Pharmacists pay for state bungling
SPRINGFIELD -- Illinois pharmacists are stuck helping pay for the Blagojevich administration's bungled health care program expansion.
The Department of Healthcare and Family Services has been informing pharmacies they must eat the cost of drugs dispensed under the expanded FamilyCare program that two courts have struck down, according to a document obtained by The Associated Press.
The computerized notice, with a specific voucher number indicating the service that would not be reimbursed, carries a date of April 21. HFS has not explained whether that was when the prescription was filled or when the notice was sent.
It was two days before an administration lawyer told a Cook County judge that officials had not come up with a way to determine who had received medical care under the illegal expansion, from whom, or how much had been paid.
HFS did not respond to questions seeking program details, but spokeswoman Annie Thompson issued a statement Monday saying officials would "continue to fight not to remove any Illinoisans who are currently covered from health care."
The notice indicates that a court order precludes HFS from reimbursing pharmacies for certain FamilyCare services. Those would be voided and deducted from future payments under related Medicaid programs.
The court order is the one that shut down the FamilyCare expansion, Illinois Pharmacists Association executive director Michael Patton said. When the expansion began, pharmacists accepted new patients as one of many, ongoing program changes.
"Little did they know that all of these prescriptions were going to be filled, ultimately, for free," he said.
Pharmacists' only other choice? Go back to patients for payment after they'd been told their prescriptions would be covered by the state. That's unlikely, Patton said.
"These people, most often, they don't even have a dollar for a copay," he said.
Patton said no one can tell him how much had been spent on the program between the time the administration began enrolling newcomers in December and when officials finally halted it in May. Gov. Rod Blagojevich said then that those enrolled still would be covered -- but with what money, no one is saying.
"If it were up to me, Rod Blagojevich's personal account would pay this," said Rep. Ron Stephens, a Greenville Republican and a pharmacist. "He did this unilaterally, and he knew, or should have known, that he didn't have the right to do it."
When the order to shut down the program was issued, state Comptroller Dan Hynes returned Medicaid bills he had not yet paid to HFS and instructed the agency to extract unauthorized payments, according to a spokeswoman. Since then, he's required a certification from HFS that it is not submitting any bills barred by the court.
Health care providers already are waiting months for reimbursement for claims under previously authorized Medicaid programs as the state struggles to pay its bills.
That the administration is dumping some of the cost of its blunder on pharmacies is yet another twist in the bizarre FamilyCare expansion effort.
When the Legislature rebuffed Blagojevich's universal health-coverage plan early last year, the administration wrote up a $40 million plan to expand income eligibility for state-subsidized health care for families of four making up to $83,000, with sliding premiums based on income. A bipartisan rules-making body, the Joint Committee on Administrative Rules, rejected that idea twice.
"Innocent people are going to wind up having to spend money because of an illegal stunt by this administration," said Rep. John Fritchey, a Chicago Democrat and JCAR member. "We told them repeatedly, 'You realize this could happen if you go ahead without our authority?'"
But Blagojevich began enrolling families anyway.
Cook County Judge James Epstein ruled the governor overstepped his authority and told him to shut down the expanded program April 15. That decision was upheld last month by a state appellate court that said the administration "cannot identify program participants" or say "where the premiums they have collected are kept and how much remains."
HFS has disputed that claim, saying the information exists, but has to be manually extracted from other Medicaid records. The agency has not explained how it could extract unauthorized services from pharmacists' reimbursements and void them.
Other health care providers such as hospitals that treat patients under FamilyCare have not received similar notices, according to Illinois Hospital Association spokesman Danny Chun. Officials from the Illinois Health Care Association, which represents nursing homes, did not immediately respond to a request for comment.