I serve on the Medicaid Advisory Committee which met just recently. I put a discussion
of the progress of Phase II of Integrated Care on our meeting agenda. Phase II includes
all non-developmental disability community waivers such as the Home Services and the
Traumatic Brain Injury Programs among others. The Dept. of Health Care & Family
Services indicated that Phase II was moving along fairly well.
I indicated that the roll out of Phase II, in my opinion, left a lot to be desired. For
example, in the planning of Phase I (managed care of medical needs for individuals on
Medicaid), stakeholders were very involved, meeting with high level staff at least once
per month. At one point even the CEO’s of Aetna and IlliniCare were participating in our
meetings. While the roll out of Phase I was not perfect, it gave advocacy organizations
the opportunity to work with the Dept. and the new managed Care organizations,
allowing us to inform our constituents about what to expect and what their rights were.
Phase II was not as comprehensive or consumer friendly, and the timeframe for
implementation was too rapid. For example, the case management system for
individuals in the Traumatic Brain Injury Program, TBI, is on its way to extinction with
the managed care organizations taking over that function. Communication with the
individuals in this wavier and the case management organization has been poor at best.
TBI consumers are uninformed and confused about the transition to managed care. The
same holds true for Home Services: confusion reigns for the people being rushed into
managed care. People are concerned about how their treatment plans will be developed
under managed care and if they will lose vital supports they need to live in the
community. Will they still be able to hire and train their personal care attendants? And
what about another attempt to restrict the Determination of Need scores for Home
Services? Communication and stakeholder involvement clearly did not occur as it
should.
My natural concern is what we can expect when the final phase of Integrated Care
descends upon the Developmental Disability Service System. In Phase III, it is
proposed that all community and institutional services/supports will be placed under the
umbrella of managed care. Will we witness the deconstruction of our free-standing
independent service coordination system? How will for-profit insurance companies
support “Employment First Initiatives?” What do for-profit insurance companies know
about community home-based services and money follows the person? Will state
institutions continue to close as part of the rebalancing initiative? Will people who
require lifelong care lose critical community- based supports they need to survive in the
community?
Managed care for disability services does not make sense to The Arc of Illinois and we oppose Phase III.
Arc Position on Managed Care.
Tony Paulauski
