Policy Learning Collaborative State Team Spotlight: Illinois

Protecting Confidentiality in the Medicaid Managed Care Landscape

By Anna Burnham, Coordinator- Child and Adolescent Health Initiative, EverThrive Illinois

EverThriveIllinois-logo-321EverThrive Illinois, a School-Based Health Alliance affiliate, is championing state legislation this session that would provide an added layer of confidentiality protections for those seeking sensitive health care services. The bill—HB2812 HA1—would prevent Medicaid Managed Care Entities (MCEs) from sending explanation of benefits (EOB) for sensitive services such as mental health, substance abuse treatment, and reproductive health.  An explanation of benefits is an automatically generated summary of health services provided that a health insurer sends to policyholders after a provider submits a claim. This is of particular concern to adolescents, for whom confidentiality is a primary factor in determining whether to seek necessary health services, especially those of a sensitive nature.

The passage of HB2812 HA1 would help ensure the confidentiality of school health center patients and would be a victory for the financial sustainability of school health centers that contract with MCEs. The legislation ensures that MCEs do not have to incur additional administrative costs from sending EOBs for sensitive health services and ensures that EOBs are uniformly suppressed across all MCEs.

Being selected in the first cohort of the School-Based Health Alliance’s policy learning collaborative has pushed EverThrive Illinois to think critically about policy changes such as this that will improve the long term financial sustainability of our school health centers. Illinois school health centers are required to serve students regardless of their ability to pay, so they often absorb the cost of sensitive services in order to protect the confidentiality of their patients. Legislation to prevent the sending of an EOB for Medicaid patients would allow our school health centers to bill and receive reimbursement for all services rendered within the clinic to Medicaid beneficiaries.

Through participation in the learning collaborative, we are strengthening relationships with stakeholders interested in improving care delivery systems for adolescents. The collaborative allowed us to center the discussion around the unique nature of school health centers and educate influential stakeholders and advocates on their effectiveness in delivering care for the adolescent population.  A great benefit to participating in the collaborative has been access to funding for consulting services, which we are using to strengthen the capacity of our school health centers to negotiate contracts with MCEs.

As of April 2015, HB2812 HA1 passed out of the respective House and Senate Committees with bipartisan support and no opposition. EverThrive Illinois will continue to engage impacted stakeholders in educating their representatives on the importance of voting “yes” on this piece of legislation, and are looking forward to a victory this session in Illinois.


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