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The “hollowing out” of state government, Part 29,487

Friday, Nov 16, 2018

* We talked a bit yesterday about Governor-elect Pritzker’s new health-related transition committee. Stephanie Goldberg at Crain’s interviewed one of the co-chairs, Sen. Heather Steans (D-Chicago). Steans chairs the Senate Appropriations 1 Committee and has been very active on this issue

Another focus area for the committee is the social service sector, particularly mental health and substance use treatment, which Steans says has been “decimated” over the last several years.

“We have been underinvesting in those (areas) and really need to determine how we can get people access to those services when they need them,” she said.

That’s very true. But it’s going to cost real money to heal these programs after years of neglect and deliberate undermining. It’s all part of the “hollowing out” of government that goes back to the Rod Blagojevich days. RRB always wanted to create new programs, but he wouldn’t ever propose a realistic revenue source. So, what was in place was often disregarded and allowed to whither and/or die on the vine. And then Rauner came along and all heck broke loose.

Governors generally win plaudits for coming up with new ideas. For once, I’d like to see a governor sort out what works and what doesn’t and fully fund what works and de-fund or fix what doesn’t.

* Back to the story

Rauner’s HealthChoice Illinois, the state’s overhauled Medicaid managed care program, is another initiative the industry is watching closely. The program, in which private insurers administer Medicaid benefits, has received mixed reviews since it launched in January, with detractors citing proposed rate cuts to medical suppliers and insurers not providing adequate access for members in certain areas.

“There are ways to improve (the program) without undermining the care coordination work that’s been done,” Steans said. It’s about “moving away from trying to control costs to saying, we need to get people the right care at the right time in the right setting. That way, you can provide much more preventive (services) and make sure you’re holding accountable the (Medicaid managed care organizations) and the providers for quality outcomes . . . which, long-term, does reduce costs.”

Sen. Steans is right that preventive care does save money in the long-term. But it costs more in the short-term.

- Posted by Rich Miller        

22 Comments
  1. - Perrid - Friday, Nov 16, 18 @ 10:34 am:

    The last point, about re determinations, is a little interesting. Usually I hear people (conservatives) screaming about how we need to do checks more often to “catch” people who aren’t “really” eligible, here they are literally saying the opposite, that it’s too easy to kick people off.


  2. - Rich Miller - Friday, Nov 16, 18 @ 10:36 am:

    ===literally saying the opposite, that it’s too easy to kick people off. ===

    What they are saying is it’s too easy to kick qualified people off. Big difference.


  3. - wordslinger - Friday, Nov 16, 18 @ 10:37 am:

    –Governors generally win plaudits for coming up with new ideas. For once, I’d like to see a governor sort out what works and what doesn’t and fully fund what works and de-fund or fix what doesn’t.–

    Agreed. Back-to-basics leadership is critical right now.

    Shore up the foundations of the state’s neglected core responsibilities: infrastructure, community colleges, public universities, social services, public safety.

    It ain’t sexy, but it is the gig.

    Messiahs who claim they are going to “create jobs” and “transform the economy” are snake-oil peddlers, blowing off their true responsibilities for ego-trippin’ self-gratification.


  4. - RNUG - Friday, Nov 16, 18 @ 10:40 am:

    == “There are ways to improve (the program) without undermining the care coordination work that’s been done,” Steans said. It’s about “moving away from trying to control costs to saying, we need to get people the right care at the right time in the right setting. That way, you can provide much more preventive (services) and make sure you’re holding accountable the (Medicaid managed care organizations) and the providers for quality outcomes . . . which, long-term, does reduce costs.” ==

    This … all day long.

    I have seen the results with an in-law the last several years. Go to a doctor for care on a recurrent issue, get sent home. Get bad enough to end up in hospital, heal up a bit, get transferred to intermediate care or nursing home, then sent home (with no or inadequate care) to heal up. repeat on a regular basis. This has to be costing the Medicaid system more money than proper in-home care would.

    I suspect, since most of the money is Federal, there is no incentive at the State or county level to fix the system.


  5. - VanillaMan - Friday, Nov 16, 18 @ 10:45 am:

    ==underinvesting==

    Baloney word.
    Sterns is saying that we all pay more. It also means that instead of reform and new ideas we should keep dumping our money into what doesn’t, won’t or can’t work because it’s easier and might help right away.

    Rauner unplugged everything and cost us more because there were no savings, or reforms, or bipartisanship. There was just the political fight.

    Plugging it all back in isn’t the right thing to do either.


  6. - Kyle Hillman - Friday, Nov 16, 18 @ 10:48 am:

    “But it’s going to cost real money to heal these programs after years of neglect and deliberate undermining.” No truer words have been spoken.

