Group health payment freeze could jeopardize access to care

The Illinois Department of Central Management Services (CMS) has announced that, due to the budget impasse, it is suspending payment of medical claims incurred by participants in the state’s self-funded medical and dental plans, as well as halting premiums payments to the HMO plans. The Rauner Administration claims it does not have the legal authority to make these payments.

While it is not yet clear what the full implications of the Administration’s payment freeze will be on health plan participants, AFSCME is taking proactive legal action to seek to ensure that health coverage is not in any way interrupted or compromised. AFSCME and other unions have filed suit in circuit court seeking a court order that would require the state to pay claims from health care providers in the group insurance plan.

CMS reports that, for the time being, the HMO plans have agreed to continue to operate as normal, and that plan participants will be provided with medical treatment based on the usual schedule of co-payments.

The self-funded plans are also working with CMS to try to ensure uninterrupted medical care, but questions remain as to how individual doctors, hospitals and other medical providers in those plans will react to the state’s announcement. The group health plan is already many months in arrears in paying these providers, and some say they simply cannot afford to continue to provide care without being paid.

As a result, there is a very real concern that medical and dental providers in the self-funded plans will begin to demand that employees or retirees pay the full cost of a service at the time of the treatment—especially as there is no sign that the budget impasse will be resolved in the near future.

This health insurance crisis is but the latest harmful consequence of Governor Rauner’s failure to work constructively toward developing and enacting a FY 16 budget and the revenue measures needed to fund it. The governor continues to insist that unless state legislators enact measures to strip Illinois workers of their union rights, he will not make any effort to remedy our state’s steady slide toward fiscal disaster.  That’s the height of irresponsibility.