State proceeds on health insurance enrollment
Editor's note: See Thursday's print edition for a Q&A by Debra Pressey with the Department of Healthcare and Family Services and representatives of the firm that evaluated the state insurance bids, and more from Tom Kacich on what may happen next politically.
SPRINGFIELD — The Illinois Department of Healthcare and Family Services is pushing ahead on enrollment in new health plans for state employees and retirees, despite a legislative oversight commission's decision to reject the agency's plan to shift many of those state members into a self-insured program.
"We believe the attorney general was pretty clear in her opinion of what COGFA (the General Assembly's Commission on Government Forecasting and Accountability) is permitted to do, and that does not include approving or denying (insurance) contracts," HFS spokeswoman Stacey Solano said Wednesday afternoon.
Plus, she said, the Executive Ethics Commission's decision Tuesday to uphold the insurance contracts selected by the state agency and deny protests filed by two rejected HMOs — Health Alliance Medical Plans and Humana — shows the insurance vendors were selected in a fair process, she said.
"We will continue that process so that we can ensure continuity of care for our members, so that by July 1 they'll be with their new providers," Solano said.
If HFS succeeds in carrying out enrollment in new health plans, the question for Carle patients is how much will it cost them to keep their current doctors.
That would depend on whether Carle elects to sign on to become a provider under "tier one" of the two new Open Access Plans — both of which are currently the only managed-care plan choices available to state employees and retirees in East Central Illinois for the upcoming benefits year starting July 1.
Tier one of those three-tier plans offers HMO-like benefits and the least out-of-pocket costs for state members.
Carle is still weighing its options, spokeswoman Jennifer Hendricks said Wednesday. However, whatever decision Carle makes will involve all its physicians, she said.
"We continue to carefully analyze insurance contracting options for the organization on behalf of our patients. Insurance contracts are complex and cannot be immediately negotiated," she said in a written response to a News-Gazette inquiry. "We will provide updated information to patients as soon as determinations have been made to help state employees choose an insurance plan that will provide access to Carle physicians."
On Wednesday morning, COGFA passed a resolution rejecting what it contends is a new policy to shift large numbers of state employees and retirees into self-funded Open Access Plans, but its unclear how that resolution affects HFS and the enrollment process that's been launched.
Health Alliance Medical Plans executives regarded the COGFA vote as a victory, and the company is now telling its members this issue is far from resolved.
"This is still a very uncertain situation, and we sympathize with the members who are hearing contradictory messages," the company said in a statement released after the COGFA action. "Fortunately, the benefit choice period has been extended, so they will not be required to make any immediate changes."
Health Alliance officials said they're not sure what comes next, but they expect the Quinn administration to "stop this procurement and regroup."
Hayes said as far as Health Alliance is concerned, COGFA has authority over a policy shifting state workers into a self-funded program, "and if the administration chooses to ignore that, than I think the Legislature will have something to say about that."
Here is a summary of the analysis of the bids, by consultant group Mercer Health & Benefits.
MoreI live in McLean county and even though CMS says the HMO through Blue Cross is available to me when I called I was told it was not. I would be required to go into the Open Access Program which would cost me almost three times as much as the HMO (Health Alliance) which I currently have. I taught in a small rural school district in southern Champaign County where salaries were very low and my pension is also very low.
I think this has been much worry for State plan participants for nothing. The state could have avoided all of this controversy had they put out information to participants in the beginning. IF Carle doctors would just sign up with Personal Care or HealthLink, there would be no change from the HMO to TIER 1 of the OAP. The only difference now is that you have to use Christie/Provena doctors. HealthAllaince/Carle simply priced themselves out of the market by making access to Carle doctor network exclusive to their own HealthAlliance. It worked in good times, but when the state needs to save every penny they can, we apparently can't afford Carle docs. And really, as a very familiiar user of both Carle and Christie/Provena, there really isn't that much difference. In fact, Personal Care has a much more broad choice of specialists than Health Alliance. We all just need to take a deep breath and wait for Carle docs to make their decision as to whether or not they want to continue to care for the State plan participants. If not, there are many VERY good doctor options out there on the Personal Care and HealthLink plans, and from what I have seen, the TIER 1 is identical to the HMO!
I agree that there are many good doctors out there besides Carle physicians. But as a lifelong Carle patient, I am reluctant to have to find one of those other good doctors. Because I already have good doctors, and more importantly, they know me and my family health history. It is just daunting to think of having to start over with someone else is all. I have been studying the new health insurance plans, though, and you are right. There really is no difference at all between the plans themselves, and I think that many people might actually pay *slightly* lower premiums (I could be wrong on that, though). Whatever happens, I hope that Carle can make a decision before June 17 because that's how long we get to decide which health plan to take.
The state would be self-insuring, thus the state would have the risk rather then an insurance company. The state does not have to meet the federal regulations of ERISA which private employers do. Can employees sue the state in the event the state unduly limits payments to the health care providers and requires the employee to pay? Employees of private companies have but it doesn't seem clear the rights of state employees without the ERISA protections. State self-insured plans do not have to meet many state laws either, I do believe employees public or private should have protections.
Christie has said they cannot take all of the patients. Both the HealthLink and PersonalCare mainly use Christie.
The self-insured PPO plans are much more confusing then the HealthAlliance HMO especially in regard to the prescriptions which would be handled by MEDCO. When I called MEDCO they were not even aware they handed the PersonalCare PPO perscrtiptions yesterday.
A self insured option is the worst possible scenario as far as I am concerned. The dental program is a self managed plan and when the state decides they can't pay anymore, they stop. Most dentists want their money up front. You wait on the insurance to pay. This is because ILLNOIS IS A DEADBEAT STATE! The governor just wants to control the money so he has another pot to steal out of! I will have to go with anything but the plan that the state manages!
No raises in over 5 years, cost of living sky rocketing and now the crooked politicians want to manage my healthcare? Get me out of this place!
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