Monday, December 13, 2010

Illinois may crack down on Medicaid eligiblity

By Jamey Dunn

In its ongoing quest to find savings in the state’s Medicaid system, a House committee today took up the issue of making sure those who receive benefits are eligible for them.

Legislators in both houses are looking for ways to trim the Medicaid budget and make the system more efficient. However, today’s hearing did not produce many options. The one change most agreed with was working to make records electronic and shareable between state agencies.

John Bouman, president of the Sargent Shriver National Center on Policy Law, said the state should take advantage of federal funding associated with the health care reform law. “For example, if we are going to save $200 million in managed care ideas, save $190 million, take $10 million and turn that it into $100 million pot for information technology upgrades, which adds that much money to the state budget to do tasks we should be doing anyhow.”

Legislators on the committee painted a grim picture of the administrative oversight and technological systems Medicaid operates under.

“Everything is still in paper files. Computer systems crash. The whole office is shut down. Nothing works and it’s not only undignified for recipients of our human …services but also ridiculous when it comes to being able to efficiently manage this,” said Rep. Sarah Feigenholtz, a Chicago Democrat.

“In my local office … each one of the case management people have 2,500 cases. ... This is what one of them told us: They’re just told not to answer the phone because they can’t handle it,” said Rep. Patricia Bellock, a Hinsdale Republican.

Bouman said if legislators want to crack down on verifying whether patients are eligible for Medicaid assistance, new technology is needed. He said a “staff-heavy, paper-heavy” verification system is slow, costly and has more potential for mistakes.

However, Bouman cautioned against kicking people off of Medicaid coverage — even if their eligibility lapses — if the committee’s overall goal is to provide preventative health care rather than expensive treatment for chronic medical problems. “This is not traditional cash welfare assistance where we have a stern gatekeeping function. This is health policy. And we have to pay attention to connection to care, and not interrupting care and getting the cheap sensible prevention going on and continuing.”

Members of Gov. Pat Quinn’s administration were not receptive to the idea of knocking such people out of the program as undocumented children and people whose coverage is paid for solely by the state.

“We see the issue of serving undocumented children as a policy issue, one that we’re proud of and this governor supports. So we are not proposing changes in reducing eligibility for undocumented children,” said Julie Hamos, director of the Illinois Department of Healthcare and Family Services.

Hamos said the pool of single adults that Illinois covers with no help from the feds costs the state around $16.9 million. “This is a relatively small amount of money, relatively, but it’s still money … If we don’t provide for some kind of payment for these very low-income people either they’re going to get very sick and end up in emergency rooms, and then the hospitals will be eating the cost one way or another, or they won’t even get primary health care, and they’ll by default get sicker.”

Hamos said her agency would present plans for new technology and information sharing to the General Assembly in the spring. She also said she would support stricter enforcement of eligibility standards; however, the federal government may not allow such changes. To receive federal matching dollars, Illinois cannot change the standards used to determine who is eligible for Medicaid assistance. “We will try to make the best case for why verification is different than [changes in] eligibility. …But we don’t know how [the federal government] will react.”

The committee is scheduled to meet again tomorrow. A Senate committee is also taking up the issue of Medicaid reform.

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