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updated: 6/30/2014 5:05 PM

Illinois pushes ahead with Medicaid managed care

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  • Julie Hamos, director of the Illinois Department of Healthcare and Family Service

    Julie Hamos, director of the Illinois Department of Healthcare and Family Service
    Associated Press/July 11, 2013

Associated Press

Facing a Jan. 1 deadline, the state's top Medicaid official announced a timetable Monday for moving hundreds of thousands of low-income patients into managed care health plans.

Department of Healthcare and Family Services Director Julie Hamos said 1.7 million people will get packets in the mail by the end of the year outlining their health plan choices and giving an enrollment phone number.

The change affects Medicaid patients in about 30 counties in central and southwestern Illinois and in regions including Rockford, Chicago and the Quad Cities. Those who don't choose a plan will be assigned to one. Patients can switch during the first 90 days.

Illinois has lagged behind other states in adopting managed care, which pays insurers and health networks fixed per-patient fees instead of paying separately for every appointment, surgery and test. The goal is to reduce wasteful spending.

A 2011 state law required expanding managed care to half the state's Medicaid patients by 2015. The Illinois Medicaid program now covers 3 million people with a budget of about $18 billion.

Managed care plans are operated by private companies such as Aetna and hospital systems such as Advocate Health Care. They'll benefit financially if they keep people healthy.

"We believe we still have a lot of work to do, alongside the state, to educate Medicaid enrollees about what it all means to them," said Samantha Olds of the Illinois Association of Medicaid Health Plans, which represents nine health insurers with state Medicaid contracts.

The health plans will be strictly limited in how they recruit patients. Federal and state rules prohibit telephone and door-to-door recruitment to prevent plans from cherry-picking the healthiest patients who will cost less.

The rolling enrollment schedule starts in Clinton, Madison and St. Clair counties this month and winds up in Cook County in October.

"We're trying to do this in as orderly a fashion as possible," Hamos said. If all the letters went out at once, she said, "that call center will break down and not be there for the people" who receive the first letters explaining their choices.

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