 House Bill 5420 calls for moving half of the state's 2.8 million
Medicaid participants into "coordinated" or managed care during the
next four years -- a far stretch from the 195,000 participants who
now are assigned to a primary "medical home.""That is a very
aggressive goal, it's a bold goal, but we believe that by really
looking at the holistic needs of our Medicaid clients we will, in
fact, succeed in keeping them healthier," said Julie Hamos, director
of the Illinois Department of Healthcare and Family Services.
Lawmakers were assigned the task of tightening the $14 billion
state-federal health care system in December and were still hashing
out the details Wednesday morning.
"This is probably not a bill that any one of us on this committee
would write. But that's the nature of compromise," said state Sen.
Heather Steans, D-Chicago. "I think where we are and what we're
going to see, though, is something that really does put the state
and our Medicaid system in a much better place down the line."
All states are looking at Medicaid reforms in anticipation of the
ramp-up of the federal health care law in 2014, when low-income
single adults will be eligible to enroll. State Sen. Dale Righter,
R-Charleston, said the proposal will return the "struggling" program
to a safety net for the poor, instead of a catch-all for the
potentially ineligible.
"It's struggling for the people who need it the worst," he said.
"We're talking about the people who are on the lowest rungs of the
economic ladder, the people for whom access is a truly critical
issue. The people who aren't mobile. People who can't drive two
hours and take a day off because it's not a big deal to make sure
that their child can get to a medical provider."
However, the legislation makes an attempt to crack down on fraud
by setting up administrative hearings that can collect and fine
individuals who have been scamming the system, and even refer the
cases to local prosecutors. But the Senate's chief budget expert
questioned how effective that would be.
"I can see how you recover from if they're pharmacists or doctors
that are scamming the system," said state Sen. Donne Trotter,
D-Chicago. "How do you recover from people like the guy that you
said is getting payments out of his check and his brother's check,
assuming he doesn't have any money? How do you recover that?"
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The measure also tightens eligibility by requiring individuals to
provide proof of Illinois residency and a month's worth of income,
and to periodically reapply to the program.
It clamps down on the expanded All Kids program, the state's
health insurance for children of parents who earn too much to
qualify for Medicaid. Parents pay health insurance premiums based on
their income, which will be limited to 300 percent of the federal
poverty level -- or $66,150 for a family of four.
The current 3,000 participants will be given a grace period of
one year to find new insurance, although state Sen. Dave Koehler,
D-Peoria, wondered if exemptions should be made for rural residents
lacking close medical care.
"Will the emergency room again become the point of contact for
the health care system?" Koehler asked. "Because that's going
backwards, if that happens."
The legislation also creates a "global budget" for long-term care
by allowing up to 4 percent of budget line items for nursing home
care for the elderly, developmentally disabled and the mentally ill
to go toward shifting those patients into community-based settings,
at an annual savings of $100 million.
Changes to the prescription drug program include possible copays
at federally accepted levels, 90-day prescriptions for medication
for chronic conditions and prior approval for some drugs. Interest
on late payments to pharmacists will be cut in half.
Using future appropriations to pay current bills to providers of
care will also be phased out during the next 10 years, in an attempt
at fiscal responsibility.
The measure now heads to the House, where a vote is expected on
Thursday.
[Illinois
Statehouse News; By MARY MASSINGALE]
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