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Rauner's Veto of HB1424 Jeopardizes Services for Seniors, Persons with Disabilities

Jan 10, 2018

In response to Governor Rauner's recent veto of HB1424, Health & Medicine's Executive Director Margie Schaps, MPH and Phyllis Mitzen, MSW, Consultant for our Center for Long-Term Care Reform released the following statement:
 
Governor Rauner’s veto of HB1424 as reported in the Sun Times on Sunday, Dec 31, which was intended to preserve the Community Care Program (CCP) may foreshadow a blow to the thousands of older adults and persons with disability who rely on this program to remain living in their communities rather than moving into a nursing home.  

The Community Care Program was initiated in Illinois in the 1970’s with Medicaid waivers intended to divert people from unnecessary nursing home placements.  Now, with the growing numbers of older adults in Illinois and adults with disabilities living longer, more people are turning to the CCP for help, making the program appear more costly (although not more costly than if more people move to nursing homes).  

There is no doubt that this program requires review and modernization, but this is precisely why the legislature, in conjunction with HB1424, also established a high level task force to make recommendations to modernize the program and establish a framework to put it on sound financial footing for the future.  This report is due to the legislature on January 31, 2018.  

Governor Rauner’s veto undermines the ability of our most vulnerable citizens to receive the services they need to safely live in their communities, and undermines the efforts of the legislature and advocates to recommend and enact meaningful and lasting changes in the funding and service delivery of this critically important program. The Community Reinvestment Program being promoted by the Rauner Administration, which would cover 50% of the people currently receiving help from CCP, is untested, leaving these people at the mercy of geographic resources and waiting lists. Governor Rauner should hold off on any decisions on the CCP program until the Task Force recommendations are released at the end of January. We in Illinois can and should do better to provide a safety net for people who need help – it is the right thing to do, morally and economically.

Health & Medicine Remembers Leslie Nickels, MEd, PhD

Nov 27, 2017

Health & Medicine is saddened to share the passing of Leslie Nickels, MEd, PhD. Leslie recently received a Lifetime Achievement Award from Health & Medicine in honor of her many contributions to worker health, safety, and justice. She is also a former board member and made enormous contributions to many Health & Medicine initiatives, most recently our Quentin D. Young Equity Project. Our thoughts are with Leslie’s family, many friends, and colleagues. We are deeply grateful to have Leslie’s values, partnership, and work woven into the fabric of Health & Medicine.

Leslie’s family has requested that in lieu of flowers, donations be made in Leslie’s memory to the causes important to her, including Health & Medicine. To make a donation in her memory, please use this link.

Health & Medicine Testifies Before County Board in Support of Fully Funded Health System

Nov 06, 2017

On Thursday, November 2, Health & Medicine's Executive Director Margie Schaps presented the following testimony at the Cook County Board Budget Hearing.

My name is Margie Schaps, and I am the Executive Director of the Health and Medicine Policy Research Group.  I want to thank the Board for allowing the opportunity to testify in support of a fully funded Cook County Health and Hospitals system budget.  Since 1981, Health and Medicine has been an organization committed to developing and supporting systems and policies that create a healthier society.

I have testified before the County Board and the Health System Board since our inception and always in the interest of supporting a strong Cook County Health System for the most marginalized people in our County. We spend a lot of time researching best practices and developing solutions to provide better, more efficient and effective health care for all—particularly those served by pubic systems. 

WE are at a crossroads right now.  Federal leadership is threatening our access to healthcare. The ACA is hanging on by a thread, but here in Illinois we at least have a commitment to the continuation of Medicaid expansion. This Health System is the cornerstone of our commitment to health care for all.  The County Health System has just taken a big leap in taking on the responsibility for caring for nearly 100,000 additional people over the next year through managed care contracts that reduce but do not eliminate the need for tax support. Now is a moment that the health system can be a leader in developing a high quality, highly efficient health care delivery system, focused on primary care, prevention, addressing underlying social determinants of health, high touch intervention for those with multiple chronic conditions, mental illness, substance use disorders, and more. We could be a national model for efficient and effective care that will truly improve the health of the public, and lower medical costs in the long run. 

Public health services and healthcare to detainees at the jail, and care for the thousands of uninsured in the County are services that are our obligation as a County: they are in the mission statement of the County and the Health System, and they are services that are not covered through any mechanism other than the County tax support.  Lowering the subsidy provided to the health system would mean reneging on our obligations to serve, reducing our ability to respond to things such as foodborne illness outbreaks and health services for detainees that might help them stay out of jail. Public health threats like Zika virus require intense surveillance and intervention by the public health department—again, not inexpensive, but imperative and with great consequences if underfunded.

