The Illinois Department of Public Health owes the federal government an estimated $24 million for debt that piled up from a complicated state program to vaccinate low-income kids, WBEZ has learned.
The revelation adds another layer to Illinois’ byzantine effort to get vaccines for roughly 130,000 low-income children. The state had been using free vaccines from the federal government for kids in the Children’s Health Insurance Program, known as CHIP.
But then the feds called for states including Illinois to pay for those doses. So former Republican Gov. Bruce Rauner stopped the financial bleeding with a major policy shift that led some doctors to stop vaccinating low-income children. Dozens of physicians have told Illinois public health officials this “could lead to a public health crisis with disastrous consequences” in light of the nationwide measles outbreak.
Now, the new administration under Democratic Gov. JB Pritzker is hustling to potentially unwind his predecessor’s efforts while negotiating with the feds on how to pay down the state’s big debt.
“We’ll already be thinking about back to school in just a few months,” said Dr. Ngozi Ezike, the new director of the Illinois Department of Public Health. “We want there to be as many providers out there as possible to be immunizing kids, especially in light of the nationwide measles outbreak of record proportions.”
Illinois owes the big tab to the federal Centers for Disease Control and Prevention. Ezike said the debt accumulated for about three years starting in 2014, after the CDC told states that
the agency’s free vaccine doses can’t be used for kids on CHIP.
CHIP is a state-run initiative for kids whose parents make too much money to qualify for publicly-funded Medicaid health insurance, but still can’t afford more expensive private insurance.
Illinois doctors say they thought they were allowed to use the free vaccine for patients on CHIP. In fact, Illinois was supposed to reimburse the CDC for those shots. To complicate matters, the state didn’t have a good system to track when doctors used the free vaccine for kids on CHIP.
So the debt swelled, reaching an estimated $24 million.
Concerned about this climbing IOU, Rauner’s administration hit the brakes in 2016. The state public health department stopped providing free vaccines to doctors for CHIP patients. The providers would have to pay out of their own pockets to buy vaccines instead from manufacturers, then wait for private insurers that contract with the Illinois Medicaid program to reimburse them.
Doctors say that can take months, if they get paid back at all. So they started turning away kids on CHIP, even as the program’s enrollment climbed, state records show.
“Big question mark” about where kids are now getting vaccines
Nirav Shah, who led the Illinois Department of Public Health in 2016, defended the state’s policy change because he said stopping the rising debt was critical.
Paying it back was already going to siphon away money from other public health programs, and the CDC essentially blessed Illinois’ policy shift, Shah said.
Most of all, the state wanted to make sure the rule change didn’t impact children on CHIP, Shah said.
“There is no evidence to suggest that vaccination rates have dropped,” he said.
The state closely tracked school-aged children in particular.
But it’s actually impossible to quantify how the Rauner administration’s policy change has affected Illinois’ child vaccination rates. State education officials don’t track children on CHIP specifically. Doctors say they’re turning away CHIP patients, and they aren’t required to report whether they immunize kids on CHIP in particular.
“It’s a big question mark where the kids are getting their vaccines from,” said Dr. Eddie Pont, government affairs chairman for the Illinois Chapter of the American Academy of Pediatrics. “Health departments by and large have gotten out of the business.”
Of the nearly 130,000 Illinois children on CHIP last year, the biggest portion — about 44% — lived in Cook County, enrollment data shows. DuPage County trailed far behind with the second-highest population, around 7%.
Dr. Gloria Valiente is a west suburban pediatrician who treats patients on CHIP, but because of the state rule change she sends them elsewhere to get vaccinated.
“We just don’t have that cash flow I guess in the practice because it’s just way too expensive,” Valiente said. Doctors there largely treat low-income patients on Medicaid.
She recalled two patients she recently tried to send to the Cicero Public Health Department to get immunized. But their mom works two jobs, and she couldn’t take time off to get her kids to the clinic.
“Bottom line, she’s going to have to pay for very expensive vaccines” out of pocket, Valiente said.
To help doctors like Valiente, the state health department devised a program to avoid making docs pay those upfront costs. Shah said the state gave $3.5 million to the nonprofit Illinois Public Health Association. The goal was to have the association start a consortium that would buy vaccines so physicians wouldn’t have to front the money.
But the consortium never gained steam. And ultimately, the headache of waiting for reimbursement from insurers just transferred to the IPHA, said executive director Tom Hughes.
“I think that overall the idea [of a consortium] was great,” Hughes said. But, “I think putting it into practice was hard, cumbersome, and probably I would never do it again.”
Shah defended the consortium as a good use of taxpayer money. After all, it provided vaccines for children, he said.
Lengthy negotiations over Illinois’ vaccine bill
The Illinois public health department is in the final stages of negotiations with the CDC that started more than a year ago. A spokeswoman for the CDC declined to comment.
The state plans to pay down its debt over seven years by buying about 500,000 doses of vaccines instead of getting them from the CDC for free, Ezike said.
Meanwhile, Ezike said her agency and the Illinois Department of Healthcare and Family Services, which runs Medicaid and CHIP, are still searching for ways to encourage more doctors to vaccinate kids on CHIP.
“Many of them are willing to purchase vaccine up front if they had more resources, i.e. if some of the back payments were caught up,” Ezike said.
Shah’s take: If the stumbling block is private insurers not reimbursing doctors fast enough for the vaccines they buy, the state should hold them accountable.
Enforcement falls to the Illinois Department of Healthcare and Family Services. In a statement, a spokesman said the department is working to address the delayed payments. That includes producing billing guidelines with insurers.
Kristen Schorsch covers Cook County politics for WBEZ. Follow her @kschorsch.
WBEZ's Alyssa Edes produced this interview for broadcast.