and believe it or not that went seamlessly. She is in the Together 4 Health program and they have been extremely responsive in making sure she gets all her psychiatric services. Julie Hamos deserves some credit here.
If the enrollment process was speeded up, that to would be totally messed up like the Medicaid audit process is due to the volume of audits. I would love for Bruce Rauner to sit and wait and wait to talk to a case worker to have his health insurance restored because the state lost the records or can’t process them.
Comment by Rod Friday, May 9, 14 @ 3:33 pm
And Federalist, you’re cherry-picking. Holland’s audit also found that “due to HFS incorrectly categorizing some documented immigrants as undocumented immigrants, the number of undocumented immigrants, as well as the costs associated with them are overstated in data provided by HFS.” The Auditor’s very, very small sample found that 20% of those listed as undocumented were in fact here legally.
According to HFS officials, to ensure that federal matching funds were not requested for documented immigrants who were ineligible for matching funds (i.e., those documented immigrants who had not been in this country for five years), those documented immigrants were classified as undocumented immigrants.
So it’s unclear how many of the kids receiving services through AllKids are actually undocumented. And let’s add — the net cost for AllKids in 2012 was $46 million. That’s real money, to be sure, but not the main cost driver of a $10.5 billion program (in 2012, to provide apples-to-apples.)
Comment by Soccermom Friday, May 9, 14 @ 3:33 pm
Soccermom,
Thanks for pointing this out to me. I reread the report and you are indeed correct, although it was based upon a very small sample of 48 cases. Thus, who knows the real scope for better or worse.
And any amount (interesting that you would think $46 million is not much money) be too much when state retirees with decades of service were attacked in the media and by the state itself.
Comment by Federalist Friday, May 9, 14 @ 5:24 pm