    It is not just restarting programs - you have to rebuild the workforce. Mental Health jobs were gutted and the professionals moved on. It is going to take real dollars to rebuild the workforce and to convince practioners to re-enter or enter small markets where volitality in state government makes margins impossible to stay open.


  7. - revvedup - Friday, Nov 16, 18 @ 10:49 am:

    They must also look at the entire “rede” process to minimize the storm of paper deluging their clients. Under their “improved” systems, a friend of mine gets at least 3 sets of notices, about a week apart, that contradict each other as to his Medicaid status. He freaks out, and I try to make sense of what each notice really means. When we tried to do his rede online, it wouldn’t even display the screen needed to do so. An email to their IT help desk took over a month to be answered with a generic email admitting they are far behind in handling issues. It’s not the caseworker’s fault, or even the local office administrators, who are stuck with the mess the contractors got overpaid to under-design and under-repair. HoneyBear from DHS also knows the score on the Great Purge of recipients under Rauner, and the effect it has on what’s left of social services in Illinois.


  8. - Norseman - Friday, Nov 16, 18 @ 10:53 am:

    === For once, I’d like to see a governor sort out what works and what doesn’t and fully fund what works and de-fund or fix what doesn’t. ===

    +1 is an understatement of how strongly I agree with this statement.


  9. - Liandro - Friday, Nov 16, 18 @ 10:59 am:

    “Governors generally win plaudits for coming up with new ideas. For once, I’d like to see a governor sort out what works and what doesn’t and fully fund what works and de-fund or fix what doesn’t.”

    Absolutely. IMO, the kind of personality/ego (not meant as an insult) it takes to to run and win an Illinois governorship often isn’t well-suited to the seemingly tedious, banal duties involved in efficiently running a government.

    Who wants to fix departments or properly manage debt when you can propose shiny, brand new (expensive) initiatives and programs?

    And remember–what “doesn’t work” will still be desperately defended by everyone invested in it–whether that be financially, ideologically, emotionally, etc. It’s not easy or pleasant.


  10. - Aunt Peg - Friday, Nov 16, 18 @ 10:59 am:

    I promise to be civil. That’s my usual bent anyway.


  11. - Anon221 - Friday, Nov 16, 18 @ 11:02 am:

    For any of these transition committees, I strongly encourage and urge their members to reach out and listen to the people who have been on the frontlines. The state employees, the non-profits, the patients, the families. They can help you untangle the mess and maybe even be able to suggest some great solutions.

    And, I’m not talking just about statewide tours of listening sessions. Those are good and worthwhile, but as the Prizker campaign did in revitalizing the Dem network and GOTV in Illinois, they could do the same with all of their transition teams. Get Out The Truth about programs and solutions.

    Yes, things may cost more in the short term, but we as a nation need to really get over that concept that short term costs for long term positive results is such a bad thing. It’s only e bad thing to career politicians, not to people to practice and live servant leadership.


  12. - Anonymous - Friday, Nov 16, 18 @ 11:10 am:

    My niece has been legitimately on disability for years. She has so many problems with her health that she cannot work. When she went for her usual evaluation, her doctor had retired. So, she had to pick a new one.

    The doctor did not examine her (at all), did not read her records. The doctor told her that she didn’t need to evaluate her. She could tell by looking at her that she could work. So, she disapproved her benefits.

    She knew she could appeal the decision and submitted paperwork to them. They still disallowed her continued payments. Then she found out that she only had one appeal and she had it. There was no explanation on the denial.
    Is that what Rauner’s program does?


  13. - Langhorne - Friday, Nov 16, 18 @ 11:19 am:

    Agree w rich. I would like to see transition commitees start w recent audits, and concentrate on correcting those findings, for a start.


  14. - Matts - Friday, Nov 16, 18 @ 11:27 am:

    ‘Governors generally win plaudits for new ideas…..fully fund what works and de-fund or fix what doesn’t.” So fundamental, so clear, so obvious, so necessary. What proper thinking person, of any political stripe, would disagree with this? Yes, one can argue/debate what “what works and what doesn’t” means, but the new governor can exert his leadership and make those decisions and persuade a majority to back him through convincing facts and reasoned thinking. That process is his first task/challenge. After Rauner, there’s no way to go but up in this regard.


  15. - wordslinger - Friday, Nov 16, 18 @ 11:30 am:

    ==underinvesting==

    Baloney word.
    Sterns is saying…–

    Actually, “underinvesting is a real word, but “Sterns” is not her name.


