Illinois Is Ensuring Equal Access to Preventive Care for Children

A new children’s health care initiative addresses deep problems that surfaced in a court decision called Memisovski v. Maram. The State of Illinois’s initiative aims to improve preventive health care for children on Medicaid. Beginning January 1, 2006, the Department of Healthcare and Family Services will inform families better about services, encourage families to seek preventive health care, increase the availability of doctors and dentists, and encourage health care provider participation.

Federal law requires that children on Medicaid receive pediatric care and services comparable to the general population, but this was not the case for an overwhelming majority of enrolled kids. Of the 600,000 children on Medicaid in Cook County, almost two-thirds did not receive sufficient, timely well-child health care, and one-third did not receive any well-child care at all. Instead of receiving preventive care in a medical home, children were more likely to get care in the emergency room when their health problems could no longer be ignored, and the children suffered poor health outcomes as a result.

According to the Memisovski v. Maram consent decree, the primary reason for insufficient preventive health care is the scarcity of doctors and dentists accepting Medicaid. Parents spoke of the difficulties they encountered in trying to find a doctor for their children on Medicaid compared to the relative ease of finding a doctor for a child covered by private insurance. In fact, payment rates are so low that practices cannot accommodate all Medicaid patients and remain open. Studies show that payment rates are the main factor in deciding whether to participate in Medicaid. Not surprisingly, with rates set at half of Medicare rates and much lower than private insurance rates, there are not enough doctors and dentists to give children the services they need.

The new initiative aims to increase the number of children receiving preventive health services and improve health outcomes by informing families, encouraging families, encouraging providers, and increasing provider availability.

Informing Families. Beginning on July 1, 2006, the Department of Healthcare and Family Services will inform families better about the preventive health care services available to children in the Medicaid program. These early stages of outreach involve contacting families to communicate the importance of preventive care services covered by Medicaid.

Encouraging Families. The department will send informational welcome letters and yearly materials about well-child care and medical transportation and will give every family a KidCare manual in the appropriate language. The department will hire a reading specialist to ensure that materials are readable at a sixth-grade level. By July 1, 2007, the department will begin sending notices to families to let them know when a child is due for a well-child screen, a dental screen, or an immunization. By July 1, 2008, service providers working directly with the target population will be involved in the outreach. The department will train the staff of KidCare application agencies, managed care entities, Family Case Management, and the Illinois Department of Human Services’ Family Resource Community Center to promote preventive health care and refer families to doctors and dentists.

Encouraging Providers. The Department of Healthcare and Family Services will use financial incentives and streamlined procedures to make it easier to accept Medicaid. As of January 1, 2006, payment rates for preventive services will increase, bringing them closer to Medicare payment rates and nearly tripling the rates for certain services. Doctors will no longer be denied payment for providing multiple specialty services on the same day. In the second quarter of 2007, a $30 bonus will go to doctors enrolled in the Maternal and Child Health program for each year that a patient aged 0 to 5 receives the full number of recommended office visits.

Increasing Availability. By January 1, 2006, the Department of Healthcare and Family Services will increase its use of electronic communication methods, making it easier to share information about available providers among the department, agency offices, and doctors’ offices. Then by July 1, 2007, the department will hire a contractor to create a new information, recruitment, and referral program to increase doctor and family participation as well as improve communications and procedures.

The state’s plan will be finalized on November 18 at 9:30 a.m. at a final settlement hearing in federal district court, Room 1925. This will bring to a close a case that was filed in 1992. These new initiatives offer an opportunity to improve children’s health outcomes. The Sargent Shriver National Center on Poverty Law is organizing an effort to inform families and their service providers about the importance of preventive health care.

To join in these outreach efforts, or for more information or to report any anecdotal evidence related to preventive health care or specialty care, contact Melissa Buenger, Shriver Center, at 312.368.1005.

The Shriver Center, Health and Disability Advocates, and the Chicago law firm of Goldberg, Kohn, represent the plaintiffs in Memisovski v. Maram.