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Wednesday, Oct. 12, 2005 10:02 pm

Less-than-universal

Governor touts latest health initiative as critics ding Medicaid program

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.
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