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The NSPA Blog

Illinois Medicaid – Slow to Pay

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Posted on May 22nd, 2019 by Teri Dreher, under Medicaid, Patient Advocacy, Senior Orphans

Medicaid Enrollment Numbers

The Illinois Department of Healthcare and Family Services maintains a running update of total enrollment numbers. In July 2018, 606,670 Illinois residents were covered under expanded Medicaid. After the eligibility guidelines were expanded, enrollment under Medicaid expansion grew quickly in the early years. Enrollment is lower in 2018 than it was in 2016 (In July 2016, Medicaid expansion enrollment stood at about 644,000 people).

Far more Illinois residents have enrolled in expanded Medicaid than the state expected. That means the state is receiving more federal Medicaid funding than projected. Also, it means Illinois has to pay more than projected. The state is paying 6 percent of the cost to cover the newly-eligible population in 2018, and that will grow to 10 percent in 2020 and future years.

Managed Care Plans

Illinois has been slower than many other states in moving beneficiaries to managed care plans. As a result, the state did pass a law in 2011 that required expanding managed care to at least half the state’s Medicaid beneficiaries by Jan. 1, 2015. In 2016, nearly 61 percent of Illinois Medicaid enrollees were covered under Medicaid managed care plans.

Nursing Homes

In June 2014, then-Governor Pat Quinn signed a Medicaid reform
bill. The law restored adult dental care and podiatry services, aligns Illinois
law with federal law to provide Medicaid coverage to children who have been
without private insurance for three months, streamlines hospital and
nursing-home reimbursement, and more.

helping elderly

In 2018, A lawsuit was filed in the U.S. District Court for the Northern District of Illinois, where five groups that jointly operate more than 100 skilled nursing facilities across the state said Illinois’ reimbursement rates and methodologies violated certain requirements under the Medicaid Act. Nursing homes across the country are struggling to pay landlords, employees and providers due to low Medicaid and Medicare reimbursement rates and depressed occupancy levels. However, the problem is especially acute in Illinois, where reimbursements are not only low, but also arrive with months of delays.

Some nursing facilities have waited up to nine months to
receive their Medicaid payments, which they rely on to cover everything from
salaries, rent and food to laundry and medical equipment and services.

Unpaid Bills

An impasse between Illinois’ Republican governor and Democrats who control the legislature left the state without a complete budget for an unprecedented two fiscal years. Lawmakers enacted a fiscal 2018 budget in July, and the state still has a $9.1 billion backlog of unpaid bills to vendors and service providers.

While the number of residents covered under Medicaid has vastly increased, as well as the number of services offered, payment for those covered has been significantly slower. The effects of that can be felt throughout the healthcare system. Hospitals and nursing homes are only a few that are affected. One can only hope that changes in legislation are made to counteract or improve on this. The current situation, as it exists, is only hurting Seniors and Adults w/Disabilities. It can be very hard to place residents safely when facilities don’t get paid.

Sources: Reuters; https://www.healthinsurance.org/illinois-medicaid/; Chicago Tribune

With over 36 years of clinical experience in Critical Care nursing, home based health care and expertise as a cardiovascular nurse clinician, Teri is well acquainted with the complexities of the modern healthcare system. She has served as a nursing leader, mentor, educator, and consistent patient advocate throughout her career in some of the best hospitals across the country. Her passion to keep the patient at the center of the model of nursing care led her to incorporate NShore Patient Advocates, LLC in 2011, serving clients throughout the northern suburbs of Chicago.

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