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Illinois’ Moves to Bring Down Medicaid Costs

Nursing homes are invariably subjects of controversy as are rising Medicaid costs. A decision by the state of Illinois to regulate Medicaid costs for elderly and disabled nursing home residents is generating a lot of attention. Illinois nursing home negligence attorneys are closely following this new development.

MADO Management was selected as a partner in a government project aimed at controlling health spending for high-cost recipients of Medicaid insurance. There is some controversy over the fact that MADO, an organization that operates many nursing homes, was selected even though its facilities received inspection violations and reportedly have unsatisfactory staffing levels. However, it appears that MADO was the only nursing home that applied for Illinois’ plan to shift mentally ill residents to independent apartments or group homes.

Illinois governor Pat Quinn announced six partnerships that will enable Illinois to comply with a new state law that requires at least half of all Medicaid recipients in Illinois to be transferred to managed care by 2015. State officials are opening some contracts to nonprofit mental health centers and hospitals to carry out this transfer. They hope that this move will eliminate unnecessary ER visits and other types of care while bringing down costs for Medicaid patients.

The welfare of mental patients is the chief focus of another Illinois state-initiated program called “Be Well Partners in Health” that also involves MADO Management. The organization works in partnership with various nonprofit organizations.

MADO does not particularly have a distinguished track record in helping nursing home residents with mental issues live more independently. Critics mention the MADO facility Sacred Heart Home, which repeatedly received a two-star from the Nursing Home Compare website. Among safety and health violations, Sacred Heart Home was also cited for its failure to provide rehabilitation services to a resident.

However, MADO Healthcare claims that it has been in the forefront of healthcare reform in Illinois. It collaborated with Illinois in the nursing home reform law of 2010 and worked with the state for three years to make it happen. MADO claims it wants to move towards recovery and rehabilitation services from long-term care. Experienced Chicago nursing home abuse lawyers will be closely observing how the plan works, and be ready to help residents who suffer as a result.

The controversy is further heightened by the fact that the businessman Peter O’Brien, who is the owner of MADO Healthcare, is now appointed to a state board. The family has political connections, since O’Brien’s brother, the late Daniel O’Brien Jr. was a state representative and senator. So some critics are asking if MADO’s selection was politically motivated.

The company denies any political motivations and claims that its comprehensive proposal is the reason that is was selected for this state scheme. O’Brien himself shrugs off his political connections, saying that he always likes to play an active part in making a difference to someone’s life. O’Brien claims that much of the motivation behind MADO participating in the state’s relocation plan was the mental illness of his late son. It made him think of a need for a “person-centered program” to take care of the rehabilitation, hospitalization and community care needs of mentally ill people as well as the elderly and physically weak.

The six projects are mostly run by government health agencies, hospitals and such nonprofits. A group of healthcare centers will concentrate on some counties in central and northwest Illinois. The Healthcare Consortium of Illinois leads another group of counties, as does the Macon County Mental Health Board. Cook County’s Heartland Health Outreach and Illinois’ Community Care Alliance are also involved.

Around 6,000 Medicaid recipients are expected to benefit from the efforts of these institutions. The organizations will get fees for the patient care they offer, but will be penalized if the required quality standards aren’t met. They will need to share their savings with the state too.

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