Now that Jim Edgar has helped do something about funding education, it’s time for the governor to focus on Illinois’ long-running Medicaid muddle.
A booming economy, and the taxes it produced, has enabled the state to eliminate its mountain of past-due bills from hospitals, doctors and others who treat the poor. But Edgar’s vow to move the state’s 1.1 million Medicaid enrollees into more cost-efficient managed care plans has been looping in bureaucratic circles for almost four years. Four years!
The delay is not all Edgar’s fault. Various medical interest groups–the hospitals, the doctors, the rehab programs–lobbied to prevent their low-income patients from being scooped up by for-profit HMOs and sent elsewhere for care. These so-called “carved-out” populations greatly complicated Illinois’ managed-care application to the federal government, which reimburses roughly half of Medicaid’s cost. After three years of back-and-forth with Washington over how his MediPlan Plus program should work, a frustrated Edgar decided on another approach. The strategy now is to take advantage of newly liberalized federal rules and expand the state’s existing, voluntary managed-care option.
Meanwhile, Congress last summer approved another health-insurance program for low-income families, this one aimed at working-class kids whose parents lack coverage. Illinois can tap up to $122 million a year in federal “Kidcare” funds if it can come up with an acceptable plan and 35 cents in matching funds for every federal dollar.
Gov. Edgar recently announced how the state would proceed: Illinois will expand its Medicaid eligibility limits. But while federal rules permit coverage of kids in families that earn up to twice the poverty level (the poverty level being $16,000 for a family of four), Edgar would extend eligibility only to 133 percent of poverty level.
Why not open Medicaid to all federally eligible kids, one might ask? The answer, apparently, is that GOP legislators want to set aside money for a non-Medicaid approach that might work better in the suburbs. They want to give private insurers like Blue Cross/Blue Shield a crack at writing kids-only policies, with premiums paid by the state. Edgar has set up a legislative task force to see how such a public/private program could work.
The history of Illinois’ problem-plagued Medicaid program is such that it’s hard to fault the governor and his legislative allies for seeking other options. Then again, four years of fumbling with Medicaid managed care raises doubt about Springfield’s capacity to design and oversee this kind of hybrid public/private insurance for children.
Straightening out Medicaid, now complicated by Kidcare, should be a top priority of Jim Edgar’s final year in office.
