Illinois backs off mandatory Medicaid managed care;
enrollment will be strictly voluntary under new plan
SPRINGFIELD, IL—Illinois’ 1.3 million Medicaid recipients will enroll in managed care plans on a strictly voluntary basis under the state’s dramatically revised Medicaid managed care plan.
Illinois officials have made it clear that the new plan is not going to look like MediPlan Plus, the controversial mandatory managed care plan approved by the legislature three years ago. That’s a major shift from a month ago when officials had said the new program would closely resemble MediPlan Plus.
The new proposal is likely to have far fewer "carve-outs" for children’s hospitals and school-based health clinics. Also, health plans sponsored by doctors, hospital or clinics will probably be required to meet existing state financial requirements for HMOs, requirements they would have sidestepped under MediPlan Plus.
The proposed changes in direction have brought little criticism, perhaps because MediPlan Plus was generally believed to be a poorly designed political compromise that would prove enormously difficult to implement.
How many Medicaid recipients will join HMOs under a voluntary program remains a question mark.
"I’m a little skeptical that a program without a mandatory default to managed care will increase enrollment substantially," said Jeffrey Miller, former Public Aid director and current chair of the state’s Medicaid managed care advisory committee.
Chicago Tribune, Nov. 11, 1997
Broward County Mental Health Court may keep
people out of jail, but won’t get them into treatment
TALLAHASSEE, FL—The Mental Health Court in Broward County, Florida may be keeping people with mental illness out of jail, but it is not necessarily getting them into treatment. Residents charged with petty crimes may be directed to take medication or enter outpatient treatment, but, under the law, they have the right to decline drugs or treatment.Critics say this creates a revolving door situation with the same offenders appearing again and again before the court.
The court can send offenders to an inpatient facility, but under the law, they cannot be kept in a psychiatrist ward after they’ve been stabilized.
Advocates for the mentally ill say lack of community health options for people with mental illness will also hamper the effectiveness of the Court.
Fort Lauderdale Sun Sentinel, Oct. 12 , 1997
Federal judge backs plan to to use $2.5 million from Marshfield Clinic lawsuit for charitable health care
MADISON, WI—A $4 million settlement from an antitrust lawsuit against the Marshfield Clinic in Wisconsin may be used for charitable health care under an agreement backed by a federal judge. The 200,000 residents of mostly rural counties who are covered under the class-action suit have until Nov. 28 to object to the plan.
The proposal is to put about $2.5 million in an investment fund for charity after legal costs are covered. The lawsuit covers anyone who purchased health care from Marshfield Clinic after July 24, 1992.
The class-action suit contends that the clinic and others conspired to eliminate competition in the region. The lead plaintiffs, Henry and Joann Rozema, charged that the Clinic made agreements with other health care suppliers that led to overcharges. Marshfield clinic denies any wrongdoing in the settlement.
Under the agreement, for the next two years Marshfield Clinic is barred from raising its medical fees higher than the average medical consumer price index over the past five years. It also is required to maintain its annual level of uncompensated charity care at or near the $4.8 million level of 1996.
About 80% of practicing physicians in four counties are employed or affiliated with Marshfield Clinic. In 1995 Blue Cross & Blue Shield United of Wisconsin won a jury verdict that Marshfield Clinic’s monopolistic practices had cost the insurer money. A federal appeals court in Chicago overturned much of that ruling, concluding that the clinic’s rural location made it a natural, legal monopoly and that health maintenance organizations are not a distinct health-care market subject to anti-trust laws. (Blue Cross charged that the Clinic’s monopoly interfered with its plans to operate an HMO.) An appeal is pending before the 7th U.S. Circuit Court of Appeals in Chicago.
Wisconsin State Journal, Madison, WI, Oct. 21, 24, 25, 1997
Mass. consumer group says many insurers ignore law requiring them to sell non-group policies
BOSTON—A consumer group charged that many insurers in Massachusetts were not complying with a new law that requires them to sell non-group policies. Under the new law, which took effect in October, all insurance companies and health maintenance organizations covering more than 5,000 policyholders in the small group market must also sell non-group policies. These policies must be provided without any waiting periods or pre-existing condition exclusions.
The consumer group, Health Care for All, said only two companies—Harvard Pilgrim Health Care Inc. and Blue Cross & Blue Shield of Massachusetts—were in full compliance with the law. Other insurers said they didn’t sell the policies or hadn’t set rates yet.
Company spokesmen said that their sales agents had given out incorrect or incomplete information. "If their sales agents don’t think they offer the product, then that’s (tantamount to) not offering," said Joanna Connolly, deputy chief of regulated industries in the attorney general’s office. The attorney general’s office, which conducted a similar survey, sent letters to 10 carriers and threatened three carriers with fines.
Boston Globe, Oct. 15, 17. 1997
KY will consider risk pool again in January
FRANKFORT, KY—After spending $600,000 on a special session last month that failed to adopt proposed remedies for a troubled health insurance market, Kentucky’s Legislature is looking ahead to January when the debate is expected to take center stage once again.
