Letter to Executive Director Mark Miller

Dear Mr. Miller:

Is the Medicare Payment Advisory Committee’s (MedPAC) recent draft recommendation removing two classes of medication – antidepressants and immunosuppressants – from the Six Protected Classes under the Medicare Part D program?

Removing these two drug classes would violate the longstanding policy of ensuring that patients have access to the full range of life-saving and life-enhancing medications and restrict a physician’s ability to prescribe a regimen that is both effective and considerate of the challenges that co-morbidities and medication interactions can pose.

I urge you to reconsider removing both antidepressants and immunosuppressants from the Six Protected Classes, and to instead enshrine the protection of all six classes as a pillar of the Medicare program going forward. PROTECT the protected classes!

Thank you for your attention to this important issue.

Sincerely,

Kathleen Powers, AAS

Advertisements

Illinois Home Services Program Attempts to Cut Lifeline Services to Persons with Disabilities

Home-Care-WorkerAs an advocate concerned about the Home Services Program (HSP), I find capping IP services hours egregious! HSP, critically important to thousands of people with disabilities across the state of Illinois, ensures that everyday HSP customers receive care from their Individual Providers (IPs).
Capping the hours that IPs can work at 40 will mean that people with disabilities will not be able to access personal care assistance. In most places throughout Illinois, HSP consumers cannot find, hire and keep decent good IPs.
Parents, siblings and other relatives who act as IPs, with whom Illinois desires to cut work hours below 40 hours, jeopardizes financial and supportive IP, positive outcomes and quality of life. Until more effective policies emerge for persons with disabilities, this reduction of IP hours becomes cumbersome, undo-able and strict.
HSP customers and IPs deserve flexibility, not rigidity. Please eliminate the cap hours a week is too harsh and will put too many people’s lives at risk.
Photo from http://blog.abbeyspanier.com/wp-content/uploads/2012/08/Home-Care-Worker.jpg

STATE OF OUR STATE: ALLIANCE IN ACTION on the ROAD TO RECOVERY 

By James Jones – Metropolitan Family Services
January 26, 2016

This morning we are embarking on a trip to try to save stable and productive lives, at least in Illinois. Cutting the programs for mental health facilities in this state shows an apathy that could very well cause a travesty that could also prove tragic. We have seen on buses, on the streets, and even in programs for help, people with oftentimes severe mental disturbances that could be potentially dangerous. This is why this trip is so mandatory to many of us who need these programs just as much as any with a physical impairment. If someone had a broken arm or shattered ribs, you would want them to get medical attention immediately. But a broken psyche or shattered nerves, then what would you do? The answers to that do not come as easily because of the intricate workings of the mind. This is just one of the many reasons we must protest in numbers against the cuts to our communities, to stem the illnesses before they grow out of control.
Also, the stigma attached to mental illness is far greater than the physical could ever be. Derogatory terms for mental illness are plentiful, many used in everyday conversation. If the same would be said about someone in a wheelchair or crutches, it would be deemed cruel and distasteful. But mental illness, at whatever level it would be, is fair game for ridicule unless it is hushed up, swept under the rug, or in lower levels, ignored. These have not been effective methods to achieve mental wellness.
That is why this Road to Recovery to Springfield is so important; to have our voices heard. If no one speaks out there will be no attention or empowerment, and without these, there can be no recovery. We must stress the need for these programs clearly, distinctively, and in no uncertain terms. We have the right to stand firm and express that we cannot take this lying down. Remember that many would most likely be closer to stability had it not been for previous cuts; those many who could have lived productive lives and helped more clients in need by giving their stories as examples. We have gained great strides in the education and treatment of mental disturbance and made far too much progress to stagnate or regress. We will not slow down as we approach the finish line, or listen to nay-sayers who say we will not make it or try to cast us idly aside.
This is why it is so invigorating to be part of such a huge assemblance of different mental health services coming together for such a needed common cause, battling for the soul of Illinois. Not only did we experience unity in numbers but truth in numbers, which is one of the most powerful strengths of all, giving us a renewal of spirit in case the foibles of red tape leave us frustrated and downtrodden.
It is also ironic that I felt a sense of mass therapy with so many groups converging on Springfield showing that we care enough to come to the heart of the state to let our feelings be heard, if not heeded. It is a gamble if our showing will make a difference…Whether or not the [legislators] actually do anything legislatively, they can’t say they didn’t hear our voices loud and clear. That the funding for our facilities cannot be sliced to the bone. They cannot ignore that we made a bold statement in the state capitol. We pitched straight, now it’s up to them to catch.

Mpowered | Government Affairs & Strategic Initiatives
Metropolitan Family Services
One North Dearborn, Suite 1000 | Chicago, IL 60602
P: 312-986-4227 (direct) | F: 312-986-4334
www.metrofamily.org | jenningt@metrofamily.org

My Testimony on 2/21/14 at Stean-Cassidy-Cassidy Town Hall

My name is Kathy Powers. I am on the Steering Committee of the Alliance for Community Services and on the Board of Northside Action for Justice. I live with bipolar illness since the age of 11. I thank goodness that I have Medicare and Medicaid.

