As Illinois looks to change how the state taxes hospitals to pay for Medicaid, lawmakers have two major worries: Will Illinois' smallest and poorest hospitals survive? And will the Trump administration be OK with Illinois' plans?
Illinois' hospital assessment, the tax hospitals pay to get Medicaid dollars, needs to be adjusted in order to keep up with federal changes and to modernize how Medicaid works. Illinois is still working with 2005 numbers, and a payment system that sends fixed payments to hospitals. Illinois Hospital Association Chief A.J. Wilhelmi said Tuesday that the new plan would change that.
"We will start down this path of having some of the funding follow the patient," Wilhelmi said. "Eighteen percent of the overall assessment fund will go into live rates or claims-based payments for the first time."
Illinois uses its hospital assessment to bring back $3.5 billion in Medicaid funding each year.
But many Democrats in the Illinois House worry the new plan will short change some of the state's smaller, safety-net hospitals that don't have as many patients.
State Rep. Will Davis, D-Homewood, said his fear is that attaching even some of the money to patients will reward bigger hospitals that have the ability to loudly advocate for their share of it.
"When I am looking at this in totality, I am wondering what the ultimate future of these smaller safety hospitals is," Davis said. "Safety-net hospitals don't have the big lobbyists or the big staffs to deal with this, like the big hospitals do. A lot of their ability to operate is dependent upon claims that are approved versus claims that are denied.
But Republicans, like state Rep. Ryan Spain, say Illinois must pay for the care that's actually being provided.
"We need to allocate [these dollars] and pay for services based on where patients are going to get care today," Spain, R-Peoria, said at Tuesday statehouse hearing. "Not based on what happened in 2005."
Wilhelmi said most of Illinois' hospitals either support the new assessment structure or are "OK with it."
But it could take a while before anything changes. Lawmakers in Illinois say it'll be months before they're on the same page and ready to vote on a new assessment, then federal Medicaid managers must review and approve the new program in the state.
No one in Springfield is guessing when that will happen.