Even as Gov. Rod Blagojevich spent the week
pitching his new proposal to offer health-care coverage to
uninsured Illinois children, critics took new aim at his
administration for tightening the screws on other health-related
programs. Blagojevich’s All Kids proposal would
provide health-care access to Illinois children whose families earn
too much to qualify for Medicaid but cannot afford private
insurance. Under the proposal, the state would help parents with
the costs of routine doctor visits, vision and dental care, and
prescriptions. House Speaker Michael Madigan, who, with
Senate President Emil Jones, will do most of the heavy lifting for
the bill when the Legislature reconvenes for the fall veto session,
hailed the governor’s plan as “a step to crush the
final financial barrier” for a quarter-million uninsured
children. But at the same time that Blagojevich is
garnering praise from supporters, some Illinois pharmacists and
mental-health professionals, who also work with the state’s
Medicaid population, say that many of their clients are being left
behind.
Mental-health advocates are puzzled by a
recent decision by the state Department of Healthcare and Family
Services to require preauthorization for prescriptions of Seroquel
and Zyprexa, two anti-psychotic medications used to treat symptoms
of schizophrenia, to Medicaid recipients. They maintain that making
as many varieties of medicines available as possible will save the
state money down the road and curb the immediate suffering of
mentally ill patients. “That decision struck a nerve. It
brings fear that medications that clearly work for many individuals
may not be available to them,” says Lora Thomas, head of the Illinois chapter of the
National Alliance on Mental Illness. Jay Nawrocki, a health-law analyst with
Riverwoods, Ill.-based business information provider CCH Inc., says
that the restriction should not be cause for concern because giving
medications preauthorization status is merely a “speed
bump” designed to make physicians consider cheaper
alternatives first. As a policy matter, he says, the safety net is
still firmly in place because comparable drugs are available and
preauthorization denials may be appealed, though many patients and
some physicians do not realize it. Kathleen Strand, spokeswoman for the Illinois
DHFS, says that removing the anti-psychotic medications from the
preferred-drugs list resulted from a “significant clinical
review process” that revealed that the move would not
adversely affect patient care but would save the state $7 million.
Moreover, she says, if a psychiatrist finds that a patient needs
either of the drugs, there is “no reason [DHFS] would deny
that access.”
Brenda Diedrich, executive director of Mental
Health Centers of Central Illinois in Springfield, believes that
drugs should be restricted only on the basis of clinical judgment,
not cost. And the new restriction could lead to more
hospitalizations, she says, meaning higher costs and bigger bills
for the state. The state hasn’t been doing a good job
of paying its bills, say some providers. The Illinois Pharmacists
Association, for example, notes that the state already owes
health-care providers, including its members, more than $1 billion.
Furthermore, it takes the state an average of 100 days to reimburse
pharmacists for medications dispensed to Medicaid patients, which
has put financial strain on small pharmacies. Some pharmacists have had to borrow money to
keep their businesses open or simply tell customers that the
pharmacy cannot afford to buy their medications. Comptroller Dan
Hynes has proposed, as a short-term solution, borrowing money to
help the state catch up.
If passed, All Kids will cost an estimated
$45 million to cover 125,000 children in the first year.
Blagojevich proposes paying for the expansion by shifting Medicaid
participants into a managed-care program, a move long advocated by
state Republicans. Managed care — requiring Medicaid
recipients to select a primary physician — could save the
state $57 million next year, the administration says. That, however, may be wishful thinking, in
light of the fact that two Medicaid health-maintenance
organizations recently withdrew from Illinois when the state
Legislature cut reimbursement rates.
This article appears in Oct 6-12, 2005.
