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County may see Medicaid money cut
Plan to close clinics could prove costly as state changes system

Sunday, February 18, 2007
Chicago Tribune
by Judith Graham and Mickey Ciokajlo

Cook County's health bureau could lose an enormous amount of money from Medicaid--its single largest revenue source--if it closes 14 of its 26 medical clinics, the governor's health-care adviser warned Friday.

That's because of fundamental changes now being made to the Illinois Medicaid program, which is adopting a form of managed care.
Under the new system--known as primary care case management--Medicaid recipients will be required to select a doctor to oversee their medical care.

The goal is to ensure needy individuals have a "medical home." Previously, Medicaid members could go to any doctor they wanted and change doctors at will.

More than 819,000 Medicaid members in Cook County will receive information packets over the next five weeks telling them about the changes.

If the county closes clinics and reduces the ranks of doctors, there will be fewer opportunities to sign up Medicaid members for primary care case management, said Anne Marie Murphy, a senior health care adviser to the governor. Patients who had used Cook facilities could end up finding medical homes elsewhere, and Medicaid money would follow them.

The financial losses could be devastating, Murphy said. This year, Medicaid revenues at the county's health bureau are expected to reach about $300 million, or about 78 percent of all funding for patient care.

The state reached out to county health bureau officials last year to make sure they were aware of the upcoming Medicaid changes and prepared to adapt.

"We realized it could severely affect their budgets" if Medicaid patients didn't sign up with the county health system, Murphy said. So "it came as a bit of a surprise to find they were now going to close these clinics."

Dr. Robert Simon, county health chief, said he is aware of the risk but hopes "with the right systems in place, we will retain these patients." The county's 12 remaining clinics should accommodate all existing patients when hours are extended, even though waiting times will become longer initially, Simon acknowledged.

That, too, could be a problem, because the new Medicaid rules require that patients have "timely access" to services, Murphy said.

On Friday, County Board President Todd Stroger said in a radio interview that he would reject a plan by county commissioners to keep all 26 clinics open. The interview will air at 9:30 p.m. Sunday on WBBM-AM's "At Issue" program.

"It's one of those things that sounds good ... but when you look at the whole picture you find that some of the clinics just don't justify the cost," he said.

Asked if there was room for compromise with commissioners on the number of clinics, Stroger said, "We've come up with the right number." Stroger said he would veto the commissioners' budget amendment if necessary, because it ignores Simon's restructuring.

In a related development Friday, Deputy Gov. Louanner Peters offered state assistance to Cook County in an effort to forestall cuts to medical services.

In a letter to Stroger, Peters said the state would consider purchasing 200 acres of land around Oak Forest Hospital for $30 million to $60 million and provide assistance with Medicaid billing. Some $200 million in Medicaid bills remain unpaid because the county didn't list the procedure being billed or listed the wrong procedure, the letter noted.

Steve Mayberry, Stroger's spokesman, said the county president appreciated the state's willingness to help but was disappointed that the offer "provides no immediate relief nor additional Medicaid funds."



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