SPRINGFIELD, Ill. (WCIA) — The state employees union, AFSCME Council 31, confirmed it filed a grievance challenging the state’s decision to slash retired state workers’ health insurance options to one.
After 10 years of the state-administered benefits program, retirees will go from having two or three choices in each county to one for the state.
Retirees continue to express concern over the state contracting with Aetna and leaving them without a choice, particularly the thousands who still don’t know if they’ll be able to keep seeing Carle doctors come January.
Now, not only is it a cause for retiree concern, AFSCME argues that the Illinois Department of Central Management Services (CMS) may have violated its labor contract with the union by eliminating the HMO insurance option.
AFSCME and the state agreed to save money ten years ago by separating retirees off of the employee health plan and creating a new, cheaper program: Total Retiree Advantage Illinois Medicare Advantage Prescription Drug (TRAIL MAPD).
Benefit requirements for the new plan were written into the labor contract AFSCME has with the state. It’s in effect until next summer and based on that contract, the union is challenging CMS’s decision to contract a single plan, according to AFSCME director of research and employee benefits Martha Merrill.
AFSCME is in initial conversations about the grievance with CMS at this point, Merrill said in a statement to WCIA.
“CMS has agreed with AFSCME’s recommendation to strengthen the TRAIL program by establishing a labor/management committee to review network adequacy and claims administration in the event issues arise.”
In other words, if that recommendation comes to fruition, the union would have a seat at the table if and when retirees struggle to get access to critical or even routine health care.
“As previously stated, the State fully recognizes our obligations under the collective bargaining agreements,” CMS deputy director of communications Cathy Kwiatkowski responded in an email Thursday.
“To the extent that our labor partners have raised concerns about other aspects of the plans through a grievance, we are actively meeting with them to resolve these issues. In the event a resolution is not reached, ultimately an independent arbitrator would decide whether or not the collective bargaining agreement has been violated.”
It’s unclear whether Carle Physician Group — a network of more than 550 doctors and specialists — and Foundation Hospital in Urbana would continue seeing state retirees come January even if CMS contracted with United HealthCare again or any other plan for that matter. Carle has been seeing retirees on the current retiree PPO plan but Carle is out of United HealthCare’s network and doesn’t have a contract with any Medicare Advantage plans aside from Health Alliance, which is a part of Carle Health.
Carle representatives wouldn’t answer whether patients on United HealthCare’s Medicare Advantage PPO plan would be able to see its doctors in the new year, calling the question hypothetical. Although, retirees are not the only patients who can enroll in United HealthCare.
“For the past 10 years, without a contract, Carle has agreed to treat UHC Medicare Advantage PPO members out of our concern for and commitment to our patients. But this type of accommodation isn’t one we can make indefinitely, as relationships without a fair and equitable contract in place are more costly, more difficult to manage and less efficient and Carle will not sacrifice the high-quality care patients expect from Carle providers,” a representative said, in a response that was similar to Carle’s explanation for not committing to treat state retirees enrolled in the sole Aetna plan next year.