Rauner’s Medicaid revamp just became a little less secret – Health Care News

on Dec29

28 December 2017 | 4:39 pm

NextLevel Health is no longer keeping secret how much the Rauner administration plans to pay the private insurer in the governor’s revamped Medicaid managed care program that begins Jan. 1.

Chicago-based NextLevel, led by Dr. Cheryl Whitaker, has released reimbursement rates that detail how much the state plans to pay the carrier for administering medical benefits to a portion of Illinois’ 3.1 million Medicaid recipients.

The move comes after Crain’s revealed earlier this month that the Illinois Department of Healthcare & Family Services, which runs Medicaid, redacted reimbursement rates from the contracts of four of the seven insurers selected for the new managed care program through a competitive bidding process. Crain’s obtained the contracts through a Freedom of Information Act request.

The procurement is believed to be the largest in Illinois history. The contracts are estimated to cost the state $60 billion over four years.

“As a business decision, (NextLevel) has decided to un-redact and make public the rates that were previously redacted,” Whitaker wrote in a letter to the healthcare and family services department, along with its reimbursement rates.

Previously, NextLevel told the state its rates were confidential and if disclosed would cause financial harm. IlliniCare, Harmony and Meridian also asked Illinois to keep their payment rates secret. The state complied, but released rates for three other insurers that apparently didn’t make such a request. They are Blue Cross & Blue Shield of Illinois, CountyCare and Molina.

Rauner announced in February his plan to overhaul Medicaid managed care to improve the program and rein in spending. In managed care, the state pays private insurers to administer benefits to Medicaid recipients, with a focus on preventive care. The idea is to coordinate a patient’s treatment with a team of doctors, nurses and other providers to improve their overall health, thus reducing medical costs.

The controversial overhaul is unfolding rapidly. The healthcare and family services department has said the new managed care program is estimated to save the state $1 billion over four years. That’s largely by paying insurers less.

To win new contracts, insurers earlier this year bid on a range of reimbursement rates provided by the state. The contracts were finalized in late October. Rates that have been disclosed show they vary by the age of Medicaid recipients and where they live. For example, there’s a rate for women who are 19 to 24 years old and joined Medicaid after the state expanded the program, there’s another for special needs children, and another for disabled adults.

NextLevel only will operate in Cook County. Based on a review of non-redacted contracts, the insurer will get paid more for all adult managed care recipients who joined Medicaid when the program expanded under the Afforable Care Act than even Blue Cross, the state’s largest insurer. For example, NextLevel will make $601.04 per month for a 55-to 64-year-old man, compared to Blue Cross’ $588.80 per month, CountyCare’s $581.49 per month and Molina’s $596.15 per month.

But Blue Cross will make more to cover special needs children in Cook County ($998.04 per child per month), compared to NextLevel’s $977.98 monthly fee and CountyCare’s $941.99 monthly payment.

This is just a snapshot of how much insurers will get paid. There are dozens of reimbursement rates, and Illinois won’t disclose how much the state plans to pay three other insurers come Jan. 1.



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