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Quinn Signs Medicaid Reform into Illinois Law

Gov. Pat Quinn signed major reforms to Medicaid into Illinois law on Tuesday, calling it a "landmark achievement" as he was flanked by a bipartisan group of state lawmakers who said the changes aim to reduce costs, pay bills sooner and target fraud.

But some health care advocates said they're concerned because the reforms to the program that provides medical care to the poor include requiring half of all patients on Medicaid be on managed care by 2015.

"It is a landmark achievement, I think, for health care in Illinois," Quinn said.

Quinn said the Medicaid reform efforts are one part of his plan to "stabilize our budget," as Illinois works to plug a deficit that is projected to hit $15 billion in the coming year.

The governor s office estimates the changes will save between $624 million to $774 million over five years. The program's annual budget is $7.6 billion, about one-third of the state's general revenue fund budget. In Illinois, Medicaid is administered by the Department of Healthcare and Family Services and includes about 2.8 million people.

Another cost-saving measure would limit income for future enrollees into Illinois' health care program for children, All Kids, to 300 percent of the federal poverty level.

The law emphasizes HMO-style "managed care" and reduces the use of costly institutions for people with physical and mental disabilities. It would require the state to pay Medicaid bills sooner, reducing late-payment penalties. It also would take steps to ensure ineligible people don't sign up for medical care.

Barbara Dunn, executive director of the Community Health Improvement Center in Decatur, said she has doubts and concerns about plans to require 50 percent of patients to be on managed care by 2015. The center also has offices in Champaign and Mattoon and half of the 19,000 patients it serves are on Medicaid.

"It can work for them but I don't see it as a slam dunk," Dunn said. "I think it's going to be very difficult to do."

Gina Guillemette with the Heartland Alliance in Chicago said she is particularly interested to see how the move to managed care affects populations that the group serves, including the homeless and mentally ill.

"How they proceed is really critical," Guillemette said. "I think that attention to what people's needs are and what best practices are in integrated and coordinated care are really going to be important."

Sen. Heather Steans, D-Chicago, said the bill improves the way government delivers services.

"This is providing better health care outcomes at a reduced cost," Steans said. "We are providing the opportunity to move people out of institutions into home and community-based care settings."

Republicans, like state Sen. Dale Righter of Mattoon, said there was cynicism about any success before work started on the legislation. But the changes are necessary, he said.

"This program was on a collision course," Righter said. "It had an unsustainable rate of growth where liabilities were far outstripping the revenues available to pay for it."

Other changes would help ensure that only eligible people enroll in Medicaid. Clients would have to provide additional evidence that they meet income requirements, live in Illinois and, for continuing clients, that they're still eligible.

Jim Duffett, executive director of the Campaign for Better Health Care based in Champaign, said moving patients to Medicaid managed care is a concern.

"We just want to make sure as this process moves forward that there are extra strong consumer protections for people on Medicaid and for the provider community to also be protected," Duffett said.

HFS director Julie Hamos said the state now has a road map to efficient and effective Medicaid.

"This will not be easy," she said. "We are talking about transforming the system.