Blue Cross of Illinois to pay Medicaid suppliers less
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.
Blue Cross & Blue Shield of Illinois plans to cut Medicaid reimbursement rates by 35% for medical suppliers—apparently an effort to win back business after new enrollees were blocked from the state's revamped Medicaid managed care program.
Another private insurer, IlliniCare, signaled last fall that reimbursements could be slashed by up to 50%.
The proposed cuts, starting Jan. 1, 2019, cover durable medical equipment—wheelchairs, ventilators and oxygen tanks, for example.
According to a letter this month seeking an amended agreement from providers by June 1, Blue Cross is asking for a payment cap equal to no more than 65% of the state's Medicaid reimbursement rate.
Blue Cross wouldn't discuss the letter's details, but in a statement today it said, "We're looking to evolve our provider network to better serve our members and realign provider reimbursements to bring us more in line with industry standards."
Last month Medicaid overseer Illinois Department of Healthcare & Family Services barred enrollment to Blue Cross just as Medicaid recipients are choosing providers under a revamped managed care system called HealthChoice Illinois. It debuted Jan. 1 and rolled out statewide three months later.
Blue Cross was displaced as the insurer with the largest number of enrollees in HealthChoice Illinois as of April 1. Its enrollment increased 8.5%, to 469,384, while regional carrier Meridian Health Plan's soared by 27.5% to 546,663.
Total enrollment was up even more, by 30%, to 2,249,704, according to state enrollment data, buttressed by a 67% surge in IlliniCare's numbers to 341,300. CountyCare, owned and operated by the Cook County Health & Hospitals System, reported flat enrollment, at 332,243.
HFS, which also fined Blue Cross $150,000, said the insurer failed through its network of doctors and hospitals to provide enough patient access, while inadequately addressing a backlog of grievances and appeals from its enrollees.
In a statement at the time Blue Cross said it was "committed to making the necessary investments and improvements in technology, process, staffing and training to provide long-term solutions to meet the needs of all our (Medicaid) members."
The letter to providers from Christa Mitchem, manager of auxiliary contracting, said that Blue Cross seeks to ensure that reimbursement amounts for member services "promote a stable and sustainable Medicaid program."
In a statement in November IlliniCare said the carrier works "with our providers and vendors to align with the Medicaid program and be good stewards within its financial structure."
"Blue Cross of Illinois to pay Medicaid suppliers less" originally appeared in Crain's Chicago Business.
Send us a letter