Attached is the response I got from my contact at Illinois Medicaid. Please
let me know if there are additional details you'd like to have followed up.
From: Bernard Black
Sent: Saturday, January 21, 2017 6:29 PM
To: Theresa L. Walunas <t-walu...@northwestern.edu>; Kho, Abel
<abel....@nm.org>; Dan Connolly <dconno...@kumc.edu>; gpc-dev@listserv.kumc.edu
Cc: Sparapani, Rodney <rspar...@mcw.edu>; Marc Brian Rosenman
<marc.rosen...@northwestern.edu>; Laura Jarmila Rasmussen-Torvik
<ljrtor...@northwestern.edu>
Subject: RE: Medicaid types
Theresa: Yes, just a rough sense of proportions in IL
Bernie
*************************************************************
Bernard S. Black
bbl...@northwestern.edu
Nicholas J. Chabraja Professor, Northwestern University
Pritzker School of Law
Institute for Policy Research
Kellogg School of Management, Finance Dep't
Law School: 375 East Chicago Ave., Chicago IL 60611
IPR: 2040 Sheridan Road, Evanston IL 60208 (my office: 2046 Sheridan)
Kellogg: 2001 Sheridan Road, Evanston IL 60208
tel: law: 312-503-2784; IPR: 847-491-8730; cell: 847-807-9599
papers on SSRN at: http://ssrn.com/author=16042
************************************************************
From: Theresa L. Walunas
Sent: Friday, January 20, 2017 3:20 PM
To: Kho, Abel <abel....@nm.org<mailto:abel....@nm.org>>; Bernard Black
<bbl...@kellogg.northwestern.edu<mailto:bbl...@kellogg.northwestern.edu>>; Dan
Connolly <dconno...@kumc.edu<mailto:dconno...@kumc.edu>>;
gpc-dev@listserv.kumc.edu<mailto:gpc-dev@listserv.kumc.edu>
Cc: Sparapani, Rodney <rspar...@mcw.edu<mailto:rspar...@mcw.edu>>; Marc Brian
Rosenman
<marc.rosen...@northwestern.edu<mailto:marc.rosen...@northwestern.edu>>; Laura
Jarmila Rasmussen-Torvik
<ljrtor...@northwestern.edu<mailto:ljrtor...@northwestern.edu>>
Subject: RE: Medicaid types
Are you just looking for a simple breakdown... e.g. 50% FFS, 25% MCO, 25% Other
Variant?
I might be able to help with that. Unlikely to be able to get to actual claims.
From: Kho, Abel [mailto:abel....@nm.org]
Sent: Friday, January 20, 2017 1:25 PM
To: Bernard Black
<bbl...@kellogg.northwestern.edu<mailto:bbl...@kellogg.northwestern.edu>>; Dan
Connolly <dconno...@kumc.edu<mailto:dconno...@kumc.edu>>;
gpc-dev@listserv.kumc.edu<mailto:gpc-dev@listserv.kumc.edu>
Cc: Sparapani, Rodney <rspar...@mcw.edu<mailto:rspar...@mcw.edu>>; Marc Brian
Rosenman
<marc.rosen...@northwestern.edu<mailto:marc.rosen...@northwestern.edu>>; Laura
Jarmila Rasmussen-Torvik
<ljrtor...@northwestern.edu<mailto:ljrtor...@northwestern.edu>>; Theresa L.
Walunas <t-walu...@northwestern.edu<mailto:t-walu...@northwestern.edu>>
Subject: Re: Medicaid types
I'm going to pull in Theresa who works most closely with Medicaid office in our
group.
________________________________
From: Bernard Black
<bbl...@kellogg.northwestern.edu<mailto:bbl...@kellogg.northwestern.edu>>
Sent: Friday, January 20, 2017 1:24 PM
To: Kho, Abel; Dan Connolly;
gpc-dev@listserv.kumc.edu<mailto:gpc-dev@listserv.kumc.edu>
Cc: Sparapani, Rodney; Rosenman, Marc (NU); Rasmussen-Torvik, Laura (NU)
Subject: RE: Medicaid types
Abel and Marc: March may be able to tell us for Northwestern, but what do we
know about Medicaid in Illinois?
