Managed Medicaid Pilot Program Under Debate in Illinois

HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that under a Senate amendment currently before the Illinois legislature, the state would create a pilot mandatory managed care program with up to three managed care companies participating. According to the latest Illinois Health Plan Analysis, critics of the proposal are mounting a campaign to lobby legislators and keep their current primary care case management (PCCM) system intact.

"The issue has become a recurring discussion as the rest of the country shifts toward HMO-style managed Medicaid while Illinois prefers its primary care case management model," states Roy Moore, analyst for HealthLeaders- InterStudy and author of the report.

Under the proposed legislation, the pilot would serve as a testing ground for savings and improved quality. The state is looking at having up to three managed care organizations run the program. Each plan would maintain case- specific data and produce reports based on care type and frequency and would be paid on a capitated basis. Enrollment in the managed care program would be mandatory for all Medicaid beneficiaries who are not in the spend-down program or who are excluded from state-based mandatory managed care by federal law.

Critics of the proposal believe that any change could endanger federal payments to hospitals and add further pricing pressures in a state already known for poor Medicaid payments. Illinois governor Rod Blagojevich and insurers have been somewhat quiet on the measure, but the Illinois Hospital Association (IHA) argues the pilot would jeopardize the current Medicaid financial system and endanger the future of the hospital assessment program, which generates $730 million per year in federal funds for Illinois healthcare programs. Instead, the IHA supports primary care case management and other non-risk managed care techniques.

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  For more information, contact:    Kelly Morphy   HealthLeaders-InterStudy   615-369-4818   kmorphy@healthleaders-interstudy.com 

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SOURCE: HealthLeaders-InterStudy