As Illinois nears it fourth month of operating without a state budget, not-for-profit and for-profit health organizations are doing what they can to maintain services despite what are, at best, late and erratic Medicaid payments.
Republican Gov. Bruce Rauner continues his stalemate with state Democrats, leaving the state without a budget since the beginning of the fiscal year, which was July 1.
A federal court in Chicago ruled in July that the state had to continue to make Medicaid payments. This has kept many providers from closing, but there is still much uncertainty about when payments will come and how long the state can continue making payments before running out of money.
From solo practitioners to large health systems, this affects all providers in the state, forcing some to cut services, lay off staff or even close.
Jeff Joy, president and CEO of Illinicare Health, said providers are trying to stay afloat without cutting services, but they can't prop up Medicaid in the state forever. The state is routinely at least two months behind in payments and some doctors have already stopped seeing Medicaid patients.
“The fear here is that with more erratic funding, the health of the community struggles,” he said.
Maryjane Wurth, president and CEO of the Illinois Hospital Association, said the state's safety net and rural hospitals in particular are struggling with cash flow. Hospitals are looking at layoffs, service cuts and possibly closure. Even for hospitals less affected, future projects are on hold indefinitely.
“Everything becomes more cautious with lack of knowledge,” she said.
Joel Johnson, president and CEO of the Human Resources Development Institute, which provides behavioral health services, said the organization has had to close some residential programming and furlough about 60 staff members. Psychiatric care will be eliminated on Nov. 1.
Staff try to direct patients to other providers, but it disrupts the trust and comfort those patients can have with the doctors and nurses they know and have gotten used to, he said.
HRDI is burning through cash and cutting back everywhere it can, he said.
He has spoken personally with the governor and other lawmakers. He has heard talk of a resolution by the end of the year or January, but he is afraid the impasse will last into the new year.
“It's all coming to a head right now at a risk to some of our most vulnerable people,” he said.
Thresholds, which also provides recovery services to people in Illinois with mental health issues, had to cut one program that was helping about 120 people and has only avoided more drastic measures by maintaining significant lines of credit and relying on its endowment, said Heather O'Donnell, vice president of public policy.
She called the stalemate “unconscionable” and said it resulted in a downward spiral for mental health services in Illinois, which were not being fully funded to being with.
According to the National Alliance on Mental Illness, from fiscal year 2009 to 2012, Illinois cut $113.7 million in general revenue funding for mental health services. Illinois made some of the largest cuts in mental health funding nationwide during this time period.
“Some organizations are really struggling and that means reduced access to care,” she said.
Dr. Kathy Tynus, president of the Chicago Medical Society, said delayed Medicaid payments and other issues like electronic health record requirements have led to smaller practices being sold or closed.
“I think physicians are getting squeezed in a lot of different areas,” she said.
Even other Republicans have criticized Rauner for “holding the budget hostage” while the November pension payments will be delayed and the state lottery has said it cannot make payouts of more than $600.