My testimony about the Department of Human Services (DHS) Proposed Changes on 08/26/15

082615 DHS Hearing

August 26, 2015

Ms. Tracie Drew, Bureau Chief
Bureau of Administrative Rules and Procedures
Department of Human Services
100 South Grand Avenue East
3rd Floor, Harris Building
Springfield IL 62762

Dear Ms. Drew:

Re:

Department of Human Services, Proposed Rules, 39 Illinois Register, pages 7301 est seq., May 29, 2015

As a Medicaid recipient of medical assistance and home services, I face a serious threat to my rights because the State of Illinois’ proposed hearing rules impose many overwhelming barriers for me to maintain my medical assistance benefits. I feel that the proposed rules would make it

difficult for me to appeal the Department of Human Services (DHS) decisions to terminate or deny my medical benefits, especially if I personally need to appeal a denial or termination of benefits.

Initially, I do not understand why

these proposed changes are necessary.

Secondly, because the hearing officer will impose the order of call of witnesses as she/he deems necessary, this two-hour hearing may be inadequate for me to fairly present my views in five minutes. I come here today to express my concerns.

Request for accommodation

To accommodate my disabilities, I request that DHS allow a 60-day appeal period, the historical time period, and that any delay caused by my medical condition may cause me medical and economic hardship. I suggest that a 30-days appeal period insufficient.

I request an accommodati

on for my disabilities that DHS offers me the option of an in-person hearing.

Benefits protection under federal law

The proposed rules are overwhelmingly complicated and confusing, and conflict with federal statutes and regulations that protect my eligibility rights for my Medicaid and Home Services benefits programs below noted.

Adequate notice

The proposed rules do not require adequate notices about termination or denial of my benefits. I suggest that DHS add language to the proposed rule to require a clear statement for the reason of its action. I suggest that the DHS does not delete the requirement that all written notices bear the same date as the date of their mailing and delivery.

DHS will not apprise me that I may request a hearing before a date of action (not the date of notice). I suggest that DHS gives me enough time to respond properly ‎to my notice. I suggest that it offers me a means to comment.

In the past, DHS sent me a notice of termination that did not allow me to respond to my resident agency service office in a timely manner, i.e., the respondent office was not

my assigned office. I did not have enough time to acquire the information requested. This made me spend 6½ hours travel and waiting time, and three office visits to submit my missing documentation. I needed to leave one office due to my long wait in an office with permeating fecal smell. After a two-hour wait, I had to leave to avoid vomiting. I returned to a fresher office the next morning. There were 250 people waiting before me, so I had to wait again. The condition of the two offices that I entered I found filthy, bug-infested, moldy and unhygienic. My visit to 5050 N. Broadway caused me to have an asthma attack.

With the proposed deletion of the word “adequate” in notices suggests that DHS thinks that notices can be something less than adequate, yet still be legally sufficient. If I receive a vague notice and think that it does not affect my benefits, I will lose my benefits. By the time I understand that DHS terminated my benefits, my appeal time and benefit payment pending appeal may have expired. I will again lose my needed medical benefits while I reapply and appeal.

Hearing judges

At a minimum, due process requires that hearing officers must be impartial. I suggest that the DHS include qualifications for hearing officers for all hearings, and specifically that hearing officers be licensed attorneys. An impartial hearing officer holds appeal hearings to determine fairly ‎the areas of agreement and disagreement. I strongly suggest that DHS replace the deletion of “unbiased” with “impartial” throughout the rules.

Free access to records

The proposed rules do not assure me free and timely access to my records for appeals. I suggest that DHS avail me of my full case record in the least burdensome manner.

I suggest that DHS not withhold my “confidential information” because that would restrict my review of my case record during an appeal process. DHS should not withhold anything in my case record for my review during the appeal process. Confidentiality is my choice, privilege, and not that of DHS.

Reasonable access to hearings

The proposed rules changed the hearing locations where I may not have reasonable access. I understand that long-term medical assistance, assigned to Chicago or Decatur, does not reimburse travel and associated costs. I could not afford to travel to Decatur.

The Bureau of Hearings (BOH) has the capability of taking appeals requests by telephone and has been doing so for many years. The proposed rules will not accept medical assistance appeals by telephone. This does not make any sense to me.

Due process

The proposed rules do not provide me with due process. I am entitled to administrative hearing procedures that have integrity and are fundamentally fair. The proposed rules require that only I may personally file a medical assistance appeal. I suggest that DHS permit my Power of Attorney agent, guardian or an authorized representative, and/or legal counsel to file appeals on my behalf. I suggest that the appeal form request attachment of my Power of Attorney document or other authorization form.

There is no rule requiring DHS to make the written appeal form readily accessible, although it requires acceptance of only written medical assistance appeals. There is no rule requiring the department to make the written appeal form readily accessible. Presently, I can only find the appeal form online and I do not always have Internet access. I suggest that DHS enclose a blank appeal form with any notice that initiates my appeal rights.

