Medicaid funding changes a concern in DuPage County
Updated: April 16, 2013 3:12PM
Reforms in Medicaid funding in Illinois are beginning to be felt in DuPage County.
Illinois Deputy Governor for Public Policy Cristal Thomas spoke to DuPage County Board members Tuesday about the effect of 2011 legislation that mandates that at least 50 percent of all Medicaid patients in the state have to be in coordinated care programs.
“(Illinois Health and Family Services) will no longer pay fee-for-service,” she told County Board members.
The change means that 50 percent must be enrolled in managed care organizations (such as HMOs and PPOs), which will try to tailor reimbursements to individual patients and move away from a one-size-fits-all philosophy. Moreover, the new approach will focus heavily on tracking individual patients and the results from their treatment.
With 80 percent of the DuPage Convalescence Center’s patients being Medicaid recipients, the hit to the county budget is estimated to be about $2.69 million with the changes. The center currently has 360 beds filled out of an available 368. Its annual expenses are $35 million, of which $15.4 million is paid for by Medicaid revenue.
With the county already making up the difference in what providers currently are paid and the actual costs to provide the care to the tune of $2.4 million, the search is on for ways to make up the deficit. The projected shortfall comes from the managed care groups reimbursing the county less than the actual cost of the service the county is providing.
Under the previous arrangement, the county could appeal to the federal government for relief, but that ended with the reforms.
A new agreement is currently being negotiated, also with relief coming from Washington, but will not be finalized for a few months.
Thomas reminded the County Board of the growing problem of the state meeting its obligation to care for Medicaid recipients.
“It takes up a growing portion of the state budget,” she said.
County Board members are concerned. James Healy, R-Naperville, pointed out the danger of managed care organizations not wanting to do business with health care providers, which he said could lead to a loss of spots for seniors in public nursing homes across the state.
Thomas acknowledged that managed care groups are not required to work with particular providers.
Don Puchalski, R-Addison, was skeptical the new system would be cost efficient, noting that instead of the state making payments directly to the providers, it would add another level of bureaucracy to the process.
Thomas said the new system would take time to implement, but assured the board that the new system would ultimately bring the costs down.
“They will be able to do it more efficiently than we can do it at the state,” Thomas said.
Robert Larsen, R-Wheaton, pointed out that it was not the DuPage Convalescent Center’s mission to compete with private providers of services, but rather to provide a safety net for the most needy.
After Thomas’s presentation, Puchalski came away skeptical of any cost savings by the move.
“It doesn’t make sense,” he said.