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 The funding comes from quality payments to its
Medicaid Managed Care Organizations (MCOs): Blue Cross and Blue
Shield of Illinois, CountyCare, Aetna Better Health, Meridian, and
Molina.
The money for these investments was substituted from the quality
payments the department otherwise would have made to the health
plans on a pay for performance basis. Each year the department
withholds a portion of total money due to the five Medicaid health
plans to allocate based on performance.
This year, due to the COVID-19 pandemic, HFS determined that its
quality metrics would be affected in unprecedented ways because of
changes in utilization associated with the pandemic. Rather than
relying on performance metrics disrupted by the pandemic, HFS asked
the plans to submit proposals for how they would invest the funding
into Illinois communities.
“We knew we had to be nimble with our policymaking to combat the
pandemic, and I thank our Medicaid partners for stepping up to the
plate with their investments in our communities and providers,” said
HFS Director Theresa Eagleson. “Supporting our customers, healthcare
providers, and community partners—especially those in
disproportionately affected areas—is critical to our state’s ability
to deal with this pandemic.”
Next year, the department plans to return to a pay for performance
allocation of the annual withholding. Performance metrics will
center on five pillars measured through an equity lens: Adult
behavioral health, children’s behavioral health, maternal and child
health, improving opportunities for people to be treated in their
communities, and improving health equities around breast cancer,
cervical cancer screenings, high blood pressure, and access to
primary care. Each pillar has been carefully chosen to better serve
the department’s 3 million Medicaid customers and to ensure the best
possible allocation of the state’s scarce resources.
For this year’s health plan spending proposals, investments were
directed with a lens toward equity and the greatest impact for
organizations and providers that were not already receiving other
support. Of the $56 million in redirected quality payments, $27.6
million, nearly 50 percent of the total, was spent in
disproportionately impacted areas.
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Highlights of the investments include:
To date, health plans made the following investments in critical
services and taken the following steps to help Medicaid members and
providers during this pandemic:
• $13.8M spent to increase reimbursement rates for Illinois
Behavioral Health and Mental Health Providers based off of claims
received thus far. Between March and June of 2020, Medicaid Health
Plans increased reimbursement rates by 20 percent to ensure
providers had adequate resources to continue serving Medicaid
members in need of behavioral health and mental health services.
• $4.6M invested to expand telehealth capabilities and
infrastructure. This investment in telehealth services will benefit
the Medicaid well – beyond Covid-19 and supports all Illinois
residents.
• $4M spent with vendors and community-based organizations owned by
minorities, women and people with disabilities to increase community
engagement in African American and Latinx communities which were the
hardest hit by the pandemic.
• Partnered with community organizations to provide food and other
PPE supplies to communities most impacted by Covid-19 including over
$750K invested in PPE, cleaning and disinfectant supplies for
members. Health plans also hosted drive-through food events and
provided home meal delivery service, while one health plan offered
low-income families laundry service during the crisis.
• Provided technology assistance for families to ensure members
could meet their schooling and health-related needs.
• Over $2.7M invested in housing support to extend housing benefits
for Medicaid members to ensure that members in the maintain their
current services and allow members to remain in the community where
they feel most comfortable. Recent expenditures by plans have
increased housing support investments to over $6 million that will
be captured in future reports.
• Over $800K in pay for performance grants to fund school-based
health centers, parenting and vaccine programs. The funding will be
used to develop a health food and lifestyle program targeted for
members with chronic illnesses and a program to incentivize members
to complete mammograms and other important screenings. The parenting
program will ensure underserved mothers and babies are given more
reliable care to reduce maternal mortality.
View more details about the investments from each plan.
[Illinois Office of Communication and
Information] |
