Shirley Perez and I will be meeting with Dept. of Health Care & Family Services
Director Felecia Norwood next week to discuss possible options for people with
disabilities losing their specialists and Managed Care Organizations (MCO)
dropping out of the State’s Integrated Care Program. The Arc will advocate
that individuals will be able to continue coverage with individual case
agreements and that participants in the Aetna or other MCO’s can choose
another MCO. Right now, participants are locked into their current MCO until
April, 2016 when open enrollment becomes available.
In addition to University of Illinois Hospital and Health Systems leaving the
State’s Managed Care system, the Health Alliance will no longer be part of the
Medicare-Medicaid Alignment Initiative (MMAI) program after December 31,
2015. As a result, Health Alliance will be mailing a notice to their MMAI
enrollees as soon as possible and no later than November 1 informing them
of this change and letting them know about their other coverage options.
See story on University of Illinois below, Shirley Perez is quoted, The Arc
assisted in the development of this story.
.
Aetna Better Health is terminating its partnership with University of Illinois
Hospital & Health Sciences System, a move that could force some Medicaid
patients covered by the plan to find new specialists.
U of I Health has had a contract with Hartford, Conn.-based Aetna to accept the
plan since 2011, said Kevin Dorsey, executive director of managed care at U of
I Health. The Aetna Better Health plan is provided through the insurer for
disabled adults or adults over age 65 in the Illinois Integrated Care Program
who qualify for Medicaid but not Medicare.
U of I Health, on Chicago’s Near West Side, includes University of Illinois
Hospital, Children’s Hospital University of Illinois, an outpatient care center and
13 federally qualified health centers in Chicago.
REIMBURSEMENT FIGHT
The Aetna plan covers about 1,800 patients who receive primary and
specialized care through U of I Health, as well as another nearly 4,000 that are
referred to specialists there by a primary care physician at another one of the
plan’s partners, Dorsey said.
Aetna Better Health moved to terminate the partnership because U of I Health
would not agree to a request to lower the reimbursement terms.
“Those reimbursement terms were outside of what we could agree to,” Dorsey
said.
Although talks between the insurer and health system continue, U of I Health
sent letters to its patients enrolled in the plan, informing them that they no longer
will be able to receive care at any of the health system’s institutions as of Nov. 1.
Crain’s obtained a copy of the letter (read it below).
PATIENTS WORRIED
Concern is spreading rapidly throughout the disability community, as some
families scramble to find new specialists under that looming deadline.
Shirley A. Perez, a program director at disability program provider and advocacy
organization Arc of Illinois, belongs to one of those families. Her 39-year-old
daughter is enrolled in the plan and sees a specialist at U of I Health for a
seizure disorder.
Perez is worried a change in care could trigger complications with her
daughter’s disorder. She said she has received an onslaught of emails and calls
from families with similar concerns.
“If this is detrimental to me and I’m a professional used to working with the
managed care companies, what in the world are other families going through?”
Perez said.
Coverage likely will continue for some patients under certain exemptions that
are still being discussed, Dorsey said.
SWITCHING SPECIALISTS
Otherwise, patients wishing to remain with their U of I Health specialist likely
will have to find a new specialist in Aetna Better Health’s network or find a new
managed care entity with U of I Health in its network.
Those who want to find another managed care provider will have to wait until
their open enrollment period rolls around, unless there is some exemption
worked out. A representative of the Illinois Department of Healthcare and
Family Services said enrollment is open to individuals for 60 days annually
depending on when they signed up for their plan.
Aetna and U of I Health say they have both committed to making sure patients
find coverage. A spokesman from Aetna said in a statement said the insurer
still is in negotiations with U of I Health.
“Should we not be able to reach agreement, beneficiaries will continue to
receive care through Aetna Better Health’s network, which is one of the
largest Medicaid networks in the Chicago area,” the statement said.
The spokesman declined to answer any further questions.
The continued talks and promises of a smooth transition seemingly are not
helping to allay concerns. Dorsey said these types of termination arrangements
are rare. He has only seen it three or four times in his 12 years on the job, he
said, and even then, something was worked out at the last minute.
Michael Gelder, a senior health policy adviser for former Gov. Pat Quinn, said
the move challenges the whole basis of Illinois’ Integrated Care Program.
“The intent of this Integrated Care Program was to improve access to care,
but more importantly to improve the quality of care that people with disabilities
receive,” said Gelder, a health care policy consultant and adjunct professor in
the Department of Human Development at the University of Illinois at Chicago.
“University of Illinois is a high-quality provider and a significant provider to
people with disabilities, so excluding them . . . is a big problem.”
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)
Tony@thearcofil.org