I sincerely believe that the four-drug limit be abolished. I take 20 different medications a day. If I had to choose only four of drugs on my list, I would have to choose losing my kidneys, thyroid, gi tract, perennial rhinitis, chronic pain that goes along my five back fusions, liver, suffer parkinsonian symptoms, suffer movement disorder symptoms that involve me biting my mouth spasmodically, lose control of my diabetes and/or risk my psychiatric welfare. When the rules change for dual-eligibles (persons with Medicare and Medicaid benefits), the reality of a medication limitation looms closer every day.

When the well-intentioned prior authorization process was added, there was some hope to obtain sufficient medication. Unfortunately, the prior authorization process yielded unworkable results. Persons at my C4 drop-in center had their medications denied. The reasons for the denials included “denial because it is denied,” “denial because it was already approved.”The latter denial of medication caused my friend to cut herself from head to toe in total frustration and spend a lengthy hospital time to heal from her physical wounds while she received her needed medication. The authorization process is broken and dangerous.

When one takes medications as I do, this situation effects dental health. I have three teeth left on the bottom of my mouth and I’m missing four teeth on the top (show). This lack of teeth causes me to choke a great deal when I eat, makes it almost impossible to chew. I need dentures, at least on the bottom, so I will stop choking, but I can’t afford them and can’t find any assistance to get them. I’ve been known to choke on liquids and solids, and now I have an unnecessary risk for heart disease because of my poor dental health.

Since prescribed medications prevent medical emergencies, hospitalizations and lower doctor visits, I think Congress would be wise to consider the cost savings by removing the limit on medications allowed, just as an economic boost to the Medicaid economy. As far as dental health goes, I’m sure I’m not the only one who is at risk for cardiac disease or a choking emergency or death because of lack of dental care.

Thank you for your time.

Speech at Chicago Mental Health Rally on May 15, 2013 at the Thompson Center

Kathy Powers delivering speech

Good afternoon!

My name is Kathy Powers. I am here today with the Community Counseling Centers of Chicago (C4) and the Organization of the Northeast (ONE). C4 teaches me how to control my symptoms, and ONE feeds my soul by teaching me how to advocate for my community through actions and leadership training.

I am 62 and have lived with bipolar illness since I was 11. I spent years in hospitals in four separate states. Almost every day, I used to wake up with a sense of dread and hopelessness about life. Through the support of strangers with random acts of kindness, and some hard therapy and soul searching by me, I actually feel some happiness and know that I must share what I can to help others as they helped me.

The Mental Health Justice Group of ONE is a group of mental health consumers and allies in Uptown, Edgewater and Rogers Park. We fight to protect community mental health services and thereby improve the lives of our neighbors living with mental illness. At the state level, we complement our allies’ work, including the Mental Health Summit and the Behavioral Health Advocates.

The Governor’s 2014 state budget proposes a $25M increase in the Department of Mental Health (DMH) budget, mostly to comply with the Williams v. Quinn Consent Decree that orders the discontinuation of warehousing persons living with mental illness who recovered in nursing homes and reintegrate them into the community. Although we think that Williams needs full funding, this funding must not take away money from all other mental health funding.

I used to receive excellent care at the Northtown/Rogers Park Mental Health Clinic. Due to funding cuts to the city system, with no warning or referral services, I lost the opportunity to see a psychiatrist. Because of this, I could not get my medicine. After that, I went to an emergency room to get a prescription that lasted a month. Then I needed hospitalization when my meds ran out. I did well in the hospital when I received meds, but after discharge, I could not find a psychiatrist who would accept Medicare or Medicaid. Then the five Chicago clinics closed completely, leaving me med-less and therapy-less.

After my second hospitalization in a month, I began to receive minimal psychiatric services at C4. Through group therapy, I discovered that I was not alone in trying to receive services. How many here have similar stories? Give a shout!

If the state does not increase the budget to mental health, the cuts from previous years will remain inadequate to serve the needs for recovery services. It needs to reinvest in community mental health services and bring funding to the present levels that it cut in the past.

The Supportive Housing Budget at $28.5M assures me that I will continue to get appropriate housing. This lifts a tremendous burden from me about worrying that society will “disappear” me and chuck me in a hellhole facility forever if I relapse. I see the only redeeming factor of institutionalization as self-motivation to get out or die. How many of you or your loved ones are trying to escape now?

The cumulative savings from fewer hospitalizations, ER visits and institutionalization by funding community recovery treatment is effective and less costly than non-treatment. Cuts negatively affect the community and make services scarce, increase illness by inadequate services, and multiply stigma and ignorance about mental illness. Worst of all, inadequate recovery services impair persons living with mental illness from becoming contributing members of society. Like me, like you, like your loved ones!

Thank you.

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.

%d bloggers like this: