Cures for what ails costly Medicaid

No doctor would tell a patient, "You desperately need surgery, but we can wait until next year, or the year after that."

Yet that is the approach that has been taken in managing Medicaid in Illinois. It, too, is in need of major surgery. But it is put off, year after year, and Medicaid debt keeps piling up. The amount of unpaid bills to Medicaid providers stands at a staggering $1.7 billion.

You would think, then, that the state would at least pay current Medicaid bills before incurring new ones. Yet the Medicaid program continues to grow -- particularly under Gov. Rod Blagojevich. Medicaid now takes up about 31 percent of state general revenue funds - more than what is dedicated to education, according to state Sen. Christine Radogno, a Lemont Republican.

Radogno, along with Republican state Sens. Carole Pankau of Itasca and Dale Righter of Mattoon, want to force needed reforms in Medicaid with common-sense legislation.

For one, the Medicaid program could not be expanded without approval of the legislature. The lawmakers say this is necessary to stop the governor from unilaterally taking on new Medicaid entitlement obligations. For another, a loophole would be closed that allows the state to use what is set aside for Medicaid this year to pay outstanding bills from the year before. As long as this keeps occurring, no progress can be made in reducing the Medicaid backlog.

Pankau, Radogno and Righter also want to firm up confirmation of Medicaid eligibility. This is not only fair to qualified recipients and taxpayers, but could free up more federal funds for the state Medicaid program.

The legislators also want to establish a "performance-based" system of Medicaid reimbursement. Benchmarks would be set regarding medical care and finances, saving the state $110 million in the first year of implementation, according to the legislators. They note that one of the advantages of this system is that it provides incentives for emphasizing preventive medicine. This is not only good medicine for patients, but it can save millions in the long run with early diagnosis of illnesses that would be much more expensive to treat later.

Some Medicaid providers have resisted expanding such managed care options, fearing they would limit patient care options while adding to their financial burdens. Still, performance-based reimbursement is worth exploring.

Keep in mind that this Medicaid crisis is not just about dollars and cents. Though taxpayers deserve better, so do Medicaid recipients. Many struggle to find a doctor. Others have to travel hours to get to one who will see them. This will only get worse as more providers drop out of Medicaid out of frustration with unacceptably long delays in reimbursement, or who are no longer in a financial position to write off these unpaid bills as charitable cases.

It's time to wheel the state Medicaid program into the operating room.