HR1123 99TH GENERAL ASSEMBLY

HR1123 LRB099 21189 GRL 46540 r

HOUSE RESOLUTION

WHEREAS, The Medicaid program in Illinois has an immense and growing impact both in terms of taxpayer dollars and in terms of the effect it has on citizens across the State; and

WHEREAS, State resources for healthcare services are currently so scarce that many healthcare providers are discontinuing services, leading to a profoundly detrimental impact on our communities; and

WHEREAS, Enrollment under the Department of Healthcare and Family Services Medical Programs (Medicaid) exceeds 3 million; and

WHEREAS, A sizable portion of the Medicaid population is currently enrolled (often mandatorily) in Managed Care Organizations (MCOs), making outlays to MCOs one of the largest resource uses in the State; and

WHEREAS, There has been little information disseminated to the General Assembly in terms of how State resources are being spent on MCOs and on the overall healthcare outcomes for individuals enrolled in these MCOs; and

WHEREAS, In this quickly evolving environment, the General Assembly must stay engaged in Medicaid funding and corresponding healthcare outcome issues and be prepared to make legislative and administrative recommendations; therefore, be it

RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE NINETY-NINTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that we request that the Auditor General of the State of Illinois conduct an audit of Medicaid MCO capitation payment development, State GRF expenditures on MCOs, and a review of healthcare outcomes for Medicaid individuals enrolled in MCOs; and be it further

RESOLVED, That this audit shall examine capitation rate setting and reimbursement issues for Medicaid MCOs while also examining healthcare outcomes for the Medicaid MCO population with respect to the following issues:

(1) whether the use of MCO encounter data for rate setting purposes would provide Illinois taxpayers a more accurate and value-based methodology as opposed to the current practice of using historical fee-for-service (FFS) data combined with various inflationary assumptions to estimate an MCO capitation rate;

(2) whether it is the best use of State resources to pay the ACA Health Insurance Fee for MCOs and an examination of the "gross-up" (the additional monies paid MCOs to compensate for their tax hit) in the context of whether this unusual benefit is a good value for Illinois taxpayers;

(3) how the effective Administration rate Illinois pays MCOs (14.74% effective rate) compares to rates paid in other states and how this benefits the Illinois taxpayer; and

(4) whether Emergency Room usage rates are lower or higher within the Medicaid MCO population compared to rates within the Medicaid FFS population; and be it further

RESOLVED, That legislative staff shall assist the Office of the Auditor General in carrying out this audit should the Auditor General require assistance; and be it further

RESOLVED, That suitable copies of this resolution be delivered to the Auditor General and the Director of the Department of Healthcare and Family Services.