THE BLOG
08/01/2013 12:05 pm ET Updated Oct 01, 2013

Obamacare in Cook County Has Yet to Earn Bragging Rights

It's got quantity, but quality? Not yet.

While Cook County Hospital CEO Dr. Ram Raju last week hailed the 80,679 applications submitted to its HMO-driven "CountyCare" Medicaid plan operating under Obamacare, the program's promise is at risk of failing in a critical area -- substance abuse treatment.

CountyCare is facing two formidable obstacles. One, an old Medicaid law is clashing with the new Obamacare law; and two, there is the historic problem of HMOs attempting to dodge their commitments to patients, a near universal complaint of any HMO enrollee.

Cook County's CountyCare program exists under a federal waiver that is allowing Cook officials to get a head start on the 2014 implementation of Obamacare in Illinois' largest county.

The problem is that Cook County is racking up applications, but not necessarily results.

Under Obamacare -- and the term is not being used as a pejorative here but only as shorthand for the Affordable Care Act -- uninsured, single men without children, living below the poverty line, are eligible to receive health care benefits through Medicaid.

One of those newly available Medicaid benefits is treatment for alcohol or drug abuse.

But a key problem is delivering drug treatment to CountyCare enrollees through Medicaid. Because of an oversight in the newly minted Obamacare law, those who require a residential stay to power their recovery are unable to use the vast majority of Illinois drug-treatment residential programs with 17 beds or more because they are prohibited from being Medicaid certified due to an older Medicaid law.

Years ago, the federal Medicaid program sought to prevent the warehousing of individuals who were struggling with drug and alcohol abuse in large residential facilities. But the architects of Obamacare failed to reconcile the new benefit with the old law.

So what does that mean?

Well, here's a recent example under CountyCare.

An unemployed, homeless man who was living in a Chicago homeless shelter managed, through the help of friend, to present himself at a suburban Cook County drug treatment agency, pleading for help to overcome his alcohol abuse. The assessment revealed he needed residential treatment due to severity of his condition.

The response from CountyCare's HMO provider? Denied.

The individual was denied both because the residential program was not -- and could not be -- Medicaid certified and because the man, struggling on his own to overcome his alcoholism, had taken no alcoholic drink in two days. The agency was told that the client needed to fail first in outpatient care -- he had to resume drinking -- before residential treatment became a viable option. Just what the doctor ordered.

What happened?

The man finally reported to the CountyCare HMO that he began drinking again, leading the HMO to hospitalize him in medical detox -- a vastly more expensive option than residential treatment. And Obamacare picked up the bill.

Before CountyCare, this man would have received the less costly clinical detox in the agency's residential program for men under its contract with Illinois Division of Alcohol and Substance Abuse. But for those now enrolled CountyCare, the state option is no longer available. The state, which is looking to save money, is no longer willing to expend its own precious tax dollars because the promise of Obamacare was to save states money by having the feds picking up the tab.

It's possible to see how screwed up CountyCare is when it comes to drug treatment as one example. It required that someone, who struggled to sober up long enough to seek help, had to resume drinking, according to the HMO, to get any help, and then that help came at a more expensive price tag for taxpayers. Brilliant.

The Illinois Department of Healthcare and Family Services, which is responsible for Medicaid in Illinois, is attempting to work with providers to sort through Obamacare growing pains.

Without a change in Medicaid federal law by Congress to allow 17-bed treatment facilities or more to become Medicaid certified to deliver an Obamacare benefit as intended at lower cost than a hospital stay, an enormous structural impediment to CountyCare will be imbedded in the system. But Congressional Republicans will do nothing to help smooth Obamacare wrinkles. Zippo.

Meanwhile, if CountyCare officials allow those HMO doofuses to continue to dodge its responsibilities by undermining the health of the very people whom they are contracted to serve, then Obamacare is going to flail and flop on its fanny in Cook County.

In the meantime, Dr. Raju has nothing about which to brag.

DavidOrmsby@DavidOrmsby.com