Medicaid Reform and Managed Care Proposals

Updated information:

Summit Policy Position:

The Summit supports the use of managed care programs to deliver mental health services if, and only if, these programs improve the quality and quantity of services available to persons with mental illnesses.

Background

  • The Department of Healthcare and Family Services has entered into contracts with two managed care companies--Illinicare and Aetna Better Care--to provide health care, including behavioral health care to all Medicaid recipients in suburban Cook County and the "collar" counties. The Summit is concerned that this entities will not provide appropriate access to psychotropic medications and insure continuity of care to persons with serious mental illnesses.  We are also concerned about the need for appropriate quality measures.  On October 15, 2010, the Summit wrote to Julie Hamos, Director of the Department of Healthcare and Family Services expressing our concerns about these issues.  A copy of that letter is linked below. 
  • The creation of these two managed care entities has already worsened care for persons with mental illnesses.  Instead of one inadequate formulary for psychotropic medications for people on Medicaid, we now have three formularies.  As persons move into and out of the geographic areas served by Aetna and IliniCare they are required to change medications for no clinical reason.  No mental health clinician would support such a system.  Also, because Aetna and Illinicare refuse to compensate providers at reasonable rates, there is a shortage of behavioral health care in many communities.  For example, there is now no psychiatric hospital willing to serve Medicaid patients in all of Will County.  A letter from Summit member MHAI to DHFS Director Hamos about this issue is linked below    
  • In 2010, the legislatiure enacted Public Act 96-1501 which will require that 50% of ALL Medicaid recipients in Illinois be enrolled in managed care entities by 2015.  Click here for information about the implementation of this mandate.
  • Since the effect of managed care as being implemented by the Department of Healthcare and Family services is to cut state spending on Medicaid recipients, provide additional revenue to for-profit managed care companies and reduce the quality and quantity of health care, including behavioral healthcare, to poor people in the state, the Summit opposes managed care for Medicaid recipients. 
  • Research shows that state cuts to Medicaid result in increases in admissions to state pyschiatric hospitals
  • Below are links to materials about managed care and mental health services.

Information about Douglas v. Independent Living Center (October, 2011)

Proposed Federal Rule liberalizing Medicaid standards for home and community base services (April 14, 2011)

"The Illinois Medicaid Program" Civic Federation Issue Brief (May 22, 2009)

Report of the Taxpayer Action Board (June, 2009)

Medicaid Managed Care Task Force Report (November, 2004)

Illinois Hospital Association statement on Medicaid Managed Care

Medicaid Budgets and Patients (Part 2)

Medicaid Budgets and Patients (Part 3)

Medicaid Budgets and Patients (Part 1)