Medicaid moving patients to managed-care plans

Judy Harvey
For Sun-Times Media
July 7 3:35 p.m.
Schedule for mailing enrollment packages for “care coordination programs,” as required by the Medicaid reform law passed in 2011, by county:
Aug. 25 through 30, Kane
Sept. 8 through 13, DuPage, McHenry
Sept. 15 through 20, Lake
Sept. 29 through Oct. 4, Will
Sept. 1 through Oct. 11, Cook

The five managed care regions in the state:
Greater Chicago region (Cook and collar counties)
Central Illinois
Metro East
Quad Cities


Changes are coming to how health care is delivered to Illinois residents covered under the state’s Medicaid service.

The Department of Healthcare and Family services announced June 30 a plan to move clients from the traditional Medicaid coverage into what are being called “care coordination programs,” as required by the Medicaid reform law passed in 2011.

“This is a complete redesign of Medicaid,” said Julie Hamos, director of HFS. “Moving our clients into care coordination will improve the quality of care for our clients, which in turn will improve clients’ health. Healthier clients mean a reduction in health care costs and an overall healthier Illinois.”

The programs will organize into networks, or managed care entities, the various health care providers operating in Illinois. The intent is that these defined care networks will address the specific medical needs of four different populations groups:

  • Seniors and people with disabilities;
  • Children with complex health needs;
  • Adults newly eligible for coverage under the Affordable Care Act;
  • Families and pregnant women.

These care entities or managed plans “share one key feature. They are organizing networks of providers who are working in a collaborative manner to help coordinate the care of our clients and make sure our clients are getting quality health care,” Hamos said during a web cast.

Medicaid began enrolling seniors earlier this year and families with minor children are the next targeted group. These clients will receive a packet in the mail during the next few months with information on the different coordinated care plans applicable to their needs.

Clients will have 60 days to choose a care plan, but once that deadline is passed DHFS will choose one to best fit their needs, according to DHFS.

“Our goal is to get as many people as possible to make their own choice,” said Jim Parker, deputy administrator of the DHFS’s medical division.

Once a client has signed onto a plan, they will have 90 days to change plans if they so choose. However, once that initial 90-day period is passed, the client will have to remain in that plan for a year.

Clients can make an appeal to change plans before then if there is good cause, Parker said.

Once the one-year mark is up, there will be an open enrollment period and clients can once again review their options.

Of course, these changes affect more than Medicaid clients. Health care providers will have adjustments to make. Medical groups and physicians bill the state for services to Medicaid clients. DHFS expects the “vast majority” of those clients will be moving to managed-care plans.

Rush-Copley Medical Center in Aurora is “encouraged by this new program,” said Courtney Satlak, public relations manager. The hospital has seen its percentage of Medicaid patients increase from 17 to 19 in the past year, and its Medicare population is almost 30 percent.

“One way Rush-Copley is addressing issues in the emergency room and helping to assist underinsured and uninsured patients is through the use of dedicated care managers,” Satlak said. “These staff members are able to more effectively help link these types of patients to appropriate continuing care options rather than relying on the emergency room for their health care needs.”

The state plans to enroll 2 million Medicaid clients into health plans by the middle of 2015.

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