by Debra Pressey, Champaign News Gazette
April 17, 2008
SPRINGFIELD – Now that Illinois is paying primary-care doctors more for caring for children on the All Kids state insurance program, doctors and some legislators say it's time to give pediatric specialists a raise, too.
A bill advanced by the House Human Services Committee last month and now awaiting action by the full House would give those doctors caring for needy children with such diseases as asthma, diabetes and cancer their first raise under the Medicaid rate system in more than eight years, supporters said.
The bill (HB 5331) calls for rates to be increased over the next three years, starting Jan. 1, 2009.
Specifically, by the start of next year, payments to specialists treating children covered by All Kids would have to be competitive with those paid by nongovernmental third-party health insurance programs.
And by Jan. 1, 2011, the state would have to reimburse those doctors at least as much as the federal Medicare program pays doctors for delivering those same services to adults.
The increases would cost the state $8.5 million the first year and $75 million over three years, and that money would be eligible for dollar-for-dollar federal matching funds, according to bill sponsor state Rep. Susana Mendoza, D-Chicago.
Mendoza said Illinois doesn't do a good enough job by any means of reimbursing doctors caring for needy children, and pediatric specialists were left out of the Medicaid rate increases for primary-care health services under the All Kids program.
"This is an opportunity for us to create greater access to care for children," she said.
Dr. Terry Hatch, a pediatric gastroenterologist at Carle Clinic in Urbana, said he has seen access to primary care expand around the state when the All Kids program started paying more for primary care.
But in many areas of Illinois, access to specialty care is still scarce for children on that program, he said. Not only are there fewer specialists to go around, he said, but there is also tighter access to those doctors resulting from the state's failure to cover the cost of delivering care.
Consequently, parents are driving 100 miles or more to get their kids to specialists at Carle Clinic and other providers who will see them, Hatch said.
Other parents wind up taking their children to hospital emergency rooms, and the state winds up paying even more for their care, Mendoza said.
Under current reimbursement rates, the state covers about one-third of pediatric specialists' costs, according to We Care for Illinois Kids, a coalition of Illinois doctors and families calling on the General Assembly to approve the proposed increases.
Illinois Department of Healthcare and Family Services spokeswoman Annie Thompson said raises for some pediatric specialties would have been increased under Gov. Rod Blagojevich's comprehensive health care plan, Illinois Covered, that was rejected by lawmakers.
"Raising pediatric specialist rates is something we are open to discussing, but we still believe it should be done in the context of a comprehensive effort to improve and reform the health care system in Illinois," she said.
Hatch said Carle has tried, in general, to keep its doors open to needy children despite the low state payments, but the higher reimbursements would enhance full access to these children around the state, especially at large urban medical centers that see a higher number of needy children.
