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1 in 5 people in McLean County are on Medicaid. And a big shakeup is coming.

Heidi Winfrey

Heidi Winfrey of Lexington hates Medicaid. But she wanted to enroll anyway.

Winfrey’s husband, Reggie, died last year from cancer at age 58. He was on Medicaid, the government-funded healthcare program for low-income people. Heidi feels strongly that he received subpar care because of it – manifest through dismissive encounters at hospitals and doctor’s offices where Winfrey felt discriminated against because of Reggie’s insurance card.

“I believe in my heart, if my husband wasn’t Black, and if he didn’t have Medicaid or Medicare, he’d have gotten the treatment he wanted. He would’ve gotten the full treatment. So now I’m without a husband, all because of Medicaid,” Winfrey said. “Nobody wanted to treat him. How many doctors I’ve heard, or how many nurses I’ve heard: ‘Oh, you have Medicaid. Oh.’”

Winfrey herself has been uninsured about six years. She recently tried to sign up for Medicaid at the urging of a doctor’s office and was denied – told that she made too much money at her office manager job for a small plumbing and HVAC company in Bloomington.

“My boss is looking around, but I might go to the (HealthCare.gov) marketplace,” Winfrey said. “Some of these doctors won’t even take Medicaid.”

There are about 36,000 people in McLean County who are on Medicaid, or 1 in 5 people. And that number has grown 20% over the past five years, largely due to a COVID-era expansion that enrolled more people and temporarily stopped asking them to prove they were still eligible for it.

That’s now ending. With the COVID emergency over, the state of Illinois in May resumed those eligibility checks – called redeterminations – for the first time in three years. No one knows how many people will get bumped out of Medicaid over the next year. Some will be removed because they’re eligible to join an employer-sponsored plan or a spouse’s insurance – or because they don’t know about the redeterminations and get kicked out unknowingly.

“We know a lot of enrollees have no idea this is happening,” said Dr. Kathy Hempstead, senior policy advisor at the Robert Wood Johnson Foundation (RWJF).

Nationally, an estimated 15 million people will lose Medicaid eligibility, with about 3 million of them ending up uninsured, according to RWJF.

“That’s a lot of people. That’s about a 10% increase in the total uninsured population, which is a shame,” said Hempstead.

"I absolutely think many people will fall through the cracks, will lose coverage, and not know their coverage has lapsed until they show up in need of medical services."
Colleen Kannaday, Carle BroMenn Medical Center president

The state of Illinois and providers are actively working to notify Medicaid enrollees about the redetermination process. A priority is asking people to update their mailing address.

Carle BroMenn Medical Center in Normal is trying a little of everything – posters, electronic notifications, and one-on-one conversations between staff and patients. But human nature is such that we tend to ignore stuff we get in the mail, said Carle BroMenn President Colleen Kannaday.

“I absolutely think many people will fall through the cracks, will lose coverage, and not know their coverage has lapsed until they show up in need of medical services,” Kannaday said.

Mike Romagnoli, the executive director of the free Community Health Care Clinic (CHCC), said he has a theory about when these Medicaid surprises will happen.

“A lot of people are going to find out they lost coverage at the pharmacy. Because you tend to have more interactions with your pharmacist than your doctor’s office, going to pick up meds,” he said.

Good and bad experiences

Even if thousands of people fall out of Medicaid in McLean County, that leaves about 30,000 who still rely on it. The bulk (about 14,000 today) are children.

WGLT interviewed 10 patients, providers, and other stakeholders who describe Medicaid here in very mixed terms – good and bad, deeply flawed but critical to the local healthcare picture.

Take Lyndsay and Dan Withey of south Bloomington. Dan and their 12-year-old daughter use Medicaid for their primary coverage.

Dan’s experience has been difficult. He never got to actually see his last doctor, only a physician’s assistant or nurse practitioner, and referrals and treatments took forever to happen. He switched to a new doctor in April after they began accepting Medicaid, and it’s been much better.

The Witheys have been impressed by the quality of care provided to their daughter, who was a NICU baby, has cerebral palsy, is on the autism spectrum, and has dyslexia.

“She had a case manager through Molina through Medicaid, walking us through all the referrals we needed, walking us through getting us into the right doctors’ offices,” Lyndsay said. “We have an amazing supportive care team right now.”

One challenge is the lack of local providers for certain specialties that their daughter needs.

“She’s got two or three doctors who are a good two or three hours away. We go to see them once or twice a year. It’s taking her out of school for the entire day, or it’s adding in a hotel stay because the available appointment is at 7 a.m. and I’m not getting on the road with my 12-year-old at 4 a.m.,” Lyndsay said.

Not every provider accepts Medicaid, partly because Illinois offers famously low reimbursement rates. Dental care for those on Medicaid remains a major gap. Some specialties, like mental health care or neurology, have a shortage of providers even if you have costly private insurance.

Bloomington-Normal is relatively fortunate compared to other communities when it comes to the number of primary care doctors who do take Medicaid, between Carle Family Medicine, OSF Medical Group, and the Chestnut Family Health Center, said Mike Romagnoli with the CHCC, which serves the uninsured. Options have improved for specialists too, he said, as more of those providers have been absorbed into larger organizations like Carle and OSF.

“We are not the norm by any stretch,” he said.

One of those front-line primary care doctors is Dr. Maria Saavedra at Carle Family Medicine. About 40% of Saavedra’s patients are on Medicaid.

Saavedra said the workload – and time constraints – is high.

“As primary care physicians, being that first stop, we’ve (taken) a lot of the brunt of behavioral health, and psychiatry not being available, and so we’re taking on a lot of demands from other providers who are not available in the area and trying to meet those needs,” she said.

Expanding family medicine access

There are some positive developments locally.

One is the Chestnut Family Health Center, which was renovated and expanded four years ago in west Bloomington. The clinic now serves 2,500-2,700 patients every year. 90% are on Medicaid. Chestnut is assigned some patients by the state; others are referred from the hospitals. The business model works, in part, because it’s a Federally Qualified Health Center that gets enhanced reimbursements from the government.

The clinic has had a positive impact on local healthcare, said Matt Mollenhauer, Chestnut’s chief clinical officer.

“Healthcare works in a way that – folks need it when they need it. They don’t always think of healthcare from a wellness standpoint. And our goal in this facility is to really change that as our next chapter – to have folks think of their healthcare from a proactive standpoint,” he said.

Chestnut Family Health Center is also partnering with OSF HealthCare St. Joseph Medical Center’s new Family Medicine Residency Program, bringing in six new residents per year who will see patients at the clinic, for a three-year program. Chestnut expects that to “significantly” expand its patient capacity, Mollenhauer said.

It’s a mystery, though, how many of Chestnut’s patients will remain on Medicaid after the state completes its redeterminations. Chestnut does have several clinic staffers certified to enroll people on Medicaid on site, so they can talk patients through their options.

“That’s our way of dealing with the issue, in a very direct manner, versus just sitting back and waiting and crossing our fingers to see what happens,” Mollenhauer said. “We have high hopes it’ll go smoother than what people fear, but I do think we’ll have a pretty big impact on the number of people who are ultimately enrolled.”

Ryan Denham is the digital content director for WGLT.