- Associated Press - Thursday, April 26, 2018

SPRINGFIELD, Ill. (AP) - Health care advocates are urging Illinois legislators to reverse some of the policies enacted as part of a massive shift of Medicaid clients into managed care.

The letter, obtained by The Associated Press, was dated Monday and addressed to key lawmakers who have their own questions about the state’s transfer of 800,000 people to the HealthChoice Illinois system of managed care organizations. MCOs coordinate health care and a focus on prevention, aiming to cut medical costs.

The groups, including the Illinois chapter of the American Academy of Pediatrics and the Illinois Collaboration on Youth , question the Department of Healthcare and Family Services’ ability to oversee the program.

The letter bemoans a dearth of details and updates on the rollout. It questions the ability of MCOs to link up clients with physicians, especially specialists, in rural areas of the state and says reimbursement-rate reductions will hurt medical suppliers.

“Given the risks to patients, as well as our overall health care system, we call upon you … to impose new transparency and accountability guidelines on HealthChoice Illinois,” the letter states. “Absent a significant improvement in HFS’s efforts, we believe that the General Assembly must act to hold MCOs accountable to guarantee our state’s most vulnerable citizens receive the quality care they deserve.”



A January review by Auditor General Frank Mautino found that HFS, which oversees the $60 billion, four-year MCO contract, could not properly account for $7 billion it paid for the state’s Medicaid program in 2016. HFS will “continually work with legislators and other stakeholders to strengthen the program,” spokesman John Hoffman said in a prepared statement.

Specifically, the letter questions the plan for covering children known as “medically fragile, technologically dependent,” whose medical needs are so complex and expensive that advocates don’t believe MCOs are able to adequately cover their needs. It complains of “narrow provider networks” that will “force beneficiaries to travel long distances for routine care” and lambastes “cuts to already low reimbursement rates for medically necessary supplies and equipment.”

One MCO announced before the program expanded that it was cutting reimbursement by 50 percent for durable medical equipment.

“We’re not talking about a walker or an adult diaper,” said Rep. Greg Harris, a Chicago Democrat and influential health care voice in the General Assembly. “What you’re talking about for durable medical equipment are parts for ventilators or feeding tubes.”

Harris is part of a group studying the MCO operation, the biggest part of which - 550,000 participants in 72 counties - took effect April 1. Members of the group are studying more than a dozen issues, said Rep. Patricia Bellock, a Hinsdale Republican.

Pending legislation is already taking aim at some of them. Bellock is a co-sponsor on a measure by Hoffman Estates Democratic Rep. Fred Crespo to keep the medically fragile population on traditional fee-for-service plans instead of moving them into the MCO setup later this year.

And Sen. David Koehler, a Peoria Democrat, responded immediately after IlliniCare announced last fall it would cut equipment reimbursement rates by 50 percent. His legislation would require reimbursement at the existing state-regulated rates for the Medicaid fee-for-service program.

“It’s almost like predatory pricing,” Koehler said of the rate-cut. “When they drop the price so low, it’s kind of a take-it-or-leave-it thing, what it does to our small-town businesses, it puts them out of business.”

The letter, also signed by leaders of The Arc of Illinois , Breastfeed Chicago , Great Lakes Home Medical Services Association , the Illinois Academy of Family Physicians , Family Voices and MFTD Waiver Families , specifically signaled support for those bills and requested “a seat at the table” as discussions continue.

Andrea Durbin, CEO of the Illinois Collaboration on Youth, which represents young people under the care of the Department of Children and Family Services, more generally bemoaned that “there’s not enough information and almost no substantial planning.”

“All of these children have trauma,” Durbin said. “They have specialized needs, and who is caring for them? Who is reporting to courts on their progress? Who is making sure there’s coordinated care between children and perhaps the biological family?”

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Contact Political Writer John O’Connor at https://twitter.com/apoconnor . His work can be found at https://apnews.com/search/john%20o’connor

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