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
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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.

Call to NBC on September 2, 2013 at 3:00 Requesting Apology

Here is Kathy Powers call to NBC on September 2, 2013 at 3:00,:

Hello, my name is Kathy Powers. It has been a month since Brian Williams and NBC Nightly News insulted millions of Americans saying that “arguably the face of mental illness” is Ariel Castro. In an effort to roll back the stigma rudely amplified in your newscast and editing, I want a public apology and a news story about the “Faces of Recovery” showing positive role-models of individuals living with mental illness.

 I also respond to the one-sided segment about ECT that “Today” ran on August 20, 2013. I demand that NBC reflect that ECT providers should tell potential recipients about the risk of the disabling effects of ECT treatment, including permanent memory loss and cognitive deficits, so that they can make an informed choice.

 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.

Mental Health Supplemental Appropriation

The Division of Mental Health within the Illinois Department of Human Services determined that insufficient revenue in certain funds following passage of the FY13 budget existed. Mental health crisis programs and psychiatric services experienced unintended cuts of $12 million because of this revenue shortfall. The supplemental appropriation restored these cuts and prevented further cuts to the behavioral health services.

Across Illinois, supportive housing programs serving individuals and families experiencing homelessness and with disabilities wait for $2.986 million that lawmakers appropriated last spring and did not release because the appropriations bill mistakenly omitted the words “and mental health.” The Department of Human Services, therefore, did not have the authority to spend that money. The supplemental appropriation changed to language to, “The sum of $34,450,000, or so much thereof as may be necessary, is appropriated from the Health and Human Services Medicaid Trust Fund for awards and grants to developmental disabilities and mental health programs.” The language fix does not take funds away from other programs or services, but merely gives the Department of Human Services the authority to spend on supportive housing program.

Mental Health Summit(1) Concerns about the Four-Drug Limit in Public Act 97-0689, the “SMART Act”(2)

This is a summary of a recently issued Mental Health Summit paper. -Kap

Governor Quinn signed the “Save Medicaid Access and Resources Together (the “SMART” Act) into law on July 1, 2012 to reduce Medicaid spending.  The Act requires that any Medicaid beneficiary receive no more than four medications in any month without prior authorization from the Department of Healthcare and Family Services (DHFS). Consequently, serious concerns about harm occurring to people with mental illness include:

  • More than one psychotropic medication and others may be needed to manage side effects resulting from these medications.
  • Medications may be needed to treat co-occurring chronic illness, e.g., diabetes, hypertension, morbid obesity, hypothyroidism, movement disorders, etc.
  • Medications may be needed to treat non-psychiatric illnesses.
  • Closed mental health centers(3) and movement from nursing homes and other Institutions for Mental Disease (IMDs) to appropriate community housing mandated from lawsuits(4,5) place thousands of persons with serious mental illness into the community who need multiple medications. Restriction to medication access for persons with serious mental illnesses heightens health care costs by increased Emergency Room visits, inpatient hospitalizations and symptom recurrence.

The SMART Act provides additions to the four-drug limit with prior authorization (PA). Unfortunately, the PA system appears unfeasible because:

  • It is not equipped to handle all of the 200,000+ persons with serious mental illness who already take more than four prescription medications.
  • An electronic PA system is not in place to make authorization manageable for physicians to use. Doctors might hesitate to go through the time and expense to negotiate PA to serve their poor Medicaid patients.
  • Illinois has no published standards for PA, further discouraging physician participation.
  • As an interim measure, DHFS made a decision to initiate a temporary ten-drug limit, however, 72,000 Medicaid recipients already exceed this ten-drug limit.

Accordingly, the drug-limit restriction is fiscally unsound and BAD MEDICINE! A dialogue with legislative leaders, DHFS and the community about some prospective changes may avert an impending health care disaster:

  1. Permanently eliminate the four-drug limit.
  2. Amend the SMART Act to exempt the four-drug limit for disabled Medicaid recipients.
  3. Amend the SMART Act to exempt psychotropic medications for disabled Medicaid recipients.
  4. Improve the PA system by creating a viable, transparent PA submissions process with published standards and procedures.

________________________________

(1)    Mental Health Summit, 6020 S. University Ave., Chicago, IL 60637,
http://www.law.uchicago.edu/clinics/mandel/mental/summit.

(2)   Senate Bill 2840.

(3)   Tinley Park and Singer Mental Centers.

(4)   Williams v. Quinn – Successful class action lawsuit sought community-living alternatives for residents with mental illnesses in Illinois ordered on September 29, 2010.

(5)    Colbert v Quinn – Successful class action lawsuit sought Medicaid-eligible nursing home residents in Cook County with the array of supports and services that they need in the most  integrated settings appropriate to their needs ordered on December 20, 2011.

Northtown/Rogers Park Mental Health Clinic Funeral

Northtown/Rogers Park Mental Health Clinic Funeral

On Monday, July 16th, 9:30 a.m. at the corner of Howard and Paulina Streets, the handful of mourners included ex-clients of the Northtown/Rogers Park Mental Health Clinic, members of the Northside Action for Justice, and well-wishers who grieved for and laid to rest a casket symbolic of the clinic at its former home at 1607 West Howard Street. The tear-stained mourners hung a wreathe inside the door of the building to remind the community of its significant loss. The mourners were too grief-stricken to celebrate the ceremonial ground breaking of a four million dollar project for Howard Street beautification that Alderman Joseph Moore staged during the funeral.

The Rogers Park Business Alliance and Alderman Joseph Moore hosted a ceremonial ground breaking for decorative street lighting, stamped crosswalks, landscaped planters and 68 new trees with tree grates priced at $4,000,000. Congresswoman Jan Schakowsky, State Representative Kelly Cassidy and representatives from Howard Street Special Service Area #19 and the City of Chicago Department of  Transportation also attended. The politicians’ group convened at the Willye White Park Fieldhouse, 1610 W. Howard, to greet the park’s new supervisor, Jerry Wallace, and enjoyed a complimentary breakfast, courtesy of Pete’s Grill.

Alderman Moore did not acknowledge the mental health clinic’s group, but Congresswoman Jan Schakowsky personally acknowledged the clinic’s mourners, stating hope in upcoming ACA (Obama’s health plan).

Sadly, street beautification trumps mental health.

–Kathy Powers
7/18/12

–John Powers, Photography

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