State: Deadline for insurance plan won't change
CHICAGO — A legislative panel will be asked to vote on emergency 90-day health insurance contracts for state employees and retirees today (Tuesday).
But University of Illinois employees are being warned to be prepared to make a choice with what's available now.
Illinois Department of Healthcare and Family Services spokesman Mike Claffey said late Monday the June 17 enrollment deadline won't be extended — despite the new developments that are adding even more confusion to the enrollment process.
The Commission on Government Forecasting and Accountability, set to meet at noon in Chicago, is also set to discuss self-insured Open Access Plan contracts that it rejected in a May 25 action.
Sangamon County Judge Brian Otwell on Friday entered an order directing Gov. Pat Quinn's administration to temporarily stop contracts with the only managed-care plans available to state employees and retirees in many counties in East Central, southern and western Illinois while lawsuits filed by Health Alliance Medical Plans and Humana work their way through the courts. The administration filed an appeal of that ruling on Monday.
The Department of Healthcare and Family Services will appear before the Commission on Government Forecasting and Accountability at noon today to seek approval of an interim solution for state employees — to offer health coverage past June 30 through all or some of the health plans state employees and retirees have now for 90 days, and then extend those plans for 30 days as needed until the litigations are settled, according to COGFA Deputy Director Trevor Clatfelter.
COGFA's authority extends only to the self-funded Open Access Plans, he said, but the administration is expected to bring to COGFA both 90-day HMO and Open Access Plan contracts.
"HFS would probably want us to clarify that we would like for HFS to move forward with seeking some continuity, even though the fully insured (HMOs) isn't under our authority," he said.
"But HFS is going to have to go out and negotiate these rates with the current provider, and if the current providers choose not to negotiate in good faith, I don't know what the next step is," Clatfelter also said. "HFS is still going to have the autonomy to say, that's not a good price, we can't move forward with that."
COGFGA, set to meet at noon in Chicago, is also set to reconsider the self-insured Open Access Plan contracts with HealthLink and PersonalCare that it rejected in a May 25 action.
University of Illinois employees were warned on a benefits website to be prepared for a variety of scenarios.
"Unless emergency contracts can be entered into or the trial court's order is reversed or superseded before July 1, any member not enrolled in either HMO Illinois or BlueAdvantage HMO will be automatically defaulted into the Quality Care Plan effective July 1, 2011," the website states.
The HMO Illinois and BlueAdvantage plans are Blue Cross and Blue Shield plans that aren't available in this area.
Health Alliance spokeswoman Jane Hayes said the company has received calls from many anxious people about the latest developments.
"We just hope HFS does the right thing here," she said.
MoreThis just goes to show that illegal or not, HFS is going to stick with their choices for state employee coverage and they don't care who says they can't. Whether it be a judge, lawmakers, or the people themselves, they don't care.
Pretty much at this point they are trying to save their own jobs and careers, because if they were to admit they violated either the law or procedure in the procurement process, you can bet the entire department would undergo a turnover and key positions replaced. If they had only admitted to using flawed savings calculations and not following their own guidelines to begin with, they probably would have been forgiven since they were given wrong info to base the decision on to begin with.
We can all pretty well be assured the state will not "do the right thing" considering the way this has gone already.
It sounds like COGFA will vote to extend all the contracts, the state will refuse to extend the contract for the HMO's but extend the contracts for the OAP's by Friday, possibly even today.
The state will then "allow" people to enroll in the OAP's again, and if you haven't done so by Friday, you will default to the QCHP plan. So the state ends up forcing everyone where they want anyhow.
They state then goes to Court, says problem solved, and the case gets dropped. The state will probably not even have to bother with their appeal.
QCHP (another self-insured state plan) payments have been so late the providers have come after enrollees for the states share of the payment in some cases. The state has to pay interest on the late payments, probably one reason why QCHP costs so much. Some providers ask patients for payment before service, some providers just won't take the QCHP patients.
... but it won't be over if the State rejects HA's HMO, because that would be such a 10-year hit for HA that the court case would still be pressed by HA. The COGFA reasoning made the injunction an easy call, but there are numerous other allegations in the court case that won't disappear after the COGFA meeting today: conflicts of interest, faulty scoring, etc. Between the court case and union grievance, HFS will have to come up with a schema that includes HA or this will drag on longer than the proposed contract timeframe.
It is sad that Health Alliance will lose employees without the State contract. But, if they aren't willing to be competitive with a state contract, they SHOULDN"T be able to politically or legally force anything. That is the frustrating thing about this, we want to have Health Alliance, but it is not right for them to be given a contract if they aren't competitive. That would be like Champaign playing Chicago politics!
But that's why they're suing -- the process wasn't conducted fairly. Health Alliance contends they did have a competitive bid. I believe them more than I believe the state, because the state can't back up any of the claims it has made about cost savings with facts. Saying they think the market will adjust isn't the way the state is supposed to do business -- they are supposed to base decisions on what is already in place at the time the RFP is issued.
But what is most unbelievable about the whole thing is that they are sticking to their selection date. No one knows anything -- except, of course, the Chicago employees, whose choices did not change. It's enough to make anyone reach for their blood pressure medicine.
They are suing about the Open Access Plans...something they didn't even submit a bid for. So now, they have taken away the ONLY options (Health Link and Personal Care) that people in East Central and Southern Illinois have. If Helath Alliance wanted to be competitive, they shold have submitted an OAP bid. Now, because of them we have to pay almost 3-4 times what we have been paying for decent health care, I personnally am losing all of my doctors, and cannot see my specialists in Chicago. At least with the OAP's I would have been able to afford the extra costs....now I will have to go without doctors and some of my prescriptions
So since the cheapest is always the best, why is quality care offered anywhere in the state?
Just choose the cheapest, whether HMO, OAP or whatever in each area.
Oh, right, the state is actually supposed to consider more then just cost in the decision according to the state employee health care law.
What is not reported is that there are 10's of thousands of state employees on the Personal Care HMO right now. For those employees, there is NO change in coverage or doctors under the Personal Care OAP, Tier 1. Also for the Health Alliance HMO employees, the Personal Care and Health Link OAP plans give them access to Carle docs on Tier 2. Depending on usage on Tier 2, your actual out of pocket costs may be very close to the same as on the HMO, or Tier 1. For my family, (who have been on Health Alliance HMO for years) we had performed an in-depth analysis of our usage and determined the Personal Care OAP was actually a good deal.....But Health Alliance went to court and got that taken away! I hope Health Alliance just shuts up and goes away so that employees can have at least some kind of choice!
Did you ever think maybe the state should have handled this a bit better.
After all the only reason the Judge stopped the OAP's is because the plans are self insured, meaning the state of Illinois is at risk for the bills and pays the bills which gives COGFA the right to let the state proceed or not on the OAP's.
Nor were the plans ready with a network on January 1st, they are still in flux on their network.
You are so upset at Health Alliance when they just exercised their rights under the law, it is our employer - the State of Illinois - that is supposed to make sure we get continuance of benefits, at much the same price. It is our employer that failed to do that.
Another example of how Illinois works. If you loose a competitve bid..just find some looney judge to engage a lawsuit. Hey, Carle....you are not entitled to this business unless you have the best bid...quit playing lawyer and be a bit more competitve the next time.
Can I please just have my PersonalCare OAP? QCHP will increase my monthly premiums 67% even though I hear we'll get a "special reduced rate". Whatever!! I don't want them. How about the State giving me what they pay for my current coverage every month and I'll go get my own. Sounds like a plan to me.
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