As the amount of state money owed to the Christopher Rural Health Planning Corp. edges ever closer to $1 million, the nights get longer for its president and CEO Kimberly Mitroka.

CRHPC, a not-for-profit organization that operates 15 healthcare clinics in nine Southern Illinois counties, provides medical, dental and pharmacy services for more than 30,000 patients.

Fully one-third of those patients are on Medicaid, the medical benefits program administered by the state.

As of Friday, the organization was owed a little more than $900,000 by the state for services provided to Medicaid patients.

"Basically, we are going to have to cut expenses dramatically. Even though we are a non-profit, we still have to pay our bills, pay our staff," Mitroka said. "The very last step we want to take would be cutting patient services, because people need the services whether we're being paid or not. It's something I think about all the time."

Community health centers like those operated by the corporation are considered safety-net providers.

"If we aren't here, all our patients end up in emergency rooms, which would cost the state many, many more dollars," she said.

Hervey Davis, CEO of Franklin Hospital in Benton, feels Mitroka's pain. As of the end of October, the state owed the hospital $1.956 million for Medicaid-related services.

"In Franklin County, the indigent health care problems are not improving; if anything, they are getting worse with the effects of the national economy," Davis said.

While the critical access hospital is not in any danger of shuttering services, Davis said the amount owed by the state does create difficulties.

"We have about five months of activity on the books that has not yet been paid," he said. "What it does is create a ripple effect. If we can't pay our local vendors on time, they can't pay their bills on time, either. That can have a real impact."

St. Mary's Good Samaritan Inc., which has hospitals in Mount Vernon and Centralia, averages a 20 percent Medicaid patient population, up from 17 percent in 2006.

Right now, the payment cycle is about 99 days on Medicaid claims, a cycle that has actually seen improvement since the spring, when the figure was more like 180 to 210 days, Richard Huntington, SMGSI vice president of business development, said.

"It's very hard on hospitals and providers who don't get paid on time. It's the same thing as giving an interest-free loan, and the cost of health care keeps going up. Late payments are a great stress on us, and we're hopeful that our government can come to a resolution soon."

Huntington said late payments affect operations in that there is a time value associated with money.

"Late payments mean we lose the opportunity to earn the interest on those funds we could get if they were placed in a bank. Also, lateness means deferring the usage of those funds for other projects," he said, but added, "We have not cut staff or services as a result of the Medicaid situation and have no intention of doing so."

State Comptroller Dan Hynes wrote a letter recently to state leaders, urging them to make changes in the law that would "provide greater flexibility when the state borrows money and allow the state to establish a revolving line of credit to deal with the current problems."

The state bill backlog could top $5 billion by March, he said.

Mitroka said she hopes state leaders can come together to solve the crisis.

"I have confidence in the legislature that they will come up with an answer and fix the state of the state," she said. "There is a way to do it, but I thank God it's not my job to do it. There are going to have to be painful and difficult decisions made."

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