By Bruce Japsen | Some influential state lawmakers are pushing for a delay in a pilot program that would place some elderly and disabled Medicaid patients into HMOs.

The Illinois Department of Healthcare and Family Services, which runs the state Medicaid program for the poor, has issued a request for proposals by managed-care plans to provide medical care services to 40,000 seniors and adults with disabilities in suburban Cook, DuPage, Kane, Kankakee and Will counties. The Medicaid patients have to enroll in one of two health plans.

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 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.

But lawmakers say the state is trying to launch a program before it has
been adequately vetted by lawmakers, medical care providers and other
groups.

“Where is the model in any of our other states that would be a model
for Illinois to have the aged, blind and disabled put into this
integrated pilot program,” said Illinois Rep. Esther Golar (D-Chicago),
chairwoman of the House Disability Services Committee.

Another key concern is whether there is going to be an adequate network
of medical care providers. Medicaid already pays notoriously low rates
to doctors in Illinois so it’s unclear how many physicians will even
agree to be a part of the HMO networks established to care for the
patients.

“More and more physicians are saying: ‘I am not going to deal
with Medicaid,” said Janet Stover, executive director of the Illinois
Association of Rehabilitation Facilities.

Legislation introduced in the Illinois House and Senate would create a
task force of various “stakeholders” that would include consumers,
legislators, medical care providers and state agency staff to assess
whether Illinois is ready to develop a mandatory managed-care program.

For years, the state Medicaid program has offered HMOs as a form of
managed care for poor Illinois residents, largely children and parents
of those children. But that managed care program has less than 200,000
of the state’s 1.9 million Medicaid recipients enrolled largely because
it is voluntary, say health plans and observers.