CCHHS is unique and is a treasure to our County.  Its mission is clear and lays out their commitment to caring for all regardless of ability to pay.  Its practice is priceless. They train healthcare providers who are mission driven and expert in working with patients with complex needs; they have forged relationships with health centers, support services, hospitals, and related services across the County to ensure continuity and high quality care for their patients.

We recognize that these are difficult financial times for the County and that the implementation of the ACA and expanded numbers of Medicaid covered people in the County system may lull some into believing that federal money flowing into the system is enough to cover all of the services the health system provides.  This is NOT true—we still have hundreds of thousands of people in our county without health insurance, some not eligible, many seeking healthcare for the first time in decades and presenting with complex behavioral and physical health needs—requiring more staff time, a greater array of services, and therefore at a greater cost than the System was accustomed to.  Because of federal cutbacks and threats to the ACA, navigators who help people sign up for insurance have been eliminated from the federal budget, leaving many who might be eligible for Medicaid or Marketplace coverage not even aware of it, placing additional burden on the public sector.

Finally I think we must not take new taxes off the table for discussion.  Other municipalities like the District of Columbia have established differential property tax rates for vacant properties. If implemented in Cook County, a policy like theirs would generate millions and incentivize building on vacant lands.

Our County is making tremendous progress in reducing the number of people who are incarcerated—but many who are in the system require extensive health and behavioral health interventions.  New programs and collaborations are commendable but will not immediately reduce expenditures.  It is the job of this board to approve a budget that will allow the Health System to succeed.  We must continue to provide the needed resources for the System to flourish and provide the services they are obligated to provide and allow the System to fully implement the strategic vision that will ultimately reduce costs and improve the health of the residents of the County.  We cannot abandon the most marginalized in our County.  It is critical that the amount proposed in the Health System budget be approved.

New Report Points to Barriers to Mental Health, Addiction Coverage

Sep 19, 2017

Today, Health & Medicine in collaboration with a group of organizations including the Kennedy Forum, the Illinois Psychiatric Society, the Community Behavioral Healthcare Association, and others who seek to improve mental health and addiction treatment released a new report pointing to significant barriers to coverage. The report highlights the results of a provider survey asking hospitals, psychiatrists and community providers about their experiences with reimbursement for mental health and addiction services. The survey findings raise red flags about a number of potential barriers to services that families may face and whether Illinois’ health plans are providing mental health and addiction treatment on par with other types of medical conditions, which is required by state and federal parity laws for most plans.

The report makes recommendations for policymakers, regulators, health plans, providers and consumers to ensure that Illinois residents have access to the services they need.

In response, State Representatives Steve Andersson, Deb Conroy, Sara Feigenholtz and Lou Lang have introduced a resolution to address these issues, HR 607. Rep. Conroy, chairwoman of the Mental Health Committee, has pledged to hold hearings.

Attorney General Lisa Madigan said, “This report raises important questions about whether consumers can access mental health and addiction insurance coverage when they need it. My office is committed to holding insurance companies accountable to our state’s mental health parity laws. Anyone who has problems with their health insurance coverage should contact my Health Care Bureau for help at 1-877-305-5145.”

The survey and report were conducted jointly by The Kennedy Forum Illinois, the Illinois Psychiatric Society, Illinois Association for Behavioral Health, IARF, the Community Behavioral Healthcare Association of Illinois, the Illinois Health and Hospital Association, and Health & Medicine Policy Research Group, and in partnership with members of the Illinois Parity Coalition.


Finding highlights:
  • Upwards of 75 percent of responding providers reported that Medicaid managed care organizations (MCOs) sometimes/often/always denied coverage for inpatient treatment, partial hospitalization, intensive outpatient treatment, and medication-assisted treatment. Nearly half of responding providers reported commercial insurers at least sometimes denied inpatient treatment.
  • More than 60 percent of responding providers reported that Medicaid MCOs sometimes/often/ always refused to cover the requested level of care and instead approved only a lower level of care, while 54 percent of responding providers reported commercial insurers did the same.
  • With Medicaid MCOs, nearly 65 percent of responding providers reported that they were told often or always that networks were simply closed. Nearly half of responding providers were told this often or always with commercial plans. The result: with mental health and addiction care providers unable to join plan networks, patients have more difficulty accessing care, due to the narrow network.
  • More than 90 percent of responding providers report that both Medicaid MCOs and commercial plans have refused to provide requested medical necessity criteria, despite clear legal requirements that plans do so.