SPRINGFIELD - Frustrated with the failure of Governor Pat Quinn to implement the broad Medicaid reforms set forth in the 2011 law and the 2012 SMART Act—even as he advocates for an extension of the Democrats’ 67 percent tax increase, State Senator Dale Righter (R-Mattoon) and State Representative Patti Bellock (R-Downers Grove) rolled out a new initiative placing a moratorium on all Medicaid expansions, including benefit increases, until a 2011 managed care requirement is achieved.
“Gov. Pat Quinn and the Democrat leaders are trying to sell the notion that they have done such a good job of cutting, driving efficiencies into and refining the Medicaid program that we can’t possibly move forward in this state without making the tax increase permanent. However, the facts show that simply is not true,” said Righter.
The two lawmakers are filing legislation that would expand and extend the current moratorium on Medicaid expansions to specifically include a moratorium on benefit increases until the Department of Healthcare and Family Services meets a 50% managed care mandate by the legally established Jan. 1, 2015, deadline.
Bellock and Righter said they feel an added sense of urgency because of recent meetings in which majority Democrats in the Senate and House of Representatives have been pushing for further unraveling of the agreed-to reforms.
“What we have seen since passage of the 2011 and 2012 laws is the ‘un-reform’ of the Medicaid system,” said Righter. “Where the reforms have been implemented, the state has experienced significant savings. However, these carefully negotiated reforms have consistently fallen short of projections and mandated goals because the Quinn administration and Democrat lawmakers refuse to implement the reforms as mandated in law and have quietly worked behind the scenes to undermine and disassemble the bipartisan reforms we enacted.”
In 2011, only 7% of Medicaid enrollees were in a managed care program, leaving the majority of Medicaid enrollees without a medical “home,” with many relying on more costly emergency room care. In response, the 2011 Medicaid reforms mandated that within four years, managed care enrollment was statutorily required to reach 50%. Well over three years later, and quickly approaching the end-of-year deadline, the number in managed care stands at an abysmal 16%.
The lawmakers stress this lagging enactment is indicative of the program’s overall implementation. Many provisions in the SMART Act have been ignored and program expansions have continued. Provisions limiting the number of prescriptions have not been enforced, and the third-party vendor hired to scrub the Medicaid rolls was relieved of its duties—despite saving the state more than $86 million after only reviewing 25% of total Medicaid cases.
“It’s hard to watch the unraveling of so much work that went into negotiating these reforms,” said Bellock. “Every dollar is critical to these programs. Our most vulnerable citizens rely on our state’s Medicaid system, and these reforms were aimed at making sure the resources are there for those who are eligible and truly need it. Not implementing these changes only puts an increasing number of people at risk.”
By zeroing in on the managed care component of the Smart Act, Righter and Bellock are hoping to create a renewed urgency toward the full implementation of the reforms. Conversely, indications point to a move in the opposite direction by legislative Democrats looking to further unravel the reforms as they look to cash in on the extension of the “temporary” income tax increase.