Hospitals in central Illinois are rejecting managed Medicaid plans at such a troubling rate that lawmakers are calling it a “crisis.”
Decatur (Ill.) Memorial Hospital and Memorial Health System and Hospital Sisters Health System, both based in Springfield, have all said they will cut ties with Molina Healthcare of Illinois over the past few months. The decision leaves tens of thousands of patients in a tough spot since the region's other managed-care plan, Health Alliance, exited the market last year.
The situation is so dire that Illinois lawmakers gathered on Feb. 8 for a hearing, “Medicaid Managed Care Network Adequacy Crisis in the Central Illinois Region.”
Managed care is still relatively new in Illinois. A state law passed in 2011 required 50% of the state's Medicaid population, which was around 3 million people, to be enrolled in a managed-care plan by the start of 2015. It's been harder to get central Illinois hospitals to join and remain in managed care as they are in a less competitive market that is home to many people insured through employers.
“Central Illinois is the last bastion of fee-for-service in the state,” said Barbara Otto, CEO of Health and Disability Advocates, a group that represents people who mostly depend on Medicaid. After long dealing only with fee-for-service, some hospitals have found it difficult to work with managed-care plans such as Molina.
“The termination notice was due to ongoing and unresolved issues around medical management, claim payments and credentialing of physicians,” said Brian Reardon, a spokesman for Hospital Sisters Health System.
A Molina spokeswoman says the providers ended their agreements “without cause,” adding “we worked with them in good faith in an attempt to come to an agreement, but unfortunately could not reach a resolution.”
—Virgil Dickson