  16. - Retired Educator - Friday, Nov 16, 18 @ 11:33 am:

    Two of the last three Governors hurt all areas of Illinois Government. Quinn tried but was inept. Blago and Rauner almost destroyed our entire system of support. It is hoped the new Governor will help reestablish the sore programs that help those who need it.


  17. - Honeybear - Friday, Nov 16, 18 @ 11:33 am:

    Revved up. IES is a real mixed bag. What I tell my customers is
    Computer don’t care
    Computer don’t play
    Computer is a cold stone case killer

    Computer does what it’s supposed to do, enforce eligibility
    And bring accountability.
    Policy and statute are built in

    Here’s the problem
    Computer can kill a thousand cases in a night
    They were 1 second late
    Where do all those people go
    The “aid office”
    Packed lobby- 3 hour wait
    Hollowed out by loss of caseworkers
    812 to1 at my office
    We’re being waterboarded
    By casework that takes us 3 times
    Longer than our old system
    Meanwhile
    Folks are suffering
    Folks are hungry
    The slightest error sets them back
    Sometimes for days or weeks.
    Computers are great at accountability
    Amoral
    Unfeeling
    Uncaring
    and it’s going to be worse
    X10
    When the work requirement comes on.

    Look, I had a nice young man come in yesterday
    He kept overtly squinting
    ” my eyes are bad. I can’t see”
    Hey no problem, I say taking the late redetermination
    Let me just ask you the questions and I’ll fill it out for you.
    We’re cool
    Computer don’t care that even though he had medical and could have gotten attention for his vision
    Computer don’t play with being a few days late
    Computer killed his food stamps
    Computer couldn’t tell that he wasn’t really sight impaired
    He couldn’t read
    Only a caring caseworker can
    Help him overcome his barriers
    To self sufficiency
    Preserving his dignity and worth
    And there aren’t enough of us.


  18. - JS Mill - Friday, Nov 16, 18 @ 12:16 pm:

    =Agreed. Back-to-basics leadership is critical right now.

    Shore up the foundations of the state’s neglected core responsibilities: infrastructure, community colleges, public universities, social services, public safety.

    It ain’t sexy, but it is the gig.

    Messiahs who claim they are going to “create jobs” and “transform the economy” are snake-oil peddlers, blowing off their true responsibilities for ego-trippin’ self-gratification.=

    Can we get that on a petition so we can make sure Pritzker sees this message? It is 100% the truth.


  19. - Sense of a Goose - Friday, Nov 16, 18 @ 1:42 pm:

    Completely agree with Rich. We are terrible at measuring outcomes and it’s a huge reason people are so frustrated with government. A program will last forever regardless of its effectiveness. We need to try new more holistic approaches but get rid of programs that don’t move the ball-being careful in how this is accomplished.


  20. - Norseman - Friday, Nov 16, 18 @ 2:15 pm:

    === We are terrible at measuring outcome ===

    We have a lot of measurement data floating around. The SEA (Service Efforts and Accomplishments) measures reported to the Comptroller and included in their Public Accountability Report. GOMB also includes measurements in the budget.

    The problem is that there is a lot of talk by pols and government managers, but little use of the data to actually make budgetary and program decisions. Not addressing the efficacy of the measures or the limited number of programs actually required to submit data, accountability based on the data is essential.

    We know pols like to announce new programs because the give the appearance of activity - which the media types eat up. Blago was famous for announcing new things, but the admin didn’t follow through on most of them. I would love if JB’s efforts focused on culling or revamping underperforming programs. If there is an identified need for a new program, performance measures and data collection processes must be clearly enunciated.


  21. - Boochie - Friday, Nov 16, 18 @ 3:37 pm:

    May I direct your attention to the Budgeting for Results Commission? https://www2.illinois.gov/sites/budget/pages/results.aspx


  22. - Quill - Friday, Nov 16, 18 @ 3:49 pm:

    One piece of this is that HFS needs smart, competent staff who are not burned out running the State Medicaid Plan, and liaising efficiently and diplomatically with CMS. Current staff are fundamentally tinkering with a Medicaid system that is a holdover from the 80s. No. No. No. Updating that clunker will keep us failing even more. Get talent from states that have FUNCTIONAL Medicaid systems. Current staff have zero vision for how to get this together, plus they are short-staffed as it is. Start talking to people in Minnesota, California, Michigan, New York about what actually works. People keep talking about outcomes measurement and that’s fine, but we’re working off a poor state plan with poor waivers and THAT needs to be fixed. Also, the redetermination system makes me want to set my hair on fire. It’s nothing but a witch hunt conducted by mail.


Sorry, comments for this post are now closed.


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