Illinois Community

Disruptions Mount As Illinois Shifts Medicaid Patients To Managed Care

Aimee Sharp
Author | Shield HealthCare
02/18/15  10:28 PM PST

Originally published by Kaiser Health News. Kaiser Health News (KHN) is a nonprofit national health policy news service.

By Wes Venteicher, Chicago Tribune

When Angelica Hernandez received a letter from the state telling her to pick a Medicaid managed-care plan for her daughter, the Naperville, Illinois, woman chose one that included the doctor’s office where she had always taken the 10-year-old girl.

After selecting the plan, Hernandez learned it didn’t cover the audiologist who had fitted her daughter, who is partially deaf, with a hearing aid. A Spanish speaker, Hernandez said through a translator that she was told it would cost at least $400 to see the audiologist under her new plan, and she has not gone back.

Officials at the Illinois Department of Healthcare and Family Services say they have tried to avoid disruptions of care as the state shifts 2.2 million of its 3.1 million Medicaid patients to managed care, a system in which the state pays a fixed amount for each patient instead of reimbursing providers for each test and treatment.

But some patients are reporting difficulties keeping their doctors and confusion navigating plans as they try to make the shift.

The reports include wrong information on websites for insurance plans and hospitals; hours on the phone with insurers, hospitals and a state contractor who helps with enrollment; conflicting letters in the mail; changes to prescriptions, and other frustrations. For Hernandez, the change has meant she will need to find another audiologist for her daughter.

Some doctors say the state is reassigning their patients to new offices and has created new administrative requirements that burden their practices, delay care for patients and slow payments from insurers.

Read the Full Article at Kaiser Health News.