Ill. EMS Providers Suffer Wait for State Payments
When an ambulance is dispatched in Illinois to help the victim of a car crash, shooting or heart attack, the paramedics who arrive don't ask - and are prohibited by law from considering - whether that person has a certain kind of health insurance or no coverage at all.
Ambulance services can't discriminate when it comes to relieving patients' suffering. But the state's ongoing backlog of bills is inflicting financial pain on ambulance providers if those patients are covered by Illinois' Medicaid program or the group health-insurance program for state employees, retirees and dependents.
"Nobody seems to care," said Andrew Thornton, the Illinois State Ambulance Association's chairman for governmental affairs.
Delays of six months to a year for Medicaid payments, and delays of more than a year for state employee insurance, have prompted ambulance services to borrow money to make payroll. The delays, on top of already inadequate Medicaid payments, also have depressed salaries for ambulance crew members and made it harder to replace aging equipment, emergency medical service officials say.
Though there's no hard data, there are anecdotal reports that the cash-flow problems have resulted in fewer ambulances on the road and longer response times, Thornton said. Delays in medical attention can result in death and in long-term health consequences for those who survive, he said.
"There is a human cost involved, but it's hard to quantify," said Thornton, a paramedic who lives in Springfield and directs the not-for-profit Fulton County Emergency Medical Association.
The 400 to 500 ambulance services in Illinois operate under a variety of structures. Some are part of city or village government, some are not-for-profit organizations that contract with local governments, and some are private companies that may be dispatched to "911" emergency calls by government-operated call centers.
But when they bill for services, many are suffering because of payment delays.
Delays in state payments began to get worse in 2009 and 2010 and are closely related to the economic downturn, Thornton said. The impact was magnified in July, when a 2.7 percent Medicaid rate cut imposed by Gov. Pat Quinn and the General Assembly took effect for most services provided by ambulance crews.
That cut, on top of a 6 percent Medicaid rate cut in 2002, rolled the rates back to levels paid in the 1990s, Thornton said.
There's no end in sight to the payment delays. The Legislature approved $550 million in spending for state employee health coverage this fiscal year, but the bills for that coverage are expected to total $2.65 billion. The state paid $87 million in interest payments last year to medical providers owed money by the state insurance program, according to Scott Adams, director of research and employee benefits for Council 31 of the American Federation of State, County and Municipal Employees. Illinois currently owes about $20 million statewide to medical transportation providers, with most of the money owed to ambulance providers, according to Kelly Jakubek, spokeswoman for the Illinois Department of Healthcare and Family Services.
Jakubek said HFS "cannot speculate as to when provider time frames will improve. It is, however, likely that similar delays will continue for the foreseeable future."
State Rep. Donald Moffitt, R-Gilson, who sat on a bipartisan Illinois House task force that held hearings throughout the state and produced a report in November on emergency medical service funding, said the payment delays "absolutely worry me. If it's your loved one suffering a cardiac arrest, you want a quick response and the best that there is."
Moffitt, who co-chaired the task force with former Rep. Lisa Dugan, D-Bradley, said EMS service is "a very basic funding role of government and should be considered an essential service," regardless of whether the EMS provider is for-profit or not-for-profit.
"They all need to be paid," he said.
Moffitt said he will continue to advocate that EMS funding be given higher priority, and he plans to work with Lt. Gov. Sheila Simon, a Democrat, to push for legislation in the spring session that carries out the task force's recommendations. The task force report is available at http://tinyurl.com/emsfunding.
The group's recommendations include establishment of zero-percentage interest loans to EMS providers, a boost in Medicaid rates, quicker state payments and a dedicated funding source for EMS equipment and training.
Not-for-profit EMS providers would receive priority if a dedicated funding source were created, Moffitt said.
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