Illi­nois pushes ahead with Med­i­caid man­aged care

Modern Healthcare - - REGIONAL NEWS -

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.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.