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Study questions long-term prospects for All Kids

Posted August 10, 2007 11:00 pm

Dean Olsen

Illinois' All Kids expanded health insurance coverage to 54,000 children in its first year of operation, but a study released Friday raises questions about the program's long-term future.

The All Kids expansion, which reached its first anniversary in July, was supposed to be paid for with savings generated by two managed-care initiatives affecting children and adults in Illinois' Medicaid and All Kids programs.

But those initiatives - known as primary-care case management and disease management - have experienced "implementation problems," according to the analysis by the California-based Kaiser Commission on Medicaid and the Uninsured.

The two initiatives are designed to reduce emergency-room use and referrals to specialists, help patients stay healthy and make it easier for patients to find doctors willing to accept payment from the state. They were projected to save the state about $56 million in the first year, more than enough to cover $45 million in anticipated first-year costs associated with the All Kids expansion.

"It is critical for the program's long-term viability that these new managed-care initiatives be successfully implemented," states the analysis by researchers from the Washington, D.C.-based Urban Institute who produced the Kaiser report.

Theresa Eagleson, head of medical programs for the Illinois Department of Healthcare and Family Services, had a more optimistic view of the managed-care initiatives, which she said are on track to deliver the promised savings to the state.

"All in all, I think this has gone great," she said.

She added that the Kaiser report overall was "really positive" and highlighted what she called Illinois' groundbreaking efforts to expand health coverage under Gov. Rod Blagojevich.

Kaiser's case study cites unnamed "advocates" for families and unnamed health-care providers who questioned whether enough doctors could be persuaded to enroll in the primary-care case-management program to serve the 1.6 million Medicaid and All Kids recipients involved.

But Eagleson said her department so far has been able to enroll 2 1/2 times more doctors than needed to care for the Chicago-area and northern Illinois patients to be served, and she believes more than enough doctors will sign up statewide.

The case-management program, known as Illinois Health Connect, assigns current patients to a primary-care physician to establish a "medical home." It is expected to begin in the Springfield area in September but started in the Chicago area this spring.

State officials hope the program discourages patients from unnecessarily seeking care in hospital emergency rooms, where treatment can be more expensive. Primary-care doctors in the program decide whether patients should be referred to specialists.

The Kaiser study said it's too early to judge how well the disease-management initiative is reaching its targeted population of 225,000 Illinoisans who have chronic diseases such as diabetes, heart disease and persistent asthma.

But advocates told the researchers that McKesson Corp. - the company hired by the state to run the "Your Healthcare Plus" disease-management program - hasn't publicized it enough.

Eagleson said state officials have received a "very positive response overall" to the program from doctors.

Jerome Stermer, president of Chicago-based Voices for Illinois Children, said he hasn't heard the concerns from advocates described in the Kaiser report.

"We continue to think this is the right policy choice," he said of the All Kids expansion.

At least 24,000 of the 54,000 children added to the state's health-care rolls are immigrants who couldn't prove their citizenship status when their parents signed them up.

The prospect of the state covering illegal immigrants - a group not eligible for the regular Medicaid program but covered by the state-funded All Kids expansion - has been criticized by some state lawmakers.

The rest of the 54,000 formerly uninsured children became eligible when the legislature agreed to expand coverage to families with incomes exceeding 200 percent of the federal poverty level - with no upper income limit, but with a sliding scale of All Kids premiums.

A total of 164,000 children have obtained state-subsidized health coverage since November 2005, when the legislature approved All Kids, though two-thirds would have qualified under the state's old income guidelines.

A total of 1.3 million children are covered by All Kids, the state's new name for what used to be known as the Medicaid and KidCare programs.

Dean Olsen can be reached at (217) 788-1543 or dean.olsen@sj-r.com.

On the Web: Read the All Kids case study by the Kaiser Commission on Medicaid and the Uninsured at www.kff.org/uninsured/7677.cfm

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