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Inadequate Health Care
Medicaid Reimbursement Rates
Forty-eight year old Sylvia Ortega is fighting to maintain good health. Two years ago her husband lost his job and the Ortegas were left without insurance. For eight frightening months, Sylvia went without medication, watching her health spiral out of control. With Medicaid reimbursement rates at a low, even after Sylvia received Medicaid doctors either turned her away or appointments would not be scheduled for months.
Untimely care has serious impact on patients like Sylvia. She has high blood pressure, high cholesterol, and diabetes. At the age of 48, Sylvia still has a long life ahead of her and a family to take care of. Lack of access to prescriptions puts her in danger of life-threatening spikes in blood pressure, leading to an increased risk of stroke. And Sylvia’s uncontrolled diabetes could eventually lead to kidney problems, blindness or limb amputation. But none of this needs to happen. With regular physician checkups and medicine, Sylvia can prevent these problems from escalating.
After encountering multiple delays in getting an appointment, it was finally at a Health Care Justice public meeting in Homewood that she got some attention. A physician on the Adequate Healthcare Task Force advised her of Alivio Medical Center, a community health center that would not turn her away. Sylvia explains, “The doctor told me ‘we will help’ and she saved my life that day.” In fact, Sylvia was treated with an insulin injection when arriving at the clinic, as her blood sugar level was so high that it was deemed a medical emergency.
Sylvia is now able monitor both her glucose and cholesterol levels. She has found a clinic she can see regularly that accepts Medicaid as she waits to find out if her recently employed husband’s insurance can cover the family. However, ever with these positive developments, she still does not feel secure.
It is incredibly important that the state of Illinois reimburses providers who accept Medicaid patients in a fair and timely manner. The Adequate Health Care Task Force has proposed a reimbursement cycle that sets rates at cost and that is paid within 30 days. Access to health care will greatly improve for Illinois residents should these measures be enacted by our state’s legislature.
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