Illinois Comptroller Susana Mendoza wants Gov. Bruce Rauner to hit the pause button on revamping the Medicaid managed care program.
In a state without a budget for two years, rebidding a program that could potentially award up to $9 billion a year over four years in contracts should have more scrutiny, Mendoza, a Democrat, said in a letter today to the Republican governor. She said the procurement could be the largest in the state's history.
"We are effectively seeking to restructure the state's largest budget item without a budget," Mendoza wrote. "Why are we making this monumental change during this period of unprecedented upheaval?"
Rauner in February announced that he would overhaul the managed care program, a key Medicaid initiative that intends to rein in costs, but one that the governor says hasn't saved enough money. It's an unpopular program with doctors and hospitals alike. They complain about its heavy administrative burden.
About 65 percent of Medicaid enrollees, or about 2 million people, are in managed care. The intent is to surround patients with providers, including social workers, nurses and doctors, who closely monitor and coordinate their care with an eye toward lowering medical costs.
Now, 12 insurers participate in the program. Under Rauner's shake-up, these insurers will have to rebid to stay in. There will be losers. Rauner plans to narrow the number of carriers in managed care to just up to seven.
"I worry that this undertaking could very well further limit our ability to support our failing social service agencies, universities and other basic state functions," Mendoza wrote. "Right now we need greater flexibility—not fewer resources and options—to navigate the ongoing crisis."
The backlog of unpaid bills in Illinois today totals $12.15 billion. Of that, managed care companies are owed about $2 billion.
At least one managed care company has alluded to potentially closing its doors because of the rebidding process, Mendoza noted. In April, the board chairman of Chicago-based Family Health Network told Crain's the health plan feared it was being locked out of keeping its contract and likely would dissolve.
Mendoza is calling for the General Assembly to hold a forum on this issue, and for Rauner to extend deadlines for companies rebidding to participate.
"The managed care reboot will improve health care delivery through a transparent process that was designed with significant stakeholder input to ensure integrity, competition and sustainable program costs for Illinois," said John Hoffman, spokesman for the Illinois Department of Healthcare and Family Services, which implements Medicaid.
"Mendoza blasts Rauner over speedy managed care overhaul" originally appeared in Crain's Chicago Business.
