Quicker payments to safety net hospitals among proposals

•March 13, 2019•

By Peter Hancock
Capitol News Illinois

Democratic state leaders said Tuesday that Illinois’ “managed care” Medicaid system is threatening the viability of hospitals and access to health care in many parts of the state, and they are pushing legislation they say would reform the system.
“We have a broken managed care program in Illinois, and it’s threatening the very future of our health care providers and the patients they serve all around this state,” Senate Majority Leader Kimberly Lightford said during a news conference unveiling the legislation.
Under the managed care system, which Illinois launched in 2011, insurance companies are paid a flat, per-patient monthly fee to manage the care of most Medicaid recipients. These managed care organizations, or MCOs, are required to reimburse health care providers and make sure patients receive follow-up care with specialists, therapists or rehabilitation facilities following a medical procedure.
In theory, the managed care system is supposed to improve patient care and lower costs by avoiding preventable emergency room visits or hospital readmissions.
But Lightford, a Democrat from the western Chicago suburb of Maywood, argued that neither of those goals has been achieved. Instead of managing care, she argued, the MCOs are merely managing costs through excessive denials of claims and delayed payments, especially for facilities known as safety net hospitals, which serve large numbers of Medicaid and uninsured patients, and small, rural “critical access” hospitals that have 25 or fewer beds. Read More