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The perils of Medicaid managed care

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Illinois

* AP…

Health care advocates are urging Illinois legislators to reverse some of the policies enacted as part of a massive shift of Medicaid clients into managed care.

The letter, obtained by The Associated Press, was dated Monday and addressed to key lawmakers who have their own questions about the state’s transfer of 800,000 people to the HealthChoice Illinois system of managed care organizations. MCOs coordinate health care and a focus on prevention, aiming to cut medical costs.

* From the letter…

HealthChoice Illinois is the State’s largest public procurement, and it aims to place up to 80% of Illinois’s Medicaid population in managed care. Though HealthChoice Illinois is in its infancy, we already have concerns that HFS is abdicating its role as regulator. Indeed, a recent Illinois Auditor General report demonstrated that HFS lacks the data it needs to oversee the managed care program.

Media reports, House Appropriations-Human Services Committee hearings, and the Illinois Auditor General have already exposed numerous critical issues with HealthChoice Illinois. For example:

● The Department of Children and Family Services does not have an adequate plan for coverage for children who are Medically Fragile;

● Narrow provider networks will force beneficiaries to travel long distances for routine care;

● Cuts to already low reimbursement rates for medically-necessary supplies and equipment such as diabetes equipment, breast pumps, nutrition supplies, and oxygen equipment will hurt patient access and choice, as well as potentially diminish the quality of the medical supplies themselves;

● Poorly-written contracts between MCOs and nursing homes may violate state and federal regulations; and

● Deficiencies in HFS’s data collection processes impede the Department’s ability to oversee the managed care program.

Given the risks to patients, as well as our overall healthcare system, we call upon you, as leaders who understand the needs of the chronically ill and disabled, to impose new transparency and accountability guidelines on HealthChoice Illinois. Absent a significant improvement in HFS’s efforts, we believe that the General Assembly must act to hold MCOs accountable to guarantee our state’s most vulnerable citizens receive the quality care they deserve. We specifically request that any new MCO regulations take into account the reforms currently being considered by the General Assembly, including HB 4736, which would remove children who are Medically-Fragile from HealthChoice Illinois, and SB 2262, which would require MCOs to use the state fee schedule for medical supplies and equipment.

* Back to the AP…

Andrea Durbin, CEO of the Illinois Collaboration on Youth, which represents young people under the care of the Department of Children and Family Services, more generally bemoaned that “there’s not enough information and almost no substantial planning.”

“All of these children have trauma,” Durbin said. “They have specialized needs, and who is caring for them? Who is reporting to courts on their progress? Who is making sure there’s coordinated care between children and perhaps the biological family?”

posted by Rich Miller
Friday, Apr 27, 18 @ 11:37 am

Comments

See question of the day.

Comment by Not a Billionaire Friday, Apr 27, 18 @ 11:40 am
When the incentive is to achieve lower immediate cost, you end up with less / poorer care.

If the incentive is to achieve better health outcome / possibly lower long term (+10 years) costs, then it might work.

But you still have the problem of educating the population that health care is not going to the emergency room but a combination of regular preventative check-ups at a doctor’s office and lifestule choices.

Comment by RNUG Friday, Apr 27, 18 @ 11:48 am
Iowa’s in the midst of this “experiment” with people’s lives. Maybe we should learn from their mistakes. http://wqad.com/2018/04/03/agency-report-iowa-medicaid-complaints-doubled-in-2017/

Comment by Anon221 Friday, Apr 27, 18 @ 11:49 am
Don’t forget that the State pays the HMO a monthly premium for each active client every month, regardless whether they are living or deceased. The state has a terrible track record about being able to detect and cancel deceased clients.

Medicaid, on the other hand, only pays for actual doctor visits.

Comment by Me Again Friday, Apr 27, 18 @ 11:56 am
–When the incentive is to achieve lower immediate cost, you end up with less / poorer care.–

Yet the $63 billion contract for managed care came in at 50% over estimate.

Some great work there by BTIA(TM).

https://capitolfax.com/2017/11/27/medicaid-managed-care-contract-cost-skyrockets-more-than-50-percent/

Comment by wordslinger Friday, Apr 27, 18 @ 11:59 am
An actual case
a deaf mother who not on Medicaid, has two children on Medicaid that was assigned to an MCO, the primary doctor is not doing MCO, so they have to change doctor, finds a doctor, but then cant communicate with MCO, as there website does not allow a change involving children on line, and MCO don’t know if that will ever be fixed, and there published (on letters and website) TTY numbers do not work. So she had to dial 711 and use a TTY (which she does not have one and does not use one) to call MCO main number, and that MCO staff does not know how and still does know how 711 works, so how many other MCO customers have no or limited access to the MCO

Comment by 13TH Friday, Apr 27, 18 @ 1:22 pm
>Representative Greg Harris has scheduled a hearing to address the numerous complaints regarding Medicaid rejections and now SNAP benefit denials.

Not only are the savings and quality of managed care doubtful, Rauner has not demonstrated the ability to successfully execute a program like this.

Comment by Earnest Friday, Apr 27, 18 @ 1:42 pm
I’m glad Harris is looking into this. Their $300 million new system is filled with errors that can completely mess up cases, both SNAP and Medicaid. There are days when the system itself is inoperable. Modernization is a great goal, but when people can’t get medication for their children or can’t get funds on their LINK cards because of this shiny new operating system, that’s a problem.

Comment by Fixer Friday, Apr 27, 18 @ 2:50 pm
It’s interesting the letter attributes MFTD problems to DCFS and not HFS. To my knowledge the program is a Medicaid HCBS waiver, and so DCFS is not directly involved. Some of the kids in the waiver could be adopted and have DCFS involvement that way, but I just don’t get what they are talking about. DCFS does have fragile children (wards/youth in care) but they don’t get services through the waiver, again to my knowledge.

Comment by Perrid Friday, Apr 27, 18 @ 3:18 pm