The Law on Managed Care Options in Chicago

It is a controversial move but one that is considered to be a reflection of the reality that many state governments are not able to sustain the increasing healthcare costs of their citizenry. Chicago is no exception, and its new managed care provisions reflect a need for reform. Recently, the state has amended the law in such a way as to move Medicaid users towards the more affordable managed care options. Like any change, there are political and legal ramifications to this one. Some have argued that the changes are inhumane and could actually constitute a illegal or unconstitutional act. At the moment, the supreme court has not yet fully pronounced itself on the matter.

Meanwhile, the provisions of the law continue to impact the citizens of Chicago. It is particularly onerous for those who are disabled in some way or another. There are benefits to the managed care options, including an investment in infrastructure such as ramps. However, some of the Medicaid users feel that there will also be an additional administrative burden and the possibility of being rejected for full benefits. The changes are based on a public-private partnership model that has been used in other areas of public spending. In this case, not-for-profit organizations such as the Community Care Alliance are given access to some funds and income generating opportunities so that they can provide services that better reflect the needs of the service users.

Practical and Administrative Changes

Although the move is somewhat perceived to be controversial, there is evidence to suggest that these partnerships are far more responsive than the alternatives. They understand what people need and are closer to them. It is one of the ways to increase consumer choices. The dirty term that is “pre-existing conditions” has been gradually phased out by the Affordable Healthcare Act (read “Obamacare”). That means that even the managed care arrangements have to give due credence to the generally accepted rules of engagement when it comes to offering people access or even removing that access at one point or the other. The people that are most affected in this respect are those with chronic conditions that require constant care.

Others have characterized the new arrangements as a form of pre-illness investment. The service user is essentially preparing for an eventuality in which they would need to be looked after. The same applies to the other health insurance schemes that are common within the USA. Evidence suggests that the organizations that have been brought in to partner with the Chicago government are making a conscious effort to be a lot more efficient than the Medicaid system was.

Critiques of Medicaid

One of the most stinging and damning criticisms of Medicaid is that it tends to reward service providers for quantity rather than quality. The ones that are most likely to benefit from government contracts are the ones that can offer high-volume, low-grade healthcare. Those that really pay attention to the needs of the patients are often outbid and lose their business model. Under the new arrangement, the patient is able to opt for those institutions that appear to be giving them the standard of care that they want and need.

The old reimbursement system has been replaced by a fixed monthly payment that is allocated to a patient or service user. The organization will make a profit as long as it is able to keep the service user healthy. If they ignore their needs, then most of the money will be spent on treatment. It is one of the most successful ways of encouraging providers to move towards preventative health care under the Chicago provisions. For expert legal advice on your managed care options case, contact David Freidberg, Attorney at Law at 312-560-7100.

(image courtesy of Daan Stevens)