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“Everyone knows this is a train wreck waiting to happen”

Thursday, Jan 30, 2020 - Posted by Rich Miller

* From the Cook County Public Guardian…

January 30, 2020

VIA EMAIL

Theresa Eagleson, Director
Illinois Department of Healthcare and Family Services

Marc Smith, Director
Illinois Department of Children and Family Services

Re: MCO Daily Horror Story

Dear Directors Smith and Eagleson:

I am at a loss as to how Illinois can, in good conscious, precipitously move forward on Saturday with the [managed care organization] scheme for 19,000 former youth in care who have been adopted or are in subsidized guardianship, many of whom have complex medical needs. Everyone knows this is a train wreck waiting to happen. The many and complex problems have been well documented. I’ve now sent you the plights of 9 families involving 15 special needs children.

Yesterday we received a call from an employee at IlliniCare. As you know, IlliniCare is the default MCO for the 19,000 children formerly in care. The utter dysfunction, chaos, and confusion within IlliniCare are well documented in the 6 prior letters I’ve sent you over the past two weeks.

The IlliniCare employee contacted us because she is alarmed by the dysfunctional way the MCO transfer is happening and its harmful impact on medical care for our most vulnerable children. Among other alarming concerns, this IlliniCare employee reported:

    • Many of the people doing assessments are not qualified. You will recall that I shared in a previous letter that a different IlliniCare worker reported the same problem to us.

    • Staff are assigned too many assessments to do them in a competent manner. Staff are pressured to just complete assessments, whether or not they are accurate or complete, for the sake of getting them done to meet a daily quota.

    • As a result, assessments are incomplete or inaccurate. Sometimes when a foster parent calls with a problem or question, and a worker looks at the assessment completed on the child, the assessment indicates that the child is healthy when, in fact, the child has special medical needs.

    • Basically what staff are doing is copying and pasting template assessments into the system.

    • DCFS caseworkers are often not helpful in assisting parents with the MCO process because it’s time consuming and they have so much else to do.

    • The IlliniCare phone lines are overwhelmed. Parents cannot get through. This is consistent with what foster parents, adoptive parents, and guardians are telling us.

For all of these reasons, the employee said that if anyone did an audit on the assessments, IlliniCare would fail. I am therefore requesting that DCFS and DHFS conduct a thorough audit of the IlliniCare assessments. I also request that the precipitous dump of the 19,000 former youth in care be delayed until the audit is complete and we have a handle on IlliniCare’s ability to competently manage the transfer without disruption in medical care for the children. I have copied Heidi Dalenberg and urge that the ACLU and Judge Brown oversee this audit.

Sincerely,

Charles P. Golbert
Public Guardian

       

20 Comments
  1. - Robert the Bruce - Thursday, Jan 30, 20 @ 10:54 am:

    Strong letter. I’m happy to see IlliniCare employees doing some whistleblowing.

    Next time I hope Golbert copies Governor Pritzker on a letter like this.


  2. - All This - Thursday, Jan 30, 20 @ 10:56 am:

    So in short Illinicare is committing fraud.

    What does “Precipitous dump of the 19,000 former youth” or the “scheme for former youth” mean? Does it mean the youngsters age out and can no longer access care?


  3. - NIU Grad - Thursday, Jan 30, 20 @ 11:08 am:

    Does anyone know which Deputy Governor oversees DCFS and HFS?


  4. - Perrid - Thursday, Jan 30, 20 @ 11:12 am:

    All this, I’m not sure what your question is? The state is making a distinction between current youth in care (”wards”, foster kids), and kids that have been adopted or are in subsidized guardianship, i.e. “former” youth in care. Youth in care are not being enrolled on Saturday, that has been delayed, but right now the plan is for former youth in care to be enrolled. The distinction, seemingly, is that the families of former youth in care were given a choice of which MCO plan to enroll with, while youth in care would only be enrolled in IlliniCare’s special YouthCare program. However, as the Public Guardian pointed out, if the families don’t make an active choice, they will go into IlliniCare’s YouthCare program.


  5. - Bud K. - Thursday, Jan 30, 20 @ 11:20 am:

    It’s a sham being perpetrated on Illinois taxpayers and foster children/adoptive parents are the victims. It comes at a time when Illinois is trying to recruit new foster parents only to tell them “Be a foster parent so we can give you bogus insurance for your foster children with special medical conditions.” As if the job isn’t hard enough.


  6. - Al - Thursday, Jan 30, 20 @ 11:31 am:

    Managed Care problems? Please refer to the Office of the Auditor General’s 1991