Illinois pushes ahead with Medicaid managed care

Facing a Jan. 1 deadline, Illinois’ top Medicaid official has announced a timetable for moving hundreds of thousands of low-income patients into managed-care health plans.

Julie Hamos, director of the Department of Healthcare and Family Services, said 1.7 million people will receive information in the mail by the end of the year outlining their health plan choices and giving an enrollment phone number.

The change affects Medicaid patients in about 30 counties in central and southwestern Illinois and in regions including Chicago, Rockford, Rock Island and Moline. Those who don’t choose a plan will be assigned to one. Patients can switch during the first 90 days.

Illinois has lagged behind other states in adopting managed care, which pays insurers and health networks fixed perpatient fees instead of paying separately for every appointment, surgery and test. The goal is to reduce wasteful spending (See related story, p. 20).

A 2011 state law required expanding managed care to half the state’s Medicaid patients by 2015. The Illinois Medicaid program now covers 3 million people with a budget of about $18 billion.

Managed-care plans are operated by private companies such as Aetna and hospital systems such as Advocate Health Care, based in Downers Grove, Ill. They’ll benefit financially if they keep people healthy.

“We believe we still have a lot of work to do, alongside the state, to educate Medicaid enrollees about what it all means to them,” said Samantha Olds of the Illinois Association of Medicaid Health Plans, which represents nine health insurers with state Medicaid contracts.