The state of Illinois is about to overhaul the way it provides health care to an estimated 74,000 of the state’s most vulnerable children and young adults, and the prospect of that is making many lawmakers and health care providers nervous.

At issue is a plan by the Department of Children and Family Services to place all of the children under its charge into a single managed care health insurance program, similar to those that now manage the bulk of the state’s Medicaid program, by Nov. 1.

Those involved will be an estimated 17,100 children in foster care, another 18,800 former foster children who still receive health coverage from the state, plus another 38,200 children with special needs that qualify them for federal Supplemental Security Income benefits.

Managed care is a system in which private insurance companies, known as managed care organizations, or MCOs, are paid a flat, per-patient monthly fee to manage the health care of Medicaid patients. In Illinois, it has been the source of controversy, especially among health care providers who have complained about late reimbursement payments, high rates of claim denials and lengthy appeal processes to resolve claim disputes.

I want to acknowledge that we’ve had some growing pains with managed care in Illinois,” Theresa Eagleson, director of the Department of Healthcare and Family Services, the agency that administers Illinois’ Medicaid program, told lawmakers during a hearing Tuesday, Sept. 10, in Chicago.

Eagleson, along with Leslie Naamon, president and CEO of IlliniCare Health, the company selected to run the program for DCFS children, tried to assure lawmakers they are trying to work out those issues before the new program launches.

Some lawmakers indicated Tuesday they were just beginning to learn about the transition, and some, like state Rep. Celina Villanueva, D-Chicago, said they were not comforted by what they were hearing.

I don’t need fluff. I need answers,” Villanueva said. “I acknowledge that this is new and this is unique, and that in and of itself is great. But with that also comes the situation where DCFS right now is not in the best light.”

A number of lawmakers also questioned whether managed care would be appropriate for those children and young adults because of the number of times they are moved from one setting to another. And they expressed particular concern about the children who age out of the system, many of whom lose contact with state officials and therefore may never learn about their health care options.

Tuesday’s hearing was for discussion purposes only and no action was taken. But many lawmakers who were present indicated they wanted to be kept informed as the scheduled start date approaches.

 

Lawsuit against opiod firms

Illinois Attorney General Kwame Raoul this week said he would reject a settlement agreement with opioid manufacturer Purdue Pharma under its reported current terms and announced a lawsuit against several other opioid manufacturers.  

In April, Raoul’s office filed a lawsuit against Purdue Pharma, the manufacturer of the opioid OxyContin and defendant in thousands of other lawsuits from local municipalities and states affected by the opioid epidemic.

Raoul’s suit alleged the company “dispatched sales representatives to Illinois hundreds of thousands of times” between 2008 and 2017, and “funded third-party publications under the guise of educational materials to promote opioids and downplay their risks.”

Raoul alleged these tactics more than tripled prescriptions of Purdue’s opioids in Illinois. In a news release, he pointed to Illinois Department of Public Health statistics that showed more than 2,000 Illinoisans were killed by opioid overdoses in 2017. IDPH also reported instances of babies born with neonatal abstinence syndrome, which can be caused by opioid exposure, increased by 64 percent from 2011 to 2017.

In August, Raoul expanded the suit against Purdue to include members of the Sackler family, which founded and operates Purdue Pharma.

Raoul’s statement was in response to media reports that detailed a tentative settlement between Purdue and thousands of municipal governments and more than 20 states.

Raoul, however, was among at least 20 attorneys general who told NBC News they had not agreed to the deal.

Raoul filed a similar lawsuit Tuesday, Sept. 10, against 16 other opioid manufacturers.

 

Nursing ratios

Advocates for a law that would limit the number of patients each hospital nurse is allowed to care for at one time are touting a new national survey that suggests such a rule would lead to better working conditions for nurses and better care for patients.

But Illinois’ leading hospital lobby group remains solidly opposed to the idea, arguing it would result in the closure of many hospitals, especially in rural areas, and accelerate the already rising cost of health care.

The survey was conducted in 2018 by the group Nurses Take DC, a national organization that lobbies for stricter nurse-to-patient ratios. Two Illinois-based organizations, the Illinois Economic Policy Institute and the University of Illinois’ Project for Middle Class Renewal, then took the results of that survey and produced a report on the differences between Illinois and California, which so far is the only state to impose nurse-to-patient ratio limits.

By reducing patient-to-nurse ratios, enacting a safe patient limits law in Illinois could improve occupational safety, increase nurse retention rates, and promote better health outcomes for patients and have little to no negative impact on the financial performance of Illinois’ hospitals,” the Illinois groups said in their report.

However, the survey found, only 29 percent of Illinois nurses who responded to the survey indicated their hospital has such a committee. And of those, fewer than half (44 percent), said their recommendations were being implemented in daily staffing decisions.

In addition, the survey found that Illinois nurses, on average, are responsible for 5.2 patients at a time, compared to 4.3 patients in California, and that only 18 percent of Illinois nurses considered the nurse-patient ratio to be “safe,” compared to 40 percent in California.

A bill that would have imposed minimum nurse staffing levels for hospitals was debated in an Illinois House committee earlier this year. House Bill 2604, sponsored by Rep. Fred Crespo, D-Hoffman Estates, passed out of the Labor and Commerce Committee in March but was never voted on by the full House.

That’s partly due to strong opposition from the Illinois Health and Hospital Association, which argued strongly against the bill.

Mandatory nurse-staffing ratios will not improve patient outcomes or quality,” IHA spokesman Danny Chun said in a separate interview.

And he said the results would be “devastating” for rural hospitals in Illinois, many of which are already struggling financially.

 

Capitol News Illinois is a nonprofit news service operated by the Illinois Press Foundation that provides coverage of state government to newspapers throughout Illinois. The mission of Capitol News Illinois is to provide credible and unbiased coverage of state government to the more than 400 daily and weekly newspapers that are members of the Illinois Press Association.