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Payment freeze may jeopardize health care for state workers

9/20/2015
The Illinois Department of Central Management Services (CMS) announced late last week that, due to the budget impasse, the state does not have the available funds or the legal authority to continue to pay medical claims incurred by participants in the self-funded medical and dental plans. While the initial announcement mentioned only self-funded insurance plans, the Governor’s office has stopped paying premiums to the HMO plans as well.

These drastic decisions may potentially jeopardize the health care of hundreds of thousands of workers employed by the state, including IFT members who work in state agencies and universities.

This situation is unprecedented in Illinois, and it is unclear exactly how the Governor’s action to freeze health care payments will directly affect plan participants. To ensure that workers’ health coverage is not interrupted or compromised, the IFT, AFSCME, and other unions are taking proactive legal action. Our union coalition has filed suit in circuit court seeking an order to compel the state to pay claims from health care providers in the group insurance plan.

CMS has indicated that it is working with the health plans to mitigate the impact of this payment freeze on plan participants. For the time being, the HMO plans say they will continue to operate normally, and plan participants will be provided with medical treatment based on the usual schedule of co-payments.

The self-funded plans are also working with CMS to try to ensure uninterrupted care, but it is not known how individual doctors, hospitals, and other providers in those plans will react to the state’s announcement. Payment to many of these providers is already months in arrears, and some say they cannot afford to provide medical care without receiving payment.

CMS has stated that once a FY16 budget is in place and funds have been appropriated, payment of medical and dental claims will resume. But the Governor continues to show no sign that he is willing to reach agreement on a budget until his obsessive demands to strip workers’ collective bargaining rights are met. His political conditions don’t save the state a dime, but could cost many middle-class families everything.

With no immediate budget resolution in sight, there is serious concern that medical providers in the self-funded plans may begin requiring participants to pay the full cost of service at the time of the treatment. This could be cost prohibitive for thousands of plan participants and their families, and they may be forced to delay or forego critical medical treatment.

This health insurance situation is unacceptable and is the latest proof that this Governor will do anything – including jeopardize the well-being of hundreds of thousands of dedicated public servants, retirees, and their families – to further his extreme political agenda.


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