| By Bruce Japsen | An advocacy group for the disabled is urging Gov. Pat Quinn’s health care team to abort a plan requiring 40,000 Medicaid patients enroll in HMOs.
Access Living of Metropolitan Chicago said it “strongly objects” to the effort by the Illinois Department of Healthcare and Family Services, which runs the Medicaid program for the poor. The department has issued a request for proposals by managed-care plans to provide medical care services to 40,000 seniors and adults with disabilities in Cook, DuPage, Kane, Kankakee, Lake and Will counties. |
• Illinois seeking private partners to provide care for Medicare patients |
HMOs are the most restrictive form of health insurance in that they restrict their subscribers choices to doctors and hospitals in their networks. The state, however, has said giving the patients choices of two HMOs would assign the Medicaid patients a primary care physician and a network of services that would more closely follow their medical care and keep them out of expensive hospital settings.
“Historically, due to restricted provider networks, and because control is taken from the consumer and put into the hands of the primary care physician, who serves as a gate keeper, managed care systems limit access to specialists,” said, Tom Wilson, Access Living’s health care reform leader.
Why should people insured by the state have better healthcare coverage than those of us working? Many of us are insure by HMO’s and do just fine accessing care within their networks. The Medicaid managed care entities have contracts with tertiary facilities for those who need specialized care. If the care is managed by one physician, the continuity increases.
If you don’t like the FREE care, pay for what you want. The rest of us folks have to live with whatever our insurance co chooses to allow. Suck it up. Sorry, this is the reality.
People with disbilities typically need the care of specialists – NOT a GP. Often they need a specialist who is experienced with their disability and who is far removed from the area where they live and have to travel. HMOS are notorious for refusing specialist care and picking the specialists they do list based upon price – not competence and certainly without regard to their experience with the complications of illnes which is disabling. “Living with what an insuranceHMO company chooses” can mean increasing illness and even death for a person with phsyical disabilities.
people who think this is a good idea for people with disabilities, are clueless about healthcare. this is a horrible idea.
This is a horrible idea! It sounds great- someone who will help make sure that people get what they need and coordinate it, but it doesn’t work that way. There are already 3 managed care plans which work with medicaid and unfortunately, it isn’t working. I speak as a professional who works for the state and interacts with these plans for people in crisis. The “in-network” providers are not always appropriate or available. Often times, those who are “in network” won’t even take the referral because the slots that have been set aside for medicaid patients are full or because they haven’t gotten paid from the state. The decisions made are arbitrary and have nothing to do with the needs of the patient. One time, I was trying to get an inpt place for a suicidal pt (our hospital was not in network for this particular HMO) who had a chronic medical condition. We could’ve handled the situation, but the HMO would not allow the admission. I could not find any hospital on the preferred list who would take the patient. The patient was in the Emergency Room for hours upon hours. I asked the HMO for a waiver since they could not meet the patient’s needs and they refused and started referring to the same hospitals
(who had already refused) over again. The pt. became disgusted and ended up eloping from the hospital. From then on, we set a maximum amount of time before we would just admit the patient (IF we have an open bed), but it isn’t fair to expect a hospital to treat the patient for free or to the patient to be charged exhorbitant rates that she had no hopes of paying when she did have insurance and could not access in network providers due to no fault of her own. We discourage pts from staying on medicaid HMOs. Unfortunate, it is not the same when dealing with medicaid pts as when dealing with those on private or employer sponsored HMOs. It does not work!
This is a bad idea all around!! Straight Medicaid is not taken by the majority of doctors in Cook County, and elsewhere, because it doesn’t pay much. Managed care Medicaid will pay nothing to doctors and no doctors or hospitals will be willing to accept it!!
This is a bad idea all around!! Straight Medicaid is not taken by the majority of doctors in Cook County, and elsewhere, because it doesn’t pay much. Managed care Medicaid will pay nothing to doctors and no doctors or hospitals will be willing to accept it!!
Come on dude, these facts* and proof* i mean who is posting* lol