{"id":1987,"date":"2021-05-28T10:42:32","date_gmt":"2021-05-28T10:42:32","guid":{"rendered":"https:\/\/healthplan.distilinfo.com\/?p=1987"},"modified":"2021-05-28T10:42:33","modified_gmt":"2021-05-28T10:42:33","slug":"unprecedented-profits-for-illinois-medicaid-companies-in-2020","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/unprecedented-profits-for-illinois-medicaid-companies-in-2020\/","title":{"rendered":"Unprecedented Profits for Illinois Medicaid companies in 2020"},"content":{"rendered":"\n<p>Reports by the Better Government Association revealed an&nbsp;unprecedented increase in profits of five Illinois Medicaid companies from April through December of 2020. As part of an ongoing series examining one of Illinois\u2019 largest expenses, the Better Government Association reveals how the five private insurance companies running the state\u2019s healthcare program for low-income residents benefited from the COVID-19 lockdown.<\/p>\n\n\n\n<ol class=\"highlights wp-block-list\"><li><strong><em>A managed care model:<\/em><\/strong> The Illinois Medicaid program operates under a \u201cmanaged care\u201d model in which private insurance companies, known as managed care organizations, or MCOs, are paid a flat rate for managing the care of each Medicaid patient. Their profit margin is the difference between how much they are paid and how much they have to spend reimbursing health care providers for the patients\u2019 care.<\/li><li><strong><em>The windfall:<\/em><\/strong> The for-profit insurance companies running Illinois Medicaid collected hundreds of millions of dollars in extra profits during the COVID-19 pandemic \u2014 much of it for services never provided to patients. The windfall was the result of a payment system based on annual, per-patient estimates. While the number of patients in the state\u2019s Medicaid program swelled as people lost their jobs, many deferred elective medical procedures during the pandemic.<\/li><li><strong><em>Huge profit margins:<\/em><\/strong> Three of the Medicaid companies \u2014 Meridian Health Plan of Illinois, IlliniCare Health Plan, and Molina Healthcare of Illinois \u2014 reported a combined $282 million increase in profits in Illinois during that nine-month stretch when the pandemic was at its height, compared to the same period in 2019. The other contractors \u2014 insurance giant Blue Cross and Blue Shield of Illinois and Aetna Better Health of Illinois, Inc. \u2014 also reported large profits on a national scale.<\/li><li><strong><em>First state implementing risk corridors:<\/em><\/strong> Presented with the BGA\u2019s findings, the top official at the Illinois Department of Healthcare and Family Services said her office will investigate and work to recover some of the taxpayer money as part of a routine state-wide accounting due in 2023. \u201cIllinois was one of the first states in the country to implement risk corridors during the pandemic to further, restrict possible profit margins,\u201d said Jamie Munks. \u201cWe will recoup more from the health plans than we otherwise would have.\u201d<\/li><li><strong><em>Funds Retrieval: <\/em><\/strong>While the number of Illinois Medicaid members increased due to job loss during the pandemic, most members deferred elective treatment, a scenario that occurred across the country and resulted in larger profits for payers. A spokesperson for the Illinois Department of Healthcare and Family Services told the Better Government Association earlier this month that &#8220;initial incomplete figures indicate HFS would recoup over $120 million&#8221; from the insurance firms for the 2020 calendar year.<\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Reports by the Better Government Association revealed an&nbsp;unprecedented increase in profits of five Illinois Medicaid companies from April through December&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/unprecedented-profits-for-illinois-medicaid-companies-in-2020\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":2,"featured_media":1988,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[],"class_list":{"0":"post-1987","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/1987"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=1987"}],"version-history":[{"count":1,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/1987\/revisions"}],"predecessor-version":[{"id":1989,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/1987\/revisions\/1989"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/1988"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=1987"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=1987"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=1987"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}