For more than a decade, Illinois’ Medicaid program has failed to meet the needs of the state’s most vulnerable residents. Access to high-quality care has deteriorated, even as record amounts of taxpayer dollars are spent on the ballooning program.

Over the years, eligibility standards have loosened to increasingly include families earning ever-higher incomes. Today, only 40 percent of Medicaid patients are in poverty, meaning that scarce budget money is being siphoned away from those most in need. To cope with ballooning enrollment and higher costs, the state has opted to ration the fees it pays for each service.

Sadly, the state’s mismanagement of the Medicaid program has forced many doctors to opt out of the Medicaid program altogether. These factors have created an environment in which Medicaid enrollees are given a medical card, but very little access to care.

In many cases, Medicaid patients have a more difficult time finding a doctor and suffer worse health outcomes than even the uninsured. The problems were so bad that a federal judge ordered state officials to study them. The results of that study, detailed more thoroughly later in this report, were published in the New England Journal of Medicine.

Illinois’ Medicaid program is a one-size-fits-all model that’s broken, and it’s failing Illinoisans on three fronts: costs, access to quality care and health outcomes. Illinois should follow the lead of states such as Florida and Louisiana and fundamentally transform how the program operates. To address these problems, Illinois should:

  • Give Medicaid patients meaningful choices for their health plans from a variety of provider service networks and managed care organizations.
  • Allow plan providers to customize their plans to meet the individual needs of their enrollees, which will help ensure plans compete on value.
  • Pay plan providers a fixed, risk-adjusted monthly rate based on enrollment in a particular plan.

Florida’s reform pilot is a proven success. It has improved access to quality care and delivered better health outcomes to its patients than the traditional Medicaid program. Better yet, the reform pilot has seen average annual savings of more than 20 percent when compared to per-person spending in Florida’s traditional program.

These reforms can be implemented without a waiver from the federal government, and similar reforms have already been implemented in Florida and Louisiana.

Transforming how Medicaid operates is the only solution that does right by both patients and taxpayers.