03 Mar Manuevering Medicaid: Changes Coming to Illinois

speroMD conducts business nationally, but we are based out of Illinois which, therefore, is also the location of many of our readers.  In the interest of our Illinois readers, this week’s blog is focused on the news that broke earlier this week regarding Governor Bruce Rauner’s plan for major changes to the state’s Medicaid program.

Currently, almost two thirds of Illinois’s Medicaid population is participating through managed care plans.  When the patient migration from traditional Medicaid to managed care occurred in 2015, the result of a bill signed by former Governor Pat Quinn, about half of the patients in the Medicaid program shifted to managed care, so this population has increased over time, and Governor Rauner has set a goal under his new plan for 80% of Medicaid patients to participate through managed care plans.

Another significant change is a limit imposed on the number of permitted payors in the managed Medicaid program.  When the program started, there were 30 insurers involved.  Today there are 12, and Governor Rauner has set a ceiling of 7 insurance companies to be involved in the revamped program.

The intention of these changes is to decrease the cost of care for the state’s very costly Medicaid program.  The Chicago Tribune reports that since Illinois transitioned two million Medicaid members into managed care programs, hospital admissions have decreased, birth weights have increased for babies, and more members have been regularly seeing their primary care physician and obtaining prescriptions timely.

What changes are you seeing in your state?  Comment below!



For more information, please see these articles in Crain’s Chicago Business and the Chicago Tribune:





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