Medicaid cuts threaten access to complex rehab in Illinois

National provider suspends service, as it did in California
Friday, May 22, 2015

SPRINGFIELD, Ill. – Illinois’ decision to cut Medicaid reimbursement across the board by 16.75% is forcing complex rehab providers to reevaluate whether they can continue to provide products and services there.

“Complex rehab technology is service-intensive and has historically low profit margins,” said Don Clayback, executive of NCART. “Any cut to reimbursement presents a problem.”

The situation is further compounded by the state’s unannounced move in April to a cost-plus payment system for Medicaid, resulting in additional cuts.

Two of the state’s largest complex rehab providers—National Seating & Mobility and Numotion—have since suspended services to Medicaid recipients in the state, save for emergency repairs.

“The fee-schedule reduction, coupled with the state’s ill-conceived cost-plus model is yielding reimbursement that cannot cover our operational costs,” said Doug McDaniel, vice president of business development at NSM.“The simple fact is we’re out of the business of serving Medicaid patients with CRT needs in Illinois if there is no relief.” 

This isn’t the first time a major provider has had to make a difficult decision. When California implemented a 10% cut to Medicaid reimbursement in October 2013, Numotion stopped accepting Medi-Cal.

Stakeholders hope the shortage of complex rehab providers willing to service Medicaid beneficiaries will force the state to rethink the new reimbursement policies.

“Our request is pretty simple,” said Don Clayback. “Put things back to the way they were so these products can continue to be provided.”

Whether things go “back to the way they were” or not, Gerry Davis, president of Springfield, Ill.-based Personal Mobility, says he plans on servicing his complex rehab patients until he runs out of money.

“What are people supposed to do?” he asked.