What’s Going On With State Workers’ Health Benefits?

                                    
The payments might be stopping because the governor controls the department of Central Management Services and that’s the agency that administers the group health insurance plan for state employees. 

The  governor has interpreted the current budget situation as lacking legal authority to pay more claims and I’m sure there’s going to be disagreements on that point but he put a notice on the sea on this Web site last week. 

Notice basically said that we’re not going to say when but shortly we are going to tell all the insurance plans that send out payments to stop and not pay doctors hospitals other providers that provide health care services. 

Essential what this would be is more of a delay in those providers getting paid for many years the state has delayed payments to providers who serve Medicaid patients as well as state employees but recently there has been a court ruling that says the state has to keep processing and paying Medicaid bills. 

Rauner’s folks say that that court ruling does not apply to the payment of claims for benefits it would seem to contradict instructions that C.M.S. gave to several state lawmakers recently and they put this on their Web sites the question was posed will and employees health dental or life insurance be affected by the impasse the budget impasse and the answer was No Well when I asked the state about this latest notice if it’s contradicting what C.M.S. previously said they said no but they’re kind of parsing their words they’re saying the impasse isn’t affecting whether you are insured but it might affect whether the person who serves you will get paid the big question that is raised by this though is that is this new twist in the budget situation which apparently has never happened before the state actually stopping the payment of all claims. Well that prompt health care providers to react differently. 

Will that prompt them to request payment up front which could be a big problem especially if you’re waiting for a surgery that’s going to cost thirty or forty thousand dollars? We don’t know if that’s going to happen it already is happening now for dental providers because the state already has stopped the payment of dental claims they stopped doing that about a week ago this all creates a lot of questions I’m sure in the minds of the tens of thousands of people in the Springfield area who are insured through the state how many folks are covered by this statewide as far as on these types of insurance plans. 

This applies to state workers, university employees, all sorts of people dependence of those people as well as retirees. Statewide it’s almost three hundred sixty three thousand people and it’s a little bit less than that for the dental plan because you have to opt to pay for the dental plan in a lot of towns where they have large state agencies or state prisons state universities those are areas where you’re going to see a lot of people who have coverage through the state and the hospitals and the doctors all benefit from that because it’s pretty good insurance. 

It may pay late but it does pay and it pays better than Medicaid and the state health plan is quite generous compared to most health plans in the States so this is good insurance a lot of people are in these jobs for this these types of benefits and these people work hard for them and they generally want to see them administered correctly so I think there’s going to be a lot of people following whatever happens with this story. 

Full disclosure on that I am a university employee so it applies to me as well. 

Do you reach out to the administration on this are they making any other efforts besides this posting on the C.M.S. website to notify folks and want to know what’s going on here? They didn’t tell me about anything it was kind of curious on how it happened I mean here you have. We’re three hundred fifty thousand people throughout the state are insured and covered you know, children, old people. Active workers retirees and the only communication they’ve had so far is a posting and it’s an obstacle or posting you have to dig into the C.M.S. Web site. 

They haven’t said whether how they’re going to communicate this and so I found out about it through just looking into some rumors that I that I had heard about the dental coverage and then found out that yes the dental payments had stopped but the state was considering stopping the medical payments too, and that increases the stakes tremendously because dental payments are one thing but nobody can afford to pay out of pocket for medical care these days. You’d be bankrupt pretty quickly unless you’re a millionaire. 

I asked them if this is being done to put more pressure on the legislature to adopt the governor’s turnaround agenda or to just negotiate more to the governor’s liking and they said no we just can’t legally process more claims because the claims that were authorized in the fiscal two thousand and fifteen spending are being paid and now we’re getting to twenty sixteen and we don’t have legal authority. It’s hard to miss the irony here of what they’re saying I mean obviously it will put pressure on the legislators and the and the general public because you’re talking about middle class people here who have the ability and the wherewithal to put pressure on their elected officials. 

Probably in a stronger way than Medicaid recipients are able to and so the Medicaid bills are going to get paid. Although they they’ve been late, but now you’re affecting people who vote more who can make phone calls who can elect lawmakers and so I would think that the pressure is going to be ramped up especially if the governor pulls the trigger and stops the payments. And the governor is currently negotiating with ASCME the union that represents a lot of folks who are covered by these health care plans for the new contract. 

You talked with folks from ASCME about this situation what was their reaction and do they feel like this is at all tied to those negotiations you know what are their concerns I think they were still looking into all the ramifications of how it affects the contract negotiations, whether this would amount to something that they could file a grievance over or take to court. I think this really surprised them. Few things surprise ASCME nowadays because they’ve worked with many different governors, but they were very upset so the folks out there that have this coverage right now, are they just kind of holding tight and waiting to see what happens

not expecting to have to go to the doctor tomorrow there to be any kind of repercussion from this?

 I really don’t know that I think it’s so new that we don’t know what how people are going to be reacting to this. I imagine there will be conversations held but you know a lot of times the doctors and the hospitals things don’t filter down to them that quickly and so they’ve seen so much in state government with delays and payments maybe they’ll see this is just another delay and so we’ll just keep seeing their patients now. 

If some of them start putting notices on the front desk saying we expect entire payment up front that will make them very unpopular that’s why I’m thinking many of them I would assume are going to try to delay as long as possible taking that step and so I would imagine that there won’t be immediate impact from the healthcare providers but I’m sure they’re going to squawk through their own channels to their lawmakers and to the administration.  

Obviously we want to talk to more of the people in state government and the lawmakers to find out what their reaction is if this is all just posturing or if this really could happen and really affect health care providers and the general public one of the questions I own is folks who are asking on the Facebook post for the story was are they still going to be getting charged for their premiums as this is going on and I assume that that is the case I’m going to check more in. 

To that but I think they will I can’t see them not being charged because during all of these delays in payments that we’ve written about all all through the years people still aren’t getting that was drawn I mean they’re still getting paid and they’re still covered it’s different than when you opt to not get health insurance through the state then you’re not insured but you in theory are continually insured it’s just whether your benefits are being paid right now and the state is saying that if you’re asked to pay up front they’re not giving instructions on don’t pay. 

They’re saying that it’s illegal for the provider to ask you and they suggest that you contact your health insurance plan to see if your provider can be required to not do that but the state is basically saying if you pay them up front you will be reimbursed through them or through your insurance plan but that’s not much of a consolation for a huge bill.