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Move on Medicaid

In June 2009, Gov. Pat Quinn’s Taxpayer Action Board offered solid proposals to streamline Illinois’ Medicaid program — it spends roughly $14 billion a year in state and federal funds — and to conserve money. Among the panel’s proposals: Expand managed and outpatient care. Shift long-term-care patients from institutional to community settings. More effectively screen out ineligible patients.

What happened? So far, not much. But that may be changing. Lawmakers are racing toward a self-imposed deadline to concoct sweeping reforms in three realms of government: Medicaid, public education and worker’s compensation. Among the ideas under discussion by legislators assigned to modernize Medicaid:

•Moving more Medicaid recipients to managed care. That means patients are assigned a “medical home” — a doctor (often in an HMO-style clinic) who oversees their care. The state’s first mandatory managed care program, to serve an estimated 40,000 elderly and disabled recipients, has been delayed and is now set to begin in March. The plan is estimated to save the state about $200 million over five years. But Department of Healthcare and Family Services Director Julie Hamos says that there’s been “push back” from some providers and patient advocates. She has asked lawmakers for “back-up” to keep the expansion on track. That’s vital. Other states have moved more aggressively than Illinois into managed care for Medicaid recipients. Illinois needs to move faster.

•Reducing the prescription drug dispensing fee paid to pharmacists who fill prescriptions for Medicaid recipients. Hamos says the state pays $4.60 per Medicaid prescription for generic drugs and $3.40 for brand-name drugs. That’s compared to $1.36 and $1.28 under the state’s employee health care plan. The retail merchants association says paying these Medicaid fees puts Illinois in the “mainstream.” But if that’s so, it needs to move out of the mainstream and lead the way to lower fees. We say this acknowledging that pharmacists aren’t able to collect the co-pays to which they’re entitled for nearly half of Medicaid prescriptions. That’s because some recipients can’t or won’t pay.

•Tightening checks on eligibility. A U.S. Government Accountability Office report last year said 10.5 percent of federal Medicaid payments were improper — including many for ineligible recipients. That’s one reason Hamos wants lawmakers to allow DHFS to cross-check electronic data on Medicaid recipients’ income and employment to weed out ineligible enrollees. The law should allow the department to match electronic records, such as income tax returns from the Illinois Department of Revenue, with Medicaid eligibility data.
• Shifting some disabled people from costly state institutions to less expensive community care. Illinois lags the nation here too, according to a 2009 AARP report. Bottom line: Community settings “are both less costly and preferred by older adults and the physically disabled,” the governor’s Taxpayer Action Board found. In other words: This is a no-brainer, although unionized workers at state institutions historically have opposed it.

The context for the Taxpayer Action Board recommendations and the legislature’s belated interest: Illinois faces a gargantuan budget deficit that won’t be tamed unless lawmakers get serious about Medicaid reform. “It’s times like this, when we really have a budget crisis, that we should be pushing the envelope and trying to see what we can really achieve in all of the budget items,” Hamos told lawmakers.

We’re with her. Roughly one in five Illinoisans — that’s 2.6 million people — is covered by Medicaid. In 2014, perhaps another 700,000 will be eligible under the new federal health care reform law.

Illinois has dithered long enough. Lawmakers, move on Medicaid now.

And we here at Will County Watcher couldn’t agree more.