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Disruptions Mount As Illinois Shifts Medicaid Patients To Managed Care

Officials at the Illinois Department of Healthcare and Family Services say they have tried to avoid disruptions of care as the state shifts 2.2 million of its 3.1 million Medicaid patients to managed care, a system in which the state pays a fixed amount for each patient instead of reimbursing providers for each test and treatment.

But some patients are reporting difficulties keeping their doctors and confusion navigating plans as they try to make the shift.The reports include wrong information on websites for insurance plans and hospitals; hours on the phone with insurers, hospitals and a state contractor who helps with enrollment; conflicting letters in the mail; changes to prescriptions, and other frustrations.

Some doctors say the state is reassigning their patients to new offices and has created new administrative requirements that burden their practices, delay care for patients and slow payments from insurers.

“I hope this works out and is better for patients and more efficient for the state, but right now it’s been extremely challenging for all parties,” said Dr. Donald Luyre, a vice president of the Illinois Academy of Family Physicians and CEO of Elmhurst Clinic.

The 2011 law required 50 percent of the state’s Medicaid population to be enrolled in managed care by Jan. 1 of this year. Illinois had enrolled about 1.6 million as of Feb. 1, said Department of Healthcare and Family Services spokesman John Hoffman. Parker has said the department plans to enroll 600,000 more this spring.


Officials have said the change will improve patient care and stabilize spending in a budget that is projected to grow to about $20 billion for fiscal year 2015. Managed care’s per-patient payments encourage providers to try to keep people healthy, which in turn should reduce costly emergency room visits and inpatient hospital stays, proponents of the system say.

Read about this in a copyrighted story by Wes Ventelcher of the Chicago Tribune date February 10, 2015 reprinted at http://kaiserhealthnews.org/news/disruptions-mount-as-illinois-shifts-medicaid-patients-to-managed-care/


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