 However, one
key element may raise hackles among the state's
long-term care providers.House lawmakers returned to Springfield
on Monday for the Legislature's lame-duck session before
inauguration of the new General Assembly on Jan. 12. Reforms to the
state's Medicaid and workers' compensation systems are on the docket
for this week, with education waiting in the wings.
As a member of the House Medicaid Reform Committee and a House
budget expert, state Rep. Frank Mautino, D-Spring Valley, said he
expects to see reform legislation surface either Tuesday or
Wednesday.
However, he wouldn't put a number on the potential savings, nor
would his Medicaid Reform Committee Senate colleague, Sen. Heather
Steans, D-Chicago.
"We're still working out what that's likely to look like," Steans
said, although she indicated the reform legislation would start in
the Senate.
Nearly 2.8 million Illinois residents are enrolled in the
state-federal health care program for the poor and disabled, at an
annual cost of $14 billion. About 195,000 participants are in
managed care -- where patients are assigned a medical home -- with
an additional 40,000 elderly and disabled patients set to enroll in
a pilot project in March.
Expanding managed care has been one of the goals of Medicaid
reform proponents, but Mautino said that element of the proposal is
on shaky ground.
"It's where all the money is at in this bill, and that's why it's
the most controversial," Mautino said.
Steans said the challenge is finding the best medical
infrastructure throughout the state.
"We're setting the framework so that we're moving people into
coordinated care but giving the department the ability to be
flexible in working with the stakeholder groups about what models
are going to work in different regions and for different
populations," she said.
However, the proposed legislation will most likely ruffle
feathers among providers of long-term care for the elderly,
developmentally disabled and mentally ill, Mautino said.
"There's a provision in here for long-term care, where we're
going to take the pieces of the budget out of all of these other
different agencies it's located in -- make one global budget, which
would be for the long-term care side," he said. "And then up to 4
percent of that total budget would then have to be spent on
community services where the money follows the patient."
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The philosophy of "money following the person" is popular at both
the state and federal levels since it generally is less expensive
than institutional care. And the U.S. Supreme Court's 1999 Olmstead
decision calls for the disabled to live in the least restrictive
environment possible.
"It's something we haven't done, but the courts have told us we
need to do," Mautino said. "So at this time, though it's
controversial, I would expect to see that in this bill."
However, pharmacists apparently are escaping deep cuts in the
proposed legislation in exchange for cutting the interest charged on
late state payments. Lawmakers were shocked to learn the state pays
more than double in Medicaid prescription dispensing fees when
compared with fees paid for the state employees' health care plan.
"I believe their dispensing fees are going to stay the same, but
their amount that they can receive on late payment fees, they've
agreed to cut in half," Mautino said.
The proposed legislation also calls for Medicaid recipients to
periodically prove continued eligibility instead of the state
assuming they are still eligible; provide a statement of monthly
income for eligibility instead of a single pay stub; and cross-check
eligibility among databases from the Illinois departments of
Healthcare and Family Services, Human Services, and Employment
Security.
Senate lawmakers return to the Capitol on Tuesday.
[Illinois
Statehouse News; By MARY MASSINGALE]
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