Thousands of Kids At Risk of Not Getting Vaccines

Doctors blame the state budget crisis

Thousands of children in Illinois are at risk of not getting their immunizations this year amid the ongoing state budget crisis, officials said.

More than 100,000 kids on Medicaid in Illinois face potentially not get their immunizations as the state nears its third year with no budget, according to local officials of the American Academy of Pediatrics.

Under the current plans, vaccines for Medicaid Title 21 children are purchased by their doctors, who are supposed to be reimbursed by the state through Medicaid managed care organizations. MCO’s are state contractors. 

“This spring, things came to a halt in getting compensated,” said Dr. Timothy Wall, Medical Director and President of Pediatric Health Associates. “We have had to cut back the ages of children we can give vaccines to.” 

Wall’s practice is one of the largest Medicaid providers in the western suburbs. He said he’s taken out bank loans to pay for the vaccines to give to children up to 1-year-old, but “even that’s becoming difficult.”  

According to the AAP, the backlog is so burdensome for some doctors, they’ve had to stop providing immunizations altogether. 

“That’s a perfect recipe for an outbreak of a vaccine-preventable disease,” said Dr. Edward Pont, who serves as the governmental affairs chair for the Illinois chapter of AAP. 

Pont says most of the children impacted live in the densely-populated collar counties and Western Cook County. 

“These children are part of the community. They go to the camps. They participate in schools,” Pont said. “God forbid, an outbreak of a vaccine-preventable disease occurs, it won’t care what your kid’s insurance status is.” 

Ten-year-old Diego Ortiz, who is among the children impacted, visited his doctor’s office last week for an annual summer checkup, but his family was surprised to find his three immunizations were on hold this year. 

“I asked why and was told the insurance is no longer covering the vaccines,” Sylvia Ortiz said in Spanish in a joint interview with NBC 5 Investigates and Telemundo Chicago. 

The Illinois Association of Medicaid Health Plans, which represents the MCO industry, said its members are trying to minimize the negative impact to Medicaid families but the state hasn’t paid its bills since last fall. 

“At this point, we are owed over $2 billion from the state of Illinois,” said Samantha Olds Frey, Executive Director of IAMHP. “When an industry is owed over $2 billion, there are downstream impacts.”

The state is bound by a consent decree to pay its bills, but the 2-year-long impasse has significantly delayed payments. 

“Under current contracts, plans that are not reimbursed by the state for more than 60 days cannot generally be forced to immediately pay their providers. Unfortunately, this includes vaccination program payments, as well as other bills,” said John Hoffman, Director of Communications for the Illinois Dept. of Healthcare and Family Services. 

Hoffman said the department has submitted payment vouchers to the Comptroller’s Office, which is “ultimately responsible for the timeliness of state payments.” 

In response, the Comptroller’s Office sent NBC 5 Investigates a statement placing blame on the Governor’s Office. 

“Like the check bouncer who yells at his bank for bouncing a check from an account he himself emptied, the Governor disingenuously blames the Comptroller for not writing checks from state coffers that Governor Rauner emptied by failing his constitutional duty to propose a balanced budget,” said Abdon Pallasch, Director of Communications for the Office of the Comptroller. 

The back-and-forth bickering does little for families and doctors feeling the pain of cuts. 

“There’s probably no medical provider that understands the importance of vaccination (better than pediatricians) but we cannot be expected to continue providing vaccinations at a financial loss,” Pont said. 

For the Ortiz family, paying for the three vaccines that Diego needs out-of-pocket would cost more than a week’s worth of pay. 

“Imagine paying almost $800…we do not have the resources to cover all that,” said Ortiz. “If I pay for the vaccines, we stop eating.”

Ortiz said without a solution, Diego may not be able to return to the fifth grade in the fall. 

Gov. Bruce Rauner has called lawmakers back to Springfield on Wednesday to try to negotiate a state budget before the June 30 fiscal year deadline.

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