Problem: Medicaid Recipients in Illinois managed care plans report difficulties getting information about rules of the plan, available providers, what the plan does and does not cover, and procedures for filing complaints/ appealing adverse decisions. As a result, recipients can not always access even the most basic, routine care for themselves and their children. They also report difficulty accessing family planning and other specialty care.

Root Causes: 1) Medicaid recipients, as a group, have not had a specific targeted advocacy campaign to affect the managed care industry’s policies, nor has the state (Illinois Department of Public Aid) held the industry accountable to delivering quality care to Medicaid recipients. 2) The managed care industry and IDPA place financial priorities above meeting the health care needs of Medicaid recipients.

Solution: Mobilize recipients and organizations to develop the state’s understanding of its responsibility to ensure public dollars paid to Medicaid HMOs are spent appropriately to meet Medicaid recipients’ health care needs. Build the accountability of managed care organizations to state oversight agency (IDPA), Medicaid recipients, and organizations working with them.