Why a Medicaid card does not equal care in Illinois

A recent report from the Inspector General at the U.S. Department of Health and Human Services, or HHS, confirms that it will likely become harder to get access to care through Medicaid’s managed care program – a program that Illinois is using to provide care to an increasing number of Medicaid enrollees.

With Medicaid enrollment ballooning, this is bad news for Illinoisans.

More than 400,000 people in Illinois have been added to the Medicaid rolls in 2014 as part of the Affordable Care Act, or ACA, with little planning on how enrollees are going to obtain health care in an already-strained system.

When the ACA was signed into law, about one-third of Illinois physicians were already refusing new Medicaid patients. Now that Illinois’ Medicaid program is moving more patients into managed care, where payments to insurers are based on the number of enrollees rather than the number and type of doctor visits, the HHS report raises serious questions about whether Medicaid’s access problem is going to worsen.

The federal government realized the problem of limited access to doctors under the Medicaid program, so to entice physicians to participate in the Medicaid program, federal officials began temporarily paying some doctors higher fees for some routine primary-care services. But temporarily boosting a narrow subset of physicians’ reimbursements in hopes of greater participation in the Medicaid program was a gimmick. It does nothing to address the underlying problems of accessing care in a broken system.

With a target of enrolling half of the state’s Medicaid population into managed care by the beginning of 2015, the managed care population will likely face the same Medicaid access problems that have long plagued the program. According to the Inspector General’s report, Illinois has no standards for maximum distance or time an enrollee should have to travel to see a provider. The state does have a standard of a 35-day maximum that an enrollee should have to wait for an appointment for primary care, but no cap on the number of days to see a specialist.

The ACA Medicaid expansion essentially embraced an approach that increases the program’s enrollment numbers without thoughtful and equal regard for ensuring timely access to that care. The only consistent winners of this approach, up to now, have been the politicians who enthusiastically take political credit for passing out medical cards, but to do so without providing patients true access to care or control over health care decisions.

A Medicaid card is not the same thing as accessible health care. And expanding the Medicaid program ranks without addressing that simple fact is harmful to patients.

Naomi Lopez Bauman is Director of Health Policy for Illinois Policy Institute.