Gov. Bruce Rauner makes major Medicaid proposal

The proposal to increase the percentage of Medicaid medical cases that move through “managed care” was unveiled on Monday, February 27. The state’s chief executive called for expanding existing Medicaid managed care programs to cover 80% of Illinois’ three million Medicaid patients. This would mark a major increase in managed care from the current percentage of nearly 67%. In Medicaid managed care, private insurance firms serve as “gatekeepers” for treatments, performing a role similar to insurance firms that manage groups of families that receive employment-based health care.

In his proposal, the Governor noted two large groups of Medicaid patients that have not yet been moved to managed care. Many children under the supervision of the Department of Children and Family Services (DCFS) have not yet been moved to managed care; their medical care is protected by legal case law, and the move has to be performed in a manner that complies with their legal standing. Some rural Illinois counties do not yet have a Medicaid managed care provider network in place.

Governor Rauner also announced a major push to turn what have, up to now, been notional savings to taxpayers from Medicaid managed care into real savings. The effort will include rationalizing the managed-care network, better coordination of patient care, and moving reimbursement from a treatment-based model to a results-based model.

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