CMS questions $350M Medicaid payment backlog to Illinois physicians

CMS is questioning why Chicago-based Cook County Health's Medicaid managed care plan hasn't paid the $350 million it owes to physicians for treating low-income patients, according to Crain's Chicago Business.

The insurer, CountyCare, is one of six administering Medicaid benefits in the state of Illinois. Under the state Medicaid managed care program, CountyCare is required to pay claims within 30 days. However, the insurer is backlogged, and its CEO said it takes about 110 days on average to make payments, according to the report. 

Crain's found CountyCare received more than 30 complaints between last August and January from hospitals and other providers that they were owed money from the plan.

As a result of the backlog and delays, CMS now is asking the insurer and the state for an explanation and what they are doing about the hundreds of millions of dollars in unpaid claims. 

CountyCare CEO James Kiamos blamed the late payments on the state and Cook County governments, arguing the lag is a "byproduct of funding" in Illinois' managed Medicaid system, not a "byproduct of plan operations," according to Crain's. 

Healthcare & Family Services, which oversees Illinois' Medicaid program told Crain's that "We have been in contact with federal CMS, explaining the circumstances, and will continue updating the status."

Access the full report here.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars