managed care programs

Medicaid Cuts Hurt Independent Pharmacy Owner

May 4, 2018
"Meds" by Flickr User Charles Williams / (CC x 2.0)

A pharmacist in central Illinois says that HealthChoice Illinois—a recently expanded Illinois’ Medicaid program—includes cuts in reimbursement rates that make it harder for small drugstores like his to stay in business.

The April 1 expansion of Illinois’ Medicaid managed care program dropped prescription drug reimbursements to pharmacies from $5 per generic drug and $2.40 for brand-name drugs to just $0.45 for all Medicaid prescriptions. 

The state of Illinois has cut in half the number of insurers in its Medicaid managed care program.

The Illinois Department of Healthcare and Family Services announced Friday it has selected six insurers to participate in the overhauled program, down from the 12 currently participating. The insurers administer Medicaid benefits under the managed care program.

The insurers remaining in the program for the next four years are Blue Cross Blue Shield of Illinois, Harmony Health Plan, IlliniCare Health, Meridian Health, Molina Healthcare and CountyCare Health Plan.

Gov. Bruce Rauner's administration is seeking to offer more Medicaid services through managed-care programs.

Rauner and two cabinet members announced the plan in Chicago Monday. It involves choosing a vendor that'll provide managed-care services to 80 percent of Medicaid clients.

That's up from 65 percent now. It'll also be expanded to all Illinois counties and children in the care of the Department of Children and Family Services.