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Illinois Focus


Illinois has gone more than twenty months without an approved, regular operating budget.  Fortunately, the state is under court order to continue making payments to the bulk of state agencies and programs, including Medicaid, while the Legislature and the Governor negotiate the details of the budget deal. Unfortunately, those spending amounts were predicated on increased taxes that have since lapsed (resulting in a growing gap between how much the state has promised in spending versus how much it is bringing in in revenue). Today, the state has over $100 billion in pension debt, $26 billion in bond debt, owes more than $14 billion to vendors, and a credit rating that is only slightly above “junk” status.

Combined, the state of Illinois’s budget and credit outlook are a significant cause of concern and BJC Government Relations will continue to work with partners like the Illinois Health and Hospital Association to ensure that our hospitals receive the reimbursement they are due when providing care for Illinoisans covered by Medicaid or the state’s employee health plan.

ACA Access Payments

The State of Illinois recently shifted a large portion of its Medicaid population into managed care. In doing so, the ACA Access Payments (reimbursements to providers funded by provider taxes and the resulting federal match), which were intended to equalize reimbursement between new Medicaid-eligible adults (as a result of Medicaid expansion) and existing Medicaid-eligibles in the Fee For Service portion of Medicaid, needed to be reformed to include managed care organization payments to providers.

Currently, the state is working through the process of ensuring managed care organizations receive the necessary increase in their monthly capitation rates so they can pass along those payments to providers. BJC Government Relations will continue to partner with the Illinois Health and Hospital Association in its advocacy relating to this issue.

Managed Care Reform

With the expansion of managed care in Illinois to a significant percentage of the total Medicaid population, the need to ensure that Medicaid-eligibles receive adequate coverage and providers have necessary protections has increased. In 2016, several of the protections we have advocated for were signed into law and have become effective. These include:

  • Required reporting of new MCO quality metrics
  • Required accuracy of the MCO’s electronic provider directories
  • Hold harmless provisions for providers that act in good faith on documented coverage information

This was a strong first step in correcting many of the pitfalls providers and patients have come across in dealing with the numerous plans that have contracts in Illinois to provide managed care. We will continue to work towards a managed care regulatory environment that standardizes administrative burdens, emphasizes quality, and ensures patients have access to strong networks of care when and where they need it most.

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