It has been more than a year since the federal government gave Illinois the supposed green light to begin enrolling most of its 1.1 million Medicaid recipients in health maintenance organizations. Turns out nothing involving the federal government is that simple.
Federal and state bureaucrats still are wrangling over the terms and conditions of the MediPlan Plus program. The state’s HMOs haven’t even been asked yet to submit bids. Officials say the first enrollments won’t happen until next spring at the earliest.
This snail’s pace is frustrating, though the wait will have been worthwhile if it produces a Medicaid managed-care system free of the fraud and waste that marred the hyper-expensive fee-for-service program.
In the meantime, Gov. Jim Edgar and the legislature need to make sure that overaggressive HMOs don’t take undue advantage of the delay by hustling enrollees before new, stricter marketing rules are in place.
The legislature can start by accepting the minor change Edgar made through an amendatory veto of Senate Bill 317. Passed last spring by wide and bipartisan margins, the bill would prohibit HMOs already participating in the state’s “voluntary” signup program from soliciting patients door to door, from offering bonus gifts or from soliciting clients in or near welfare offices.
Such high-pressure tactics will be prohibited under MediPlan Plus, so some HMOs figure now is the time to get a jump on the rulebook and sign the best, healthiest patients.
Another thing Edgar should do is everything possible to attract the states’s highest quality HMOs into Mediplan Plus. As it stands now, executives from some of the more reputable plans say privately they’ll take a pass or minimize their involvement. An often-heard complaint: The state’s monthly “capitation” rates are set too low to provide quality care.
Gov. Edgar and welfare czar Howard Peters must act now if MediPlan Plus is to be worth the wait.
