Two days before the launch of Gov. Rod Blagojevich’s signature health-care plan, All Kids, medical groups are voicing serious concerns about the program’s viability and physicians’ interest in participating.
“We are extremely, extremely worried about whether the program will run smoothly enough to allow access to care,” said Dr. Peter Eupierre, president of the Illinois State Medical Society, a physicians group.
At issue is growing dissatisfaction in the medical community with late payments by Illinois’ Medicaid program, a problem that could discourage physicians from taking on new patients under All Kids. Also, dissatisfied doctors may decline to take on new care-management responsibilities for Medicaid patients, a move planned to make All Kids affordable.
The new program begins Saturday, only nine months after Blagojevich trumpeted plans to make Illinois the first state in the nation to offer medical coverage to every child.
The governor claimed early success Thursday with the announcement that 43,000 previously uninsured children had enrolled in All Kids–close to the 50,000 enrollment target the state had set for the first year.
“Every kid should be covered,” Blagojevich said Thursday in Chicago, announcing a new partnership with the White Sox to promote the program. “Nothing is more important than making sure our kids are healthy.”
Several families stood by the governor’s side at the news conference. Among them were Michael and Tracie Evans from the Far South Side, who don’t have health insurance for their four children because it’s too expensive. As a result, the children haven’t had regular medical care for years.
Under All Kids, the family will pay $140 a month to cover the children. That amount is a fraction of the cost of buying coverage through Michael Evans’ employer.
“They’ve given me a list of what they want–they want their teeth looked at, they want to get their eyes examined,” Tracie Evans said with a laugh. “And I’m happy to say, yes, now I can take you.”
But many experts question whether Illinois is ready to make good on its promise of health care for all children while simultaneously implementing two major new programs affecting most of the state’s nearly 2 million Medicaid recipients.
Along with All Kids, the state will roll out a new disease management program Saturday for 160,000 Medicaid members with costly chronic conditions such as diabetes and asthma. Beginning next year, it will make a form of managed medical care known as primary-care case management mandatory for 1.2 million members.
“We’re pretty well-prepared. We know how to do expansions,” said Anne Marie Murphy, head of the Illinois Medicaid program, noting that Blagojevich has added 450,000 people to government-sponsored health plans in Illinois since he took office.
But medical groups are skeptical.
“My sense is [state officials are] doing the best they can. But are they ready? No, I really don’t think so. I strongly suspect that many bumps lie ahead,” said Dr. Earl Pescatore, president of the Illinois Osteopathic Medical Society.
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“There are still a lot of things we don’t know and a lot of questions we have,” Eupierre said. On Wednesday, the chairman of his organization’s board of directors sent a letter to Barry Maram, director of Illinois’ Department of Healthcare and Family Services, asking for more detailed information.
Leading the list of concerns is whether the state can persuade doctors to participate in All Kids and the other changes it is making. Without a large network of participating physicians, access to medical care will be compromised and new medical management strategies for Medicaid won’t work, experts note.
The problem is, doctors across Illinois are increasingly reluctant to work with Medicaid because of the state’s long delays in paying medical bills, said Vince Keenan, executive director of the Illinois Academy of Family Physicians. More than $1.5 billion in medical claims are outstanding, some for over six months.
The state has tried to ease concerns by assuring pediatricians treating All Kids patients that it will pay them in 30 days. But doubts are widespread.
“The state has promised [medical] providers time and time again that it will pay our bills promptly, and they just don’t do it,” Pescatore said.
Another concern is that many physicians don’t understand how Illinois’ new managed-care or disease-management programs will work.
Many physicians mistakenly think the kind of managed care Illinois is embracing–primary-care case management, which asks primary-care doctors to oversee most medical care–begins Saturday, said Scott Allen, director of the Illinois Chapter of the American Academy of Pediatrics. In fact, it doesn’t start for most of Chicago and the collar counties until early next year.
“We would like to know, if we need to make a referral, how will that work?” Eupierre said “What number will we have to call? Will we have to fax documents? Will we have to discuss the case with someone from the state? How long will that take? Or can we do this online? None of those details are available yet, and that’s frustrating.”
Under All Kids, Illinois is extending medical coverage to all of the state’s 253,000 uninsured children. About half are from low-income families that already qualify for government aid but aren’t enrolled in state programs. Families will pay a sliding scale of premiums based on their incomes, with the state subsidizing payments for families making less than $80,000 a year.
The first-year budget for All Kids is estimated at $45 million; that should be covered by savings expected from Illinois’ new disease management and primary-care case management programs, said Murphy, the Medicaid director. In addition, the state expects to receive $37 million in federal funding for low-income enrollees.
Donna Thompson, chief executive of Access Community Health Network, has high hopes for the program, if only because more patients will have some form of insurance because of All Kids. Currently, a third of the 200,000 patients seen each year at the network’s 45 medical clinics in metropolitan Chicago are uninsured.
“In many of our sites we have capacity, and we’re fully committed to expanding our hours if we have to serve more families because of All Kids,” she said.
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