Progress Illinois

Spend less. Save more. And make people healthier. That was how State Sen. Donne Trotter (D-Chicago), at a gathering of health care practitioners today at Mercy Hospital in Chicago, described the goals of the Medicaid reform package Gov. Quinn signed into law in late January after the bill sailed through the General Assembly.

The legislation seeks major savings to the joint federal-state health care program by deploying more information technology, placing tighter restrictions on pharmacy payments, and seeking to move more people from institutions to home and community-based settings, State Sen. Heather Steans (D-Chicago) said at the event this morning. The bill also raises eligibility requirements for the state's All Kids health care program, resulting in loss of health care for an estimated 3,100 children, and wants to get 50 percent of those using Medicaid in Illinois into managed care, or "care coordination" programs, as Steans put it, by 2015, while incentivizing preventative health care. The trick is the managed care aspect of the law. "The intent is to do it well, carefully, and not have some of the problems we've had historically in Illinois," Steans said later about managed care.

Those problems have been legion in the past. Between 2000 and 2004, Illinois paid the insurer Amerigroup $243 million in state and federal taxpayer dollars to provide insurance to eligible low-income people but the group "systematically avoided" enrolling pregnant women and unhealthy patients. There are similar stories here and in many other states as well. "We have a right to be concerned about that because it hasn't worked well in the past," said Michael Dobias, the director of policy and advocacy for the Healthcare Consortium of Illinois, of managed care. (The Consortium sponsored the event today.)

The hoped-for savings seen from the Medicaid bill -- estimated at $770 million over five years -- may help the state's budget situation, but so too would a more robust economic recovery. The broader context for Illinois' Medicaid challenges in recent years is the Great Recession. Mirroring national trends, as the economy started its nosedive in the Land of Lincoln, more and more people sought health care coverage through the state's Medicaid system. According a recent Kaiser Family Foundation report (PDF), between June 2009 and June 2010, Illinois' Medicaid enrollment shot up another 12 percent, nearly doubling the U.S. average over that time period of 7.2 percent.

Which is to say the economy here continues to pressure people into seeking out a health care option when they can't get it through work or buy it on the private market. But paying for that safety net is getting harder for Illinois, even after the income tax deal Democratic legislators approved in January. Gov. Quinn's fiscal year 2012 budget as proposed puts $552 million in Medicaid rate reductions on the table, which the Illinois Hospital Association says will hurt facilities' ability to assist low-income Medicaid beneficiaries. The legislators at the panel today in Chicago insisted out Quinn's budget pitch will change. "It's not a done deal," Trotter said of the cuts proposed for the state's next budget.

Illinois received a late Christmas present on Tuesday when the U.S. Department of Health and Human Services announced that the Land of Lincoln was one of 15 states to earn a bonus Medicaid payment. The reason? The state has made significant progress in enrolling uninsured children in Medicaid. Health officials still have not decided how they plan to use their performance award, which totals $14.9 million.

To their credit, Illinois officials have been aggressive in their efforts to streamline enrollment and connect eligible children with medical services from which they can benefit. Indeed, a new state law that goes into effect Saturday ends a requirement that a child be booted from the All Kids program for at least three months if his or her guardian misses a premium payment. But with budget hawks circling the capitol dome, public health is in the cross-hairs. The Medicaid reform committees that held hearings this month, for instance, both discussed tightening the process for checking a child’s eligibility. While there are some Medicaid changes that make sense, lawmakers should be cautious about making it more difficult for the poor to access care. Doing so could endanger federal support and the health of Illinois residents.