Problems with Illinois Medicaid Doom All Kids Program to Failure

Illinois Governor Rod Blagojevich and the General Assembly took the first real step toward a universal health care program with the introduction of the Illinois All Kids Program, but the attempt at meaningful change in the medical system is doomed to fall flat.

The new program is designed to allow any child to have access to health care. No matter what the parents' income, if the parents' aren't able to provide health insurance and fill out the proper application with the state of Illinois, they can purchase health insurance for their children on a sliding scale fee.

So far, that sounds great, right? Right. It's what the press releases don't say that will cause the problem to fail.
The slick ad and campaign speech presentations on the program neglect to tell potential clients that they will be purchasing a Illinois medical card for their child, not some form of private insurance. That medical care, more often known as Medicaid, is not widely accepted in Illinois anymore, largely due to some of the governor and state legislature's other brilliant money-saving plans.

Doctors, particularly specialists, have long been reluctant to take the Illinois medical card because the state of Illinois is not exactly making anyone rich with what they pay. Take, for example, a basic eye exam for glasses. The exam is in theory covered by the card as are a very basic pair of glasses.

From the doctor's standpoint, an exam for glasses is not something you can rush, usually taking about 15 minutes. For that time, if a doctor is charging a person cash or charging commercial insurance, at the eye center where I worked previously, the charge is $49. The state of Illinois sets a maximum amount they will pay for that service and anyone who accepts the medical card has to agree to take that price. Their price, $27.

Then, if it were a private pay patient or a person with commercial insurance (like Blue Cross or Humana) , the patient would order their glasses or contacts through the doctor's office. Because this is an actual product, there is a huge markup and profit in eye glasses (not as much in contacts) and the business would see a profit there as well.

Not so with the public assistance recipients. The glasses the state will pay for are made by inmates at one of the state prisons. The doctor's office providing the service of ordering, adjusting and distributing those glasses gets paid $10 per pair, no matter how many times they have to fix them, adjust them or bring a patient back to get them right.

More importantly from a recipient's point of view, the glasses take weeks upon weeks to get back to the patient. On average, the wait time is about three months. over the summer and at the beginning of the school year, it's usually closer to four months.

Imagine needing your glasses to see to drive to work or to see the chalkboard or read to do homework and being told you would have to wait nearly half the school year before getting them.

These problems existed before the All Kids program was started in July. There was no plan to address them as part of the new program and the governor was hoping to add 250,000 uninsured children to the state's Medicaid program. Sure, it gave them a piece of paper claiming they had insurance, but if no doctor will accept it, what's the point?

The low-reimbursement problem has also been exacerbated by the general state of Illinois' budget. Politicians have been unwilling to address the budget deficit with any form of clarity and decided in the spring of 2006 to delay payments to medical providers who serve Medicaid patients. In July, the eye doctors I worked for had not been paid by the state of Illinois for more than six months. The state owed the company more than $2 million and was shocked when doctors offices across the state began refusing to see Medicaid patients anymore.

They responded by getting checks out to the medical providers most in the news, like a high-profile case of a three-year-old whose out-of-state doctor had cancelled her appointments because she had the medical cards, but are doing nothing for the great majority of providers.

One local nursing home fears failing their national inspection and worries daily about the care given to their patients because the state has not paid the bill for patients there. In late July when temperatures soared to near 100-degrees, the nursing home thought it would have to shut down because the air conditioning went out and there was no money to pay a repair crew because the state hadn't paid its bills.

A local heating and air conditioning professional made the necessary repairs so the facility could stay open and did it for free, knowing how the state had been about paying its bills. It kept the facility open temporarily, but the HVAC equipment there needs a major overhaul and it won't get it until the state pays some bills.

In the meantime, the state is not appropriating any more money to pay the bills or cutting checks, but is adding new patients to the list of those covered by the programs. State officials promised bills for the All Kids program would be paid within 25 days. Local health officials said, "Yeah, right."

The bottom line is that while the governor and the state legislature had their hearts in the right place, they failed to follow up with tax dollars. Without additional funding and a better plan to deal with the issues already plaguing the Medicaid system in Illinois, All Kids is just a pie in the sky dream destined to fail.