SPRINGFIELD, Ill. (WCIA) — Countless patients who lost affordable access to healthcare after their doctors were kicked out of their insurance network have been left with stress and bills. So far, that discussion has been around patients with private insurance but for Medicaid customers — often living at or below the poverty line — things are even dicier.
State law outlines the number of specialists that have to be available within 30, 50 or 100 miles of a patient and it promises affordable access for acute care patients, like pregnant mothers, whose doctors fell out of their insurance network. Advocates for updating the state’s Network Adequacy and Transparency Act of 2017 said expecting mothers on Medicaid have effectively been left out of policy conversation until now.
Jessica Davenport-Williams co-founded the non-profit ‘Black Girls Break Bread’. A big part of its mission is equal access to healthcare.
“Most of our Illinois births are coming from Medicaid members,” she said.
“I honestly think that when it comes to women’s health, sadly, right, like, or when it comes to like a racial equity lens, that some things are just not considered.”
The Illinois Department of Health reports the closure of 16 labor and delivery units across the state since 2016.
“Well, the issue is the MCOs are not doing their due diligence in regards to pregnant women,” shared Deputy House Majority Leader Mary Flowers (D-Chicago). She was referring to managed care organizations. These companies agree to provide a Medicaid benefits plan in exchange for a paycheck from the state. The catch is that hospitals can pick and choose which plans they’ll contract with.
“And so if you have a patient living in central Illinois that has Veridian Healthcare, and wherever they’re providing their closest provider may not accept that health plan, then they have to travel an additional distance to be able to go and receive care,” Davenport-Williams said.
“We are in a maternity, you know, infant health crisis, and to have this additional layer for the residents who are most vulnerable. It’s harmful.”
When it’s a matter of life or death, Rep. Flowers says “a mother should not be worried about whether or not this is an in-network, hospital, or out-of-network hospital.”
Rep. Flowers is sponsoring a bill, House Bill 5013, that would require managed care organizations to pay for prenatal and perinatal healthcare, no matter if it’s from a contracted provider or not.
“So they have more than enough money to pay for whatever services that this woman and child may need,” she said. “And this mother has already been proven to be Medicaid eligible. So I’m not talking about people just walking in off the streets. So I’m talking about a woman being able to make decisions on her own, without worrying about, will this bill be paid will not be paid?” Flowers explained.
The bill passed the House early in March. It’s been sitting in the Senate Executive Committee for about a week as of Tuesday. It has the backing of dozens of representatives from both sides of the aisle.