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Illinois Focus

Budget

After more than two years, Illinois adopted a budget and has begun to make up for back payments due to their vendors.  All told, health care providers and managed care organizations have a backlog of more than $4 billion of the $16 billion the state is in arrears.

BJC Government Relations has supported the budget compromise plan which included authority to issue bonds to make up for some of the back payments.  The bonds would save the state millions in interest (state law requires the state to pay vendors an interest penalty for any debt owed - this penalty exceeds the interest rate on bonds) and expedite payments to care providers.

Of course, the state's overall fiscal condition remains a concern with more than $100 billion in pension obligations and a credit rating only slightly above "junk" status.  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.

Rate Reform

Illinois is undergoing a required update to their Medicaid rates.  The State Plan Amendment (SPA) is due to be submitted to the federal government by mid-2018.  Mark Turner (Memorial Hospital - Belleville and Memorial Hospital - East) is on the Illinois Hospital Association board and both he and David Braasch (Alton Memorial Hospital) have been directly involved in rate reform.

At the same time, BJC HealthCare is a bi-state asset.  Our two academic medical centers (Barnes-Jewish Hospital and St. Louis Children's Hospital), which treat patients who tend to be sicker and poorer than the average community hospital, derive 30% of their in-patients from Illinois.  The same is true for our Rehabilitation Institute of St. Louis.  Christian Hospital and Barnes-Jewish West County Hospital also have large proportions of their volume that are attributable to Illinois.

If our Missouri-based facilities are penalized simply on the grounds that they are domiciled outside of the state, Illinoisans who rely on us for care will be inadvertently harmed.  We are encouraging policymakers to ensure that we are treated equitably in any new reimbursement scheme that is authorized by the Legislature.

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.  We are also closely monitoring the shift to statewide managed care which is set to go live on January 1, 2018.

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Illinois Medicaid Managed Care - FAQs 

Q. Last year I was able to go to a BJC HealthCare hospital through the Illinois Medicaid managed care program, Harmony Health Plan, which my family and I belong. Why don’t I see a BJC option now?

A. At the start of this year, Harmony Health Plan merged with Meridian Health Plan of Illinois.  Unless members changed to a different health plan, Meridian became their health plan in January 2019. Meridian does not offer its patients access to any BJC HealthCare facilities or to Washington University physicians, BJC’s academic partner.

Q. Can I still use Alton Memorial Hospital, Memorial Hospital in Belleville or Memorial Hospital East in Shiloh?

A. Illinois Medicaid managed care plans do not include any BJC hospital in their network, including BJC hospitals in Illinois such as Alton Memorial Hospital or Memorial Hospital in Belleville or Shiloh, Ill.  

Q. My family practice doctor is a part of Memorial Medical Group. Can I still see her using my Medicaid managed care program?

A. Unfortunately, Memorial Medical Group (MMG) is not included in your health plan network.  As of Jan. 1, 2019, all BJC hospitals and physicians are out-of-network, and the MMG practice is a part of BJC Medical Group.

Q. My son has asthma and we see his doctor at St. Louis Children’s Hospital.  Is that covered by my Illinois Medicaid managed care program, or any emergency care we might need for him there?

A. St Louis Children’s Hospital, which is part of BJC, isn’t in any of the Illinois Medicaid managed care plan networks, along with the rest of the BJC hospitals and Washington University physicians and therefore, non-emergent care cannot be obtained at any BJC hospital, including SLCH. 

For any emergency care, please go to the closest medical facility regardless of the facility’s/provider’s network participation with a managed care plan.

Q. Will BJC hospitals and Washington University physicians be offered in the future as a part of my Medicaid managed care plan?

A. BJC HealthCare believes that the lack of access to some of the best care in the area – and in the country – puts Illinois patients at a great disadvantage. For those who are suffering from a complicated illness, it even further reduces the number of specialists in the region that serve patients with Medicaid. BJC believes all people in Illinois should have access to health care services when and where they are needed.

At this time, BJC has been unable to reach an agreement with the Managed Care organizations that insure Medicaid patients in southern Illinois. We are continuing discussions and are hopeful that we can get to a point where Illinois Medicaid patients can once again receive in-network benefits for care provided by BJC hospitals, physicians and our partners at Washington University Physicians.

Q. How do I find an in-network physician or hospital? 

A. Contact your plan’s customer service number listed on your ID card. 

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Page updated 4/3/19

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