Health insurers take State of Illinois to federal court – Health Care News

on May24

24 May 2017 | 10:30 am

11:30 a.m. update: No decision was made today. The case is scheduled to return to court next week.

Earlier coverage:

A federal judge could decide today whether insurers collectively owed more than $2 billion by the state of Illinois can move to the front of the long line of vendors waiting to get paid.

If they win, Illinois Comptroller Susana Mendoza, who pays the state’s bills, says she could lose the little room she has to decide who gets paid first. Currently, she says, she prioritizes payments for agencies that care for the most vulnerable populations: children, elderly and people with disabilities, among others.

“They can’t speak for themselves,” Mendoza told the Crain’s editorial board yesterday as she painted the picture of a state in crisis.

Illinois hasn’t had a budget for roughly two years as Republican Gov. Bruce Rauner and the Democrat-controlled Legislature bicker over a deal. Caught in the middle are nonprofits, schools and companies that do business with the state.

The bill backlog for vendors has reached $14.4 billion, Mendoza said. Of that, private insurers that are contracted to manage the care of about two-thirds of Illinois’ 3.1 million Medicaid recipients are owed more than $2 billion. The budget crisis has created a ripple effect: When insurers don’t get paid, they don’t pay doctors and hospitals. Patients, particularly those on the state health insurance plan, lose out if their providers turn them away or make them pay upfront for care.

The state owes another $800 million in late interest payments.

Without a budget, the state will owe more than half of its budget to the bill backlog, or $16 billion by the end of the fiscal year, June 30, Mendoza said.

Consent decrees and court orders dictate how about 90 percent of bills are paid. But Mendoza has the discretion to prioritize who gets the remaining 10 percent, a small pool of money she wants to protect.

If the insurers win their federal case, the comptroller could lose control to the court of where that money flows. A victory for the insurers could be a “breaking point” for Illinois, she said.

Even if the carriers lose, other vendors will likely try to get in the front of the line, too. Good luck getting paid.

“There is not enough money to go around,” Mendoza said. “It’s not even close.”



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