Fiscal Year 2016 is coming to a close without a budget. Physicians throughout Illinois are owed millions of dollars in claims under the State Employee Group Insurance Program. If the delay in reimbursing physicians for the care they provide to State employees, dependents, and retirees is not addressed, this failure to reimburse will create severe access-to-care issues. Many Illinois practices and large clinics have taken out substantial loans to keep their medical practices viable while they wait for reimbursement from the State of Illinois.
As of June, our current budget situation has left a 17-month and $3 billion backlog of payments owed to physicians and health insurers who treat state government workers and retirees covered in the State Employees Group Insurance Program (SEGIP).
ISMS, along with CIGNA, successfully advocated that the Rauner Administration use available funds from the Health Insurance Reserve Fund (HIRF) to begin to pay physicians and insurers a small portion of what is owed to them. The HIRF is a fund into which premiums paid by State employees are deposited and can only be used to pay the costs associated with health insurance. ISMS, along with Cigna, advocated for the release of these funds to provide for some short term relief. Comptroller Leslie Munger very recently began releasing those funds. ISMS can also help facilitate meetings with those struggling with debts and members of the Administration
While a state budget for fiscal year 2016 has not been enacted, the Governor’s office has relayed it willingness to advocate for any health care professional currently in financial distress. Representatives from the Governor’s Office indicated that for unpaid claims from the state’s self-insured plan, they will work with those who are being adversely affected by the lack of appropriation to SEGIP to provide some financial relief through the Vendor Support Program or by certifying accounts receivable for various vendors/providers that can be used to access individual lines of credit. Professionals and facilities should also review the following link detailing the State’s vendor assistance program at www.vendorassistance.com/Program/Illinois/Home/Home.
ISMS will also provide assistance to facilitate this process. Contact ISMS at 800-782-4767 for individual assistance relating to the backlog.
Resolution to the budget impasse is key to moving forward and ISMS continues to advocate for full funding for the State Employee Group Insurance program going forward, and strongly advocates that immediate action be taken to pay for care that has been provided.