Thursday, January 06, 2011

Medicaid reform heads to the governor

By Lauren Johnson and Jamey Dunn

A substantial Medicaid reform package is headed to Gov. Pat Quinn’s desk.

According to Chicago Democratic Rep. Barbara Flynn Currie — a sponsor of House Bill 5420 — it could save the state an estimated $775 million over five years.

Co-sponsor Patti Bellock, a Hinsdale Republican, said she was pleased with efforts of legislators on both sides of the aisle, as well as stakeholders.

“Even though they thought there was a little bit of a poison pill with every interested group … they were ready to live with it because they realized that the system needed a lot of reorganization to protect the integrity of the Medicaid system in Illinois,” Bellock said on the House floor before legislators voted to approve the measure.

Opponents say disappointment surrounded the measure that would limit the income eligibility requirement for Illinois families under the AllKids program to at or below 300 percent of the federal poverty level, or an income of $66,000 for a household of four.

John Bouman, president of the president of the Sargent Shriver National Center on Policy Law, said, “We don’t think it’s the best practice.” He said the provision could cost the state more money than it could save.

Bouman added, “The research-based policy of the federal government is to promote enrollment of children in health care, to connect them quickly to primary care and to maintain their care not interrupted with administrative reasons.”

Quinn has been working with the legislature on the bill, and it is likely he will sign it.

“Today we are following through with legislation that will help stabilize our budget and rebuild the foundations of our economy. This bill will streamline services and eliminate inefficiencies, saving the state hundreds of millions of dollars. In addition, it will improve efficiency in the program to ensure that Medicaid patients in Illinois are receiving the highest quality of care,” Quinn said in a written statement. “This is a powerful example of the reforms Illinois needs to stabilize its budget and the kind of legislation I will continue to work with the General Assembly to pass. I look forward to receiving this bill from the legislature and acting on it soon.”

If Quinn signs the bill, it would:
  • Allow the governor to transfer up to 4 percent of funds from long-term care facilities to community-based alternatives as part of a shift to more in-home care.
  • Allow the state to recoup payments gained through fraud, as well as a 5 percent interest charge. It would also create a $2,000 civil penalty for Medicaid fraud.
  • Require patients to prove residency and provide a month’s worth of income information to verify eligibility. It would also require patients to prove they are eligible each year. Pregnant women would be exempt from the annual verification.
  • Create a moratorium on expanding who is eligible for Medicaid.
  • Extend the AllKids program, which is slated to expire this year, to 2016 and cap the eligibility level at 300 percent of the federal poverty level, or a $66,000 household income for a family of four. Those above that level, who are currently covered on AllKids could keep their coverage until July 1, 2012.
  • Require that half of Medicaid patients receive so-called coordinated care — which is administered in a network of health care providers and focuses on preventative treatment and connecting patients to a primary care doctor—by 2015.
  • Allow for 90-day supplies of some non-narcotic drugs, which will cut down on dispensing costs paid by the state to pharmacies.
  • Cut the interest on overdue payments to pharmacies from 2 percent to 1 percent.
  • Upgrade the state's electronic medical records systems. The funds spent on upgrades are eligible for a 90 percent federal match.

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