The proposed rules say that if I “improperly” request an appeal, then the BOH will advise me of the proper appeal process. I do not understand what this means. What is an “improper” appeal? Do I lose time to file my appeal? May I bring witnesses, pursue any argument without undue interference, submit evidence to establish all pertinent facts and circumstances, and question or refute any testimony or evidence, and include the opportunity to confront and cross-examine adverse witnesses?

I commend DHS for proposing to make an electronic recording of the hearing proceedings available to me at no cost and if such recording is not available, to make a transcript available to me at no cost.

Confusing deadlines

The proposed rules require that I provide evidence to DHS at least 3 days ( business?) days in advance of my medical assistance appeal or the hearing officer may not consider that information. This worries me because I have limited access to email, fax and/or scanned required documents. Will DHS provide me with free legal representation? What happens if my correspondence or records are lost?

The rules do not consistently specify identify deadlines; whether due dates are counted in calendar days, business or working days. I suggest that time be consistently stated throughout the rules.

Benefit payments pending appeal process

Presently, I understand that a provision exists that I am entitled to continued benefits pending appeal if I appeal in a timely manner. I cannot locate it in the proposed rules.

Burden of proof

The proposed rules require me to prove that DHS’s action is wrong, rather than requiring DHS to identify why the action is right. Because of the above-mentioned lack of reassurance for me to access to my records for the appeal, I could be unable to provide proof. This seems distinctly unfair to me. Since DHS has full access to my records located in various agency data stores, warehouses, databases, prisons, telephone records, emails and at different agency locations, I think that DHS is in a better position to provide the burden of proof.

If an attorney does not represent me, I do not have the wherewithal to defend my position within the network of governmental agency policies and procedures. Given my limitations and the inaccessibility of DHS staff, it is unfair to place the burden of proof on me.

Task-based services

Now that DHS moved to task-based staffing and special processing units, my accessibility problems have increased. With the task-based system, trying to talk to someone about my case in my DHS agency office requires me to recapitulate my entire DHS history at every encounter; affords me with little or no timely availability of my records; and, completely loses consistency of my issues with a different task worker every time. I need a caseworker to follow my case, not a task worker.

While task-based staffing and special processing units provide efficiencies for DHS, in the appeal context, it has the potential to overwhelm me and force me to abandon my meritorious appeal rather than try to navigate the system. I feel so discouraged.

In summary, these proposed rules will cause wrongful termination of my entitled benefits that will cause serious threats to my health and economic security. I implore you to review these proposed rules and their due-process violations, barriers, and uncertainties, through my eyes, as an at-risk citizen. Accordingly, I suggest that DHS withdraw the proposed amendments and refile them with adequate descriptions and reasons for every proposed change, addition and deletion in the rules.

Sincerely,

Kathleen A. Powers, A.A.S.
Northside Action for Justice, Member of the Board
The Alliance for Community Services, Steering Committee Member
Medicaid Recipient082615 DHS Proposed Changes Testimony

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The New Medicaid Opportunity in Illinois under the Affordable Care Act (ACA)

Medicaid now covers only low-income individuals who meet categorical requirements such as being a child under age 19, are pregnant, are a parent living with a child under age 19, are over age 65, or have a disability that meets the Social Security Definition of disability. The new Medicaid opportunity under the Affordable Care Act (ACA) will allow hundreds of thousands of low-income Illinois residents gain access to comprehensive coverage, including preventative care, prescription drugs, and mental and behavioral health services. The Illinois Department of Healthcare and Family Services (HFS) remains responsible for care coordination and provides for this by using six managed care entities. All Medicaid recipients must choose a managed care entity.

The ACA (Obama Care) requires states to extend Medicaid benefits to all individuals aged 19 through 64 years with income below 133% of the Federal Poverty Level in states that adopt the expansion. Medicaid exists as a federal-state partnership. Illinois currently receives a 50% match for Medicaid, meaning that for every $1 spent on Medicaid, Illinois contributes half, while the federal government contributes the other half.

From 2014 through 2016, the federal government will pay for 100% of the cost for new 2014 Medicaid eligible beneficiaries. Federal match rate reductions will start in 2017, and will never go below a 90% match in 2020, so Illinois will never share more than $.10 on each Medicaid dollar spent.

Illinois will pay for its share of new Medicaid starting in 2017 by:

  • Using monies already spent each year on uncompensated care. The estimated total of uncompensated care would decline by approximately $953 million from 2013-2022;
  • Allowing hospitals, clinics, and other local health care providers to recoup some of their costs, while providing coverage in a more comprehensive manner that includes preventive services;
  • Paying local municipalities and township offices through the general assistance program for the cost of medical care for newly eligible 2014 Medicaid recipients, thereby relieving some financial burden currently carried by these payors.

Many of the individuals who will be newly eligible for Medicaid are already using health care services at hospital emergency rooms and Federally Qualified Health Centers (FQHCs). The new Medicaid opportunity will:

  • Allow individuals access to the entire health care system including access to specialty care and affordable prescription drugs,
  • Help providers of the uninsured by reimbursement for services to allow them to expand their capacity,
  • Significantly increase pay to providers for primary care in 2013 and 2014. The state currently pays Medicaid providers at an inadequate reimbursement rate. The ACA increases Medicaid reimbursement to primary care Medicaid providers.

