During its two-year state budget crisis, Illinois racked up more than $3 billion in debt to providers who serve the state’s most vulnerable patients - and it could be months, even years, before it’s all paid off. As Christine Herman reports, some doctors in private practice are being pushed to the brink as they wait.
"<door knock> How are you doing? Good, how are you? Good."
Dr. Kristin Stahl is a pediatrician - who’s spent the past 18 years working in Metro East - the part of Illinois just across the river from St. Louis. Recently, the area has seen a rise in Medicaid patients -- they now make up about 60 percent of her clients. But there’s a major problem: She’s not been getting paid to see them.
“The state has historically been so terrible in its payments that it’s very difficult to keep in business.”
For several years, the payments have come in fits and starts - but sometimes, the dry spells would last upwards of 6 months. Dr. Stahl’s currently owed more than $100,000.
“There have been times it’s been close to $200,000.”
Illinois has now had a budget in place for a month, along with a federal court order that requires the state to prioritize paying down the Medicaid bill backlog. At the end of July, the state paid down almost one-fifth of that debt -- Checks were issued to 11 managed care organizations, which serve as the middlemen between the state and Medicaid providers.
But so far, that money has not trickled down to Dr. Stahl.
And while some Illinois providers have stopped taking new Medicaid clients, Dr. Stahl’s never been one to turn away patients - like 10-year-old Makayla.
“And Makayla, let’s look at your growth chart...
Makayla will be starting fourth grade this fall.
“So your weight has always been pretty low, but I think she’s following her own Makayla special curve. (Wendy, mom: It’s like a set pattern). Yeah…”
She and her three older siblings have all been seen by Dr. Stahl, pretty much since birth. Being on Medicaid has been tough for Makayla, who has a rare, genetic condition that requires frequent visits with specialists - many of whom won’t accept her insurance. So Makayla’s mom, Wendy Kelly, is grateful to Dr. Stahl.
“They have such a big heart that they’re still willing to see us without money because they want to make sure that our children are okay.”
The combination of low Medicaid reimbursements - and just not getting paid - has been difficult. And Dr. Stahl says she’s tired of barely making ends meet. Next month, she’ll be opening a new practice in St. Louis. She’s already purchased the building.
“It’s really cute… it’s a 1933 Conoco-Phillips cottage style B.“
The new place will be upscale - and marketed to patients with private insurance. Dr. Stahl plans to travel back and forth to work between her two practices. Once her practice in Missouri takes off, she says she’ll consider closing - or selling - the Illinois clinic.
“I cannot keep seeing a large proportion of Medicaid patients and… expect to send my children to college.”
I talked with three other pediatricians in the metro east area who echoed Dr. Stahl’s frustrations. Some have gone without paying themselves for months, and fear it will be years before they’ll get out of debt. And - they report getting more calls from Medicaid patients recently, asking to be seen because no one else will take them.
This is affecting doctors all across Illinois, according to Jennie Pinkwater, who leads the state’s chapter of the American Academy of Pediatrics.
“This is their mission - to take care of Medicaid patients, and they have a great understanding of how to connect them with the resources they need to succeed, and it’s a shame to see it go away.”
She says Illinois needs doctors like this.
”We’re certainly hopeful the state will be able to step up and make sure that these practices will be able to stay open.”
That may not be the case for Dr. Stahl. And it’s not an easy decision to leave behind her practice. But she feels like after 18 years, she’s done her service - and it’s time for her to move on.