This update includes:

1.     Comments on Managed Care
2.     State Health Care Innovation Plan
3.     Integrated Care Coming to Chicago
4.     Managed Care in Texas


Comments on Managed Care

The Arc certainly got the attention of the Administration this week with the release of our position on managed care. I look forward to productive and thoughtful discussions with the Administration around Phase III.

Arc Position on Managed Care Phase III

The state of managed care around the nation is growing and evolving. States are looking to manage services and supports to high-cost, high-need individuals like us.

There has been a recent flurry of activity around the nation regarding managed care and services to individuals with intellectual and other developmental disabilities (I/DD). What is positive is that some of the new managed care proposals are including self-direction, individual budgeting, person-centered planning and employment first initiatives.

(See the new managed care legislation summary in Texas that was signed into law by Governor Perry on June 14th, at the end of this message)

State Health Care Innovation Plan

The Alliance for Health meeting I attend yesterday involved high level discussions around how to best integrate population health into the evolving State Health Care Innovation Plan (SHCIP). Some of the attendees included Michael Gelder and Cristal Thomas from the Governor’s Office; Secretary Saddler; Directors Hamos and Hasbrouck; IlliniCare CEO Jeff Joy; Aetna Illinois CEO Sanjoy Musunuri and many public health advocates.

Michael Gelder stated the core of this project is to build a comprehensive Community-based Integrated Delivery System in Illinois. The construction must be a team approach between government, community and health providers. We must have common goals and common measurements to move away from the funding silo’s we now have in Illinois.

The plan, as I see it, is to put the person at the center of everything under the umbrella of public health in what they call a “Patient Centered Medical Home,” developing a culture of health in Illinois. Through care coordination, all supports would be integrated including:

1.     Long Term Services and Supports
2.     Social Services
3.     Behaviorial Health
4.     Substance Abuse
5.     Hospital
6.     Public Health
7.     Health-related Community Resources
8.     Specialty

The integration of health and social services is similar to person-centered planning where we look at the total needs of the individual rather than just one area such as day services.

This was a fascinating meeting with new perspectives and certainly new language to learn. I am scheduling some meetings with the people who presented yesterday to drill down the implications for children and adults with intellectual and other developmental disabilities (I/DD). One thing for sure, the Governor’s team is pushing for system reform on a large scale.

Integrated Care Coming to Chicago

At the Aetna Advisory Committee meeting, it was stated that Integrated Care Phase I will begin to roll out in Chicago around April, 2014. Phase I is health care for Medicaid adults and persons with disabilities. Phase I has already rolled out in the collar counties.

Managed Care in Texas

Advocates got some amazing supports in this legislation.

From The Arc of Texas:Throughout the legislative process, The Arc of Texas worked closely with Senator Nelson and other legislative and agency leaders to strengthen safeguards for people with I/DD in the redesigned system. Here are some of the results:

  • New definitions for key terms for things that have a specific meaning to people with I/DD (such as “basic attendant services,” “habilitation services,” and “functional need”).
  • A longer rollout period to give time to evaluate and improve each step of implementation.
  • A new committee—the I/DD Redesign Advisory Committee—to make sure SB 7 is rolled out with extreme and thorough caution.
  • Voluntary enrollment in STAR+PLUS (the state’s Medicaid managed care program) for people in the DBMD, HCS, and CLASS waiver programs. People in a waiver program by 2020 can continue to get services through the waiver indefinitely, if they want. All others will get services through STAR+PLUS.
  • HHSC can continue to operate Medicaid waiver programs or the Medicaid ICF-IID program to provide supplemental LTSS that STAR+PLUS doesn’t provide.
  • Initial functional needs assessments will be conducted by someone that is independent from the managed care organization (MCO) or service provider. The independent entity will also play a strong role in the Person-Centered Planning (PCP) process and provide independent case management (service coordination) services.
  • MCOs will be required contract with traditional providers and other partners, such as local I/DD authorities, to leverage the strong LTSS networks that already exist.
  • DADS can evaluate functional need using an evidence-based, nationally-recognized assessment tool that is specifically designed for people with I/DD.
  • New and continuous reporting requirements to allow stakeholders and state leaders to monitor the progress of the redesign rollout and make adjustments when needed.
  • Emphasis on person-centered planning, self-direction and self-determination, community inclusion, fair hearings and appeals, local safety net providers and services, and community-based services for all, including people with the most significant service needs.
  • No premiums to get medical or LTSS.

Go here for more information:


Tony Paulauski
Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)