The new Medicaid opportunity did not change existing rules regarding eligibility for immigrants and non-US citizens. Qualifying enrollees must still be US citizens or a Lawfully Present Resident with at least five years of US residency. According to the Illinois Coalition for Immigrant and Refugee Rights, there are about 490,000 immigrants in Illinois without health insurance, of which 110,000 are naturalized immigrants and 76,000 are legal permanent residents.

Fully implemented, the Medicaid Expansion will extend much-needed health insurance coverage to 17 million uninsured individuals.

Illinois Names Eight Healthcare Plans to
Care for Medicaid and Medicare Clients

The Illinois Department of Healthcare and Family Services (HFS) named eight health plans to partner with the state as it moves the majority of people covered by Medicaid to systems of coordinated care in an attempt to transform its Medicaid system from a program that simply pays medical bills to a wellness system.

Medicare and Medicaid Eligibility

It also involves changes in the way Medicare and Medicaid eligible beneficiaries have their covered services processed. The new project designed for these clients (“dual eligibles”) is a component of the state’s transition to greatly expanded coordinated care for Medicaid clients by 2015. The state estimates that approximately 136,000 seniors and adults with disabilities will be eligible for care under the new processing program. Dually eligible clients account for a high proportion of Medicaid spending, e.g., in 2010, these dually eligible made up 9 percent of the population and 27 percent of the costs of the Medicare/Medicaid programs.

HFS Director Julie Hamos stated, “We know that by aligning Medicare and Medicaid so that they are working together in concert and providing each client with a medical home and a patient-centered team of healthcare experts, we can provide better care and achieve better outcomes while lowering costs for a segment of the population that needs a great deal of care.”

Advocacy Points

The new Medicaid program is free for the state during the first three years (2014, 2015, and 2016). In these difficult financial times, Illinois cannot afford to leave free money on the table. Instead of Illinois paying an average 43% of Medicaid costs, under the new Medicaid plan, after 2016, the state will pay only 5% in 2017, 6% in 2018, 7% in 2019, and then 10% in 2020 and beyond….

It is true that the Medicaid Expansion, by covering new people, will create some new costs to states. Any time a new program starts, it generates attention. However, many conservative leaders use fuzzy math to exaggerate the cost, e.g., counting people who are already eligible for Medicaid in the new Medicaid numbers. Some eligible but unenrolled people may enroll later. This is not a cost of the new Medicaid program but a result of the state’s under-enrollment of the existing Medicaid program.

While the state will have some new Medicaid costs when it implements the new Medicaid program, it will realize financial savings because of a reduction in the uninsured population. This will reduce state dollars needed for programs currently used by the uninsured. Particularly, it will save money for local county and municipal governments. Local community health centers will be able to bill Medicaid for uninsured patients they currently see using state and local dollars.

A workforce with health insurance gets more medical attention, lives in better health and becomes more productive.

The health industry is an important part of state and local economies, and the new Medicaid program will increase business in the health industry and stimulate the state economy.

Individuals below the poverty line often live in very poor health, and Medicaid specifically meets the needs of low-income people with serious health care needs. Medicaid includes protections to limit premiums, deductibles, copays and cost sharing that otherwise make insurance too expensive for low-income people. Default Medicaid rules limit the total cost sharing that low-income families can pay and prohibit premiums in most categories of Medicaid (with some exceptions). Medicaid provides the least expensive way to cover low-income individuals.

Caveats

Managed Care Organizations may have a lot of political clout in your state, and the new Medicaid program population represents new business for them. (Consider the danger of political graft, loss of individual healthcare choice and control.)

At the same time, local groups may be neutral or support the new Medicaid, since it represents coverage for their employees that they will not have to pay for and more community jobs with healthy employees. (This may improve local economical issues.)

Aligning Medicare and Medicaid so that they are working together in concert under a managed care system may work to the client’s ill-treatment. (Danger of managed care strong-armed tactics to save money and loss of client choice of service.)

There are no clear specifics about how the dual-eligible project works. Medicare clients may opt out of the Medicaid managed care entities, but the instructions and consequences for opting out remain uncertain.

Although the Illinois Department of Healthcare and Family Services (HFS) remains responsible for care coordination, using privatized, managed care entities may offset its control over the system, reduce jobs in the government sector and could endanger patients’ right to choose and privacy. Shifting an individual’s healthcare to a large conglomerate that coordinates (controls) all aspects of healthcare endangers privacy rights under HIPAA. Although the HFS Director assured that clients might review their electronic record for errors and omissions, the appropriation does not indicate this right.

The five-year restriction for “Lawfully Present Resident” immigrants insufficiently covers the legal populations who live and work in the United States, placing undue, life-threatening hardship on immigrants.

Medicaid needs to prove “prompt” payment to providers to encourage widespread provider participation and accessibility to service. Furthermore, the current payment backlog needs immediate resolution as a good-faith gesture that the state will pay their bills in a timely manner.

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