Illinois Medicaid

University of Wisconsin

Illinois is placing tight restrictions on a new hepatitis C drug that costs $1,000 per pill. Medicaid patients must meet 25 criteria and get prior approval before the government health care program will pay for Sovaldi.

The drug can stop the liver-damaging virus, but it comes with a budget-straining price tag.

Three area residents are among more than two dozen Illinois residents who have been charged with health care fraud stemming from federal investigations.

Federal prosecutors Thursday announced charges against 29 people who allegedly abused a health care program funded by Medicaid. 

The program pays for personal assistants to help Medicaid recipients stay in their homes.   The Feds says the defendants allegedly submitted false claims for hours worked when they had other full time jobs, were in jail or the client was hospitalized.

Ill. Atty General

Gov. Pat Quinn is promising tighter controls after a review found that the Illinois Medicaid program paid an estimated $12 million for medical services for people who were dead.  

Quinn told reporters Saturday he's not happy with the findings and the state is on track to recoup all of the money.  

The Associated Press learned of the mistakes from an internal state government memo it obtained Friday through the Freedom of Information Act.  

Under the new Medicaid eligibility requirements, Oliver Wellman’s parents make too much money to qualify for the 24-7 nursing care he needs because of his tracheostomy, but not enough to be able to afford to pay for the care themselves.
WUIS/Illinois Issues

Maria, the mother in a family of four living in Willowbrook, doesn’t want her real name or that of her family made public. A private, proud woman, Maria would rather keep her problems to herself and solve them herself.

But Maria is in a Catch-22 that might force her to quit her job. Her daughter needs expensive medical care, and Maria and her husband don’t make enough money to cover the costs but make too much to get help. Out of frustration, she shares her story.

Dana Heupel
WUIS/Illinois Issues

One political party in Illinois is bound and determined to slash health care for poor people and retirees while waging attacks on organized labor and teachers — at the same time giving tax breaks to huge corporations like Sears and CME Group, which operates interests, such as the Chicago Mercantile Exchange and the Chicago Board of Trade.


And then there’s the other political party, the Republicans …

Dr. Edward Pont
WUIS/Illinois Issues

Because of the controversies surrounding expected cuts to Illinois’ Medicaid program during this year’s legislative session, Illinois Issues is publishing this guest column by Dr. Edward Pont, a pediatrician who is a member of Gov. Pat Quinn’s Medicaid Advisory Committee. The magazine’s publication of this column does not indicate either endorsement or rejection of Dr. Pont’s ideas. Executive Editor Dana Heupel’s Editor’s Note column will return in the July-August issue.


House Speaker Michael Madigan, a Chicago Democrat, spoke about Medicaid on public television’s Illinois Lawmakers: “Boiling it down in more simple terms … who are the people that are eligible? How much of it will they get? How often will they get it?
WUIS/Illinois Issues

The thought of this spring’s legislative session going into summer overtime was greeted by groans from members of the General Assembly. During his budget address in February, Gov. Pat Quinn told lawmakers they can’t go home until they pass comprehensive Medicaid reform. Now, they face the daunting task of cutting $2.7 billion in Medicaid spending growth from the Fiscal Year 2013 budget. 

WUIS/Illinois Issues

By October, Illinois state officials hope to take a small but significant step in reining in Medicaid costs. By then, they hope to move about 38,000 patients in the Chicago suburbs into HMO-style managed care plans. That group comprises some of the most expensive — and most vulnerable — types of Medicaid enrollees: the elderly, blind and disabled. Together, they cost the state about $700 million a year, or more than $18,000 each.

Aaron Chambers
WUIS/Illinois Issues

Medicaid expenses are booming. Illinois lawmakers know that. Now they know other states are dealing with the same problem.

At the National Conference of States Legislatures’ annual meeting last month in San Antonio, legislators from all 50 states learned they’re in the same boat. Across the board, Medicaid is eating up a greater share of the states’ budgets. And the end is nowhere in sight.

In Tony Cappasso's article in your Spotlight on Medicaid series ("Why costs have gone up," March, page 28), Ann Patia, the former director of the Illinois Department of Public Aid, makes an astounding assumption. She seems to imply that by cutting Medicaid payments to hospitals earlier this year, the department was able to "control Medicaid spending without hurting Medicaid patients." Does Ms. Patia really believe it is possible to neglect the institutions that provide essential medical and social services to Medicaid patients without hurting the patients themselves?

Mike Cramer

Pharmacist Mike Schaltenbrand finds himself in need of a prescription. He needs something - and soon - to soothe his ailing bottom line. 

The owner of two inner-city pharmacies in East St. Louis, Schaltenbrand has been severely affected by the state's ongoing efforts to reel in its burgeoning Medicaid budget. In the span of two months, his income has declined by 25 percent because of changes made in Springfield aimed at cutting the state's costs of providing health care services to the poor.