Gov. Bruce Rauner is overhauling a key Medicaid program that's intended to rein in costs, but hasn't saved enough money and has drawn the ire of doctors and hospitals alike.
Insurers will have to bid for a piece of the state's managed care program, which is projected to cost more than $9 billion in 2018, or nearly a quarter of Rauner's overall proposed $37.3 billion budget. He plans to narrow the number of carriers that now participate in managed care, possibly by more than half.
"Since taking office in 2015, the Rauner administration has analyzed the managed care system and found serious flaws that need to be addressed," John Hoffman, a spokesman for the Illinois Department of Healthcare and Family Services, which oversees Medicaid, said in a statement. "A clear rate structure and measurable quality and care coordination metrics are needed to reduce confusion for care providers and beneficiaries and enhance financial efficiencies."
Rauner has spent much of his roughly two years in office locking horns with the state Legislature trying to pass a budget. Restructuring managed care is among his biggest moves yet to restrain spending in Medicaid, a state-federal health insurance program for the poor and disabled.
Rauner, a Republican, inherited the managed care program from his Democratic predecessor Pat Quinn, who backed a law placing half of all Medicaid recipients in managed care by 2015 to cut costs.
Now, about 65 percent of Medicaid enrollees, or about 2 million people, are managed by one of 12 insurers contracted with the state. They include Blue Cross & Blue Shield of Illinois, the largest insurer in the state, and the Cook County Health & Hospitals System's CountyCare program.