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Doctors fevered over Medicaid HMO proposal
Medical-care providers are trying to thwart a last-minute legislative proposal to require some of the state's Medicaid patients to enroll in HMOs.
There is no requirement that the more than 2 million residents enrolled in the state Medicaid health insurance program for the poor must be enrolled in an HMO. The voluntary program, started in the 1990s, has not been popular and has resulted in less than 160,000 patients enrolled in managed-care plans.
Largely because enrollment has never been made mandatory, more than a half-dozen plans have exited the business in recent years. Harmony Health Plans, a subsidiary of Tampa-based WellCare Health Plans Inc., has remained, and has from time to time pushed the idea as a way to save the state money. Other plans, too, are looking to expand into Illinois and would also like to see mandatory enrollment.
HMOs have long argued that restricting doctor and hospital choices to their networks makes them a cheaper and more cost-effective alternative to fee-for-service Medicaid. HMOs would also provide disease management and assign patients a primary-care physician to encourage preventive care and reduce the number of poor people seeking care in the more expensive hospital emergency room.
Neither Harmony nor WellCare would comment for this story. The companies, however, have John Wyma as their lobbyist in talks with Gov. Rod Blagojevich's office. Wyma was Blagojevich's chief of staff when the governor represented Chicago's Northwest Side in Congress and remains a major fundraiser for the governor. Wyma did not return calls seeking comment.
HMOs have told staffers in the governor's office that they would like a way to prove that mandatory managed care works and that a pilot program would be one way to do that, according to a source close to the governor.
The state would start with a pilot program that would require Medicaid patients in two contiguous counties to join HMOs, according to pending legislation that was tucked in a so-called budget implementation bill and has passed the Illinois Senate. Neither county was disclosed.
The bill's fate is uncertain in the Illinois House.
Although the current Medicaid program requires patients to sign up for a specific physician under a form of managed care known as primary care case management, there is no requirement that patients sign up for an HMO.
Doctors and hospitals have long opposed forcing Medicaid patients to enroll in HMOs because they believe it would threaten patient access to medical-care providers. They also say HMOs have no proof their program saves money.
"Because Illinois Medicaid payment rates are so low and the base rate has been frozen for the past dozen years, savings have already been squeezed out of the Medicaid program," said Ken Robbins, president of the Illinois Hospital Association.
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