Meanwhile, the state insurance commissioner unveiled a plan to minimize rate increases after the legislature’s failure to pass a health-insurance bill. Commissioner George Nichols III asked Gov. Paul Patton to extend an executive order allowing some Kentuckians to renew their insurance policies at existing rates. Residents who hold health-insurance policies bought before July 15, 1995—the day the state’s insurance reforms took effect—to continue renewing their policies rather than purchasing standardized, community-rated policies.
During last month’s special session, the commissioner and Gov. Patton supported a bill that would have placed unhealthy people in a so-called high-risk pool. They would have been guaranteed coverage, but at rates of up to 150% of the standard rate. The high-risk pool cleared the Senate, but was not approved by the House.
The plan was opposed by several consumer groups, who urged instead that the state adopt a "play or pay" plan, requiring insurance to provide insurance to high-risk residents or pay fees to support companies that did.
Lexington Herald-Leader, Oct. 17, 1997, Oct. 16, 1997.
PA legislation makes Blue Cross Blue Shield insurer of last resort for residents who leave group plans
HARRISBURG, PA—Legislation approved by the Pennsylvania Legislature requires Blue Cross and Blue Shield to cover state residents switching from group health plans to individual policies if no other insurer is willing to cover them.
Under the legislation, signed by Gov. Tom Ridge, the other 70 commercial insurers in the state would not be required to offer insurance.
The Blues also would be prohibited from denying or limited coverage for a pre-existing health problem for any person who has been covered by a group plan for at least 12 months. According to an analysis by one legislator, the bill could require the Blues to hike rates by more than 20%.
The legislation brings the state into compliance with federal law protecting people with medical problems from losing insurance coverage if they lose their jobs. Under the law, states are required to designate an "alternative mechanism" for ensuring coverage.
Earlier this year, the governor signed another bill into law that guarantees coverage for people who have been insured for at least one year if they switch from one group plan to another.
Philadelphia Inquirer, Oct. 30, 1997.
Advocates charge community not getting fair share from sale of non-profit hospitals
SANTA ANA, CA—Consumer advocates charge United Western Medical Centers deceived the community when it sold its non-profit hospitals late last year and promised to set aside the proceeds for a new foundation.
Advocates say United Western officials suggested that more than $40 million would be available, not the $25 million that now may be set aside. United Western said the gap is the result of a misunderstanding of remarks by company officials.
Separately, critics question why Western Medical executives received about $1 million in bonuses shortly before the sale and question how former Western Medical officials wound up running the foundation. Western Medical officials say the bonuses are in line with long-standing company policy and say the board, which also includes community representatives, is well-suited to determine health-care needs of the community.
Los Angeles Times, Nov. 9, 1997
Families of fisherman catch a break—get insurance
BOSTON—About 20,000 families of Massachusetts fishermen will be able to obtain health insurance through the Fishing Partnership Health Plan, thanks to a $2 million grant from the federal Commerce Department. The grant will pay for start-up and pre-development costs.
Beginning Oct. 20, families can obtain insurance at four fishing assistance centers. The Fishing Partnership Health Plan is a joint venture of Caritas Christi, the Archdiocese of Boston health care network, and Massachusetts Fishermen’s Partnership. Premiums will be charged on a sliding scale, with a maximum charge of $400 per month per family.
Many fishermen have seen their incomes decline because of federal restrictions on fishing. A recent study by the Massachusetts Fishermen’s Partnership found that 40% of all fishing families had no health insurance and 70% struggled to pay for coverage.
Sen. Edward Kennedy, who played in key role in obtaining money for Massachusetts, said he hopes the program to insure fishermen may be expanded to Maine and Rhode Island.
Boston Globe, Oct. 2, 1997
No more toasters—KeyBank offers health insurance as part of new strategy to attract small businesses
DENVER, CO—An Ohio-based bank will be offering health insurance to small-business customers as part of a strategy to attract these customers by providing more than traditional banking services. KeyBank, the nation’s 14th-largest bank, rolled out group health insurance to small-business customers in Ohio last month and will provide it to the rest of its markets throughout 1998.
KeyBank has teamed up with Oakland-based Kaiser Permanente and Minneapolis-based United Healthcare Corp. to provide the benefit. The bank, which has been growing nationally as it targets the small-business customer, also offers money management, pension plan services and property and casualty insurance.
Rocky Mountain News, Cincinnati Post, Oct. 18, 1997
FBI to do background check on 48,000 Florida MDs
TALLAHASSEE, FL—To keep or obtain their licenses, 48,000 doctors in Florida will now have to undergo FBI criminal background checks and fingerprinting. Under a new law passed this spring, doctors must undergo this check along with teachers, some social workers, police officers and others.
Doctors who are currently licensed have until Jan. 31, 2000 to renew their licenses under the new law, but doctors in the Medicaid program will have to comply sooner, whenever their state contracts expire. Some doctors said they would stop seeing Medicaid patients rather than be fingerprinted.Sun Sentinel, Fort Lauderdale, Oct. 1, 1997
Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
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