Q&A: Medicaid changes at Decatur hospitals

Jan. 24--What happened and why?

Medicaid is a federally funded program run by individual states for people who can't afford health insurance.

In Illinois, for many years Medicaid recipients were issued a "medical card" that hospitals and doctor's offices accepted and charged the state directly for each encounter.

After the passage of the Affordable Care Act, states began outsourcing Medicaid to private insurance companies, the idea being that those companies could handle the process of running Medicaid better and more efficiently than state governments. This is called managed Medicaid.

In this system, the state would send the managed Medicaid provider a previously agreed-upon payment and the provider would reimburse the hospitals.

But that system has broken down in Macon County. Ideally there would be several providers for Medicaid recipients to choose from. Last year at this time there were two: Health Alliance and Molina. But Health Alliance dropped out at the end of 2016 because of lack of payments from the state.

Now, both hospitals in Decatur -- HSHS St. Mary's and Decatur Memorial -- are severing ties with Molina. St. Mary's ended its relationship as of Dec. 31 and DMH has notified Molina that it is ending its relationship on March 23. DMH, citing its contract with Molina, will not comment until after the contract officially ends. HSHS released a statement saying the termination was because of "ongoing and unresolved issues around medical management, claim payments and credentialing of physicians."

HSHS recently added Meridian Medicaid Managed Care as an option. The state is currently trying to find more managed care provider options for Macon County Medicaid recipients.

How many people does this affect?

There are 32,627 Macon County residents on Medicaid. All of them will need to find a new Medicaid provider or sign up with the state for the medical card.

This does not affect anyone on Medicare or with insurance through the ACA Marketplace.

I live in Macon County and am covered by Medicaid. What does this mean for me?

Anyone signed up with Health Alliance or Molina will need to find a new carrier or sign up with the state for the medical card. Hospital emergency rooms have to accept patients in need and the hospital will help incoming patients get the coverage they need. But Medicaid recipients will have to check with their primary care physicians and specialists to see if they accept the medical card or whatever new insurance they receive. Because of delays with payments from the state, not all doctors accept the medical card.

According to Molina, patients at both HSHS and DMH have coverage for 90 days after the effective termination date -- March 31 at HSHS and May 23 at DMH.

What should Decatur Medicaid recipients do right now?

HSHS patients should call (877) 912-8880 to switch to Meridian or find out what other options they have.

DMH patients should call the business office between 8 a.m. and 4 p.m. Monday through Friday at (217) 876-3785.

Another resource for Decatur Medicaid patients is Crossing Healthcare. Crossing can be reached at (217) 877-9117.

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