In some states, Medicaid is all/essentially all capitated, in some it is mostly
fee for service, in some states, there is more variance.
What is known about Illinois Medicaid?
Bernie
*************************************************************
Bernard S. Black
Chabraja Professor, Northwestern University
Pritzker Law School and Kellogg School of Management
375 East Chicago Ave., Chicago IL 60611
bbl...@northwestern.edu<mailto:bbl...@northwestern.edu>
tel: law: 312-503-2784<tel:312-503-2784>; Kellogg
847-491-5049<tel:847-491-5049>; cell: 847-807-9599<tel:847-807-9599>
papers on SSRN at:
http://ssrn.com/author=16042<https://urldefense.proofpoint.com/v2/url?u=http-3A__ssrn.com_author-3D16042&d=CwMFAw&c=yHlS04HhBraes5BQ9ueu5zKhE7rtNXt_d012z2PA6ws&r=9HAlVmZlyRdrrAtetkxEu4X6lYkOZnauxJjwxt0JqfU&m=DFBbbrww9bFX-nurMIaAb0igfX2ZnzOygHdU1RgAJPE&s=MxDo4VRgDIqpPmQAlnaWfFnZcT8Y6hRADQ8ug16za_8&e=>
************************************************************
From: Kho, Abel [mailto:abel....@nm.org]
Sent: Friday, January 20, 2017 10:27 AM
To: Bernard Black
<bbl...@kellogg.northwestern.edu<mailto:bbl...@kellogg.northwestern.edu>>; Dan
Connolly <dconno...@kumc.edu<mailto:dconno...@kumc.edu>>;
gpc-dev@listserv.kumc.edu<mailto:gpc-dev@listserv.kumc.edu>
Cc: Sparapani, Rodney <rspar...@mcw.edu<mailto:rspar...@mcw.edu>>; Marc Brian
Rosenman <marc.rosen...@northwestern.edu<mailto:marc.rosen...@northwestern.edu>>
Subject: Re: Medicaid types
I don't know the answer to this but I suspect Marc may be able to know this
based on the work he is doing now to get a handle on the diversity of insurance
types.
________________________________
From: Bernard Black
<bbl...@kellogg.northwestern.edu<mailto:bbl...@kellogg.northwestern.edu>>
Sent: Friday, January 20, 2017 8:55 AM
To: Dan Connolly; gpc-dev@listserv.kumc.edu<mailto:gpc-dev@listserv.kumc.edu>
Cc: Sparapani, Rodney; Rosenman, Marc (NU); Kho, Abel
Subject: Medicaid types
Medicaid is sometimes capitated and sometime not.
Is this information available from the GPC sites? It would be useful to have
this, if knowable.
Abel: Same question for the Capricorn sites.
Capitated plans can be called "managed care", or "health maintenance
organization (HMO)" and perhaps other names.
