March 9, 2010
Governor Pat Quinn’s administration is promoting a plan for Medicaid health maintenance organizations (HMOs) as a major reform initiative, but several legislators have introduced bills in the General Assembly that would slow or restrict the plan.
The pilot program would enroll roughly 40,000 disabled and elderly Medicaid recipients in Northeastern Illinois—excluding Chicago—in HMOs. The plan would mark the first time that HMO enrollment has been mandatory for Medicaid recipients in the State of Illinois. Proposals from HMOs seeking to participate are due on April 15, 2010, and the program is expected to start in October of 2010. (Please use this link to see the previous post on Medicaid HMOs in this blog, as well as links to older posts.)
On the Governor’s new budget website, the HMO plan is highlighted as a step that the administration is taking to modernize and reform state government. The Department of Healthcare and Family Services has said that the plan would provide better care and save taxpayers $200 million over five years, although state savings would represent approximately half of that amount because of federal reimbursements under the Medicaid program.
David Vaught, the Governor’s budget director, discussed the HMO plan at a hearing about the State’s fiscal crisis on February 23, 2010, before two Senate Appropriations Committees. Mr. Vaught cited the plan as an example of a program that the Democratic Governor was launching based on the advice of Republican lawmakers.
However, advocates for the disabled have expressed concern that the plan could result in cuts in services, especially in connection with care provided in home and community settings. At a press conference in Springfield on February 18, 2010, members of advocacy organizations joined with several members of the Illinois House of Representatives to unveil a bill, HB 5086, to delay the HMO plan pending a study by a newly created task force. The bill was approved by the House Committee on Medicaid Reform, Family & Children Services on February 25, 2010. There is also a Senate version of the bill, SB 3634.
Another House bill, HB 6058, would allow Medicaid recipients to opt out of the HMO program. A third House bill, HB 5113, would prohibit the State from using any HMOs except those with Medicaid contracts as of December 31, 2009. This bill was approved by the House Committee on Medicaid Reform on March 4, 2010. Illinois currently allows—but does not require---Medicaid recipients in certain counties to enroll in HMOs. Three HMOs have contracts to provide care to Medicaid recipients.