Thank you,
Bernie
*************************************************************
Bernard S. Black
bbl...@northwestern.edu
Nicholas J. Chabraja Professor, Northwestern University
Pritzker School of Law
Institute for Policy Research
Kellogg School of Management, Finance Dep't
Law School: 375 East Chicago Ave., Chicago IL 60611
IPR: 2040 Sheridan Road, Evanston IL 60208 (my office: 2046 Sheridan)
Kellogg: 2001 Sheridan Road, Evanston IL 60208
tel: law: 312-503-2784; IPR: 847-491-8730; cell: 847-807-9599
papers on SSRN at:
http://ssrn.com/author=16042<https://urldefense.proofpoint.com/v2/url?u=http-3A__ssrn.com_author-3D16042&d=CwMFAw&c=yHlS04HhBraes5BQ9ueu5zKhE7rtNXt_d012z2PA6ws&r=UogPJ7VYoAeiC8NNwyY5AxLx8QgaRiMcicgAv7oi3tc&m=zsaQNqx0nXg7eX_PveOai99CBTHNK0pHQ1S0iO27DoY&s=5l05-hPTfi2lqIPL2Uo1XlY80idKfmuD0zH19n07m98&e=>
************************************************************
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According to our website, "State law requires HFS to enroll at least 50% of
Medicaid clients into a care coordination program. Today over 60% of our 3
million clients have enrolled in Health Plans that coordinate health care. "
Also listed on the Care Coordination
page<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.illinois.gov_hfs_MedicalProviders_cc_Pages_default.aspx&d=CwMFAg&c=yHlS04HhBraes5BQ9ueu5zKhE7rtNXt_d012z2PA6ws&r=9HAlVmZlyRdrrAtetkxEu4X6lYkOZnauxJjwxt0JqfU&m=tA39XUOL-f7EX7CtJR8d0auR8voZH8Nscu8Msq-DGLE&s=vRfqmBvERfdsQadcLgxALQwg2RE20me1u5BK79IrYAU&e=>,
"According to state law, HFS enrolls Illinois Medicaid and All Kids clients
into care coordination in five mandatory managed care regions: Rockford,
Central Illinois, Metro East, Quad Cities, and the greater Chicago area."
This care coordination
map<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.illinois.gov_hfs_SiteCollectionDocuments_CCExpansionMap.pdf&d=CwMFAg&c=yHlS04HhBraes5BQ9ueu5zKhE7rtNXt_d012z2PA6ws&r=9HAlVmZlyRdrrAtetkxEu4X6lYkOZnauxJjwxt0JqfU&m=tA39XUOL-f7EX7CtJR8d0auR8voZH8Nscu8Msq-DGLE&s=JmTZ4i97KSbRERkgv2MGXTRo78KZHsIhXo9Xd8RvSAo&e=>
or this billing encounter
presentation<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.illinois.gov_hfs_SiteCollectionDocuments_092414-5FFQHC-5Fpresentation.pdf&d=CwMFAg&c=yHlS04HhBraes5BQ9ueu5zKhE7rtNXt_d012z2PA6ws&r=9HAlVmZlyRdrrAtetkxEu4X6lYkOZnauxJjwxt0JqfU&m=tA39XUOL-f7EX7CtJR8d0auR8voZH8Nscu8Msq-DGLE&s=uxS9YrF7Hhx1YQZZt1WHjQNTbxwzQLlauf7pqAncuuA&e=>
may also be helpful.
I don't know that I can answer the FQHC question; Kelly Carter of Illinois
Primary Healthcare would probably give you a better answer. If she can't, I
will try to get an answer.
Dave Barnes
IL Dept of Healthcare and Family Services
Division of Medical Programs/Program and Policy Coordination
Federal Health Information Planning
201 South Grand Avenue East
Springfield IL 62763
Ph:217-558-9529
From: Theresa L. Walunas [mailto:t-walu...@northwestern.edu]
Sent: Sunday, January 22, 2017 8:24 PM
To: Barnes, Dave
Subject: [External] Medicaid Payment Types in Illinois
Hi Dave -
Quick question for you. Do you know what percentage of Illinois Medicaid
payments are fee for service and what percentage are capitated/managed care?
Do FQHCs fall under the FFS model or capitated? Or something else?
We're trying to make sure we understand all the payment models Medicaid
providers operate under.
Thanks!
T
Theresa L. Walunas, Ph.D.
Research Assistant Professor
Division of General Internal Medicine and Geriatrics
Northwestern University
633 N. St. Clair, 20th Floor
Chicago, IL 60611
Ph. 312.503.3691
Fax. 312.503.4401
Email t-walu...@northwestern.edu<mailto:t-walu...@northwestern.edu>
State of Illinois - CONFIDENTIALITY NOTICE: The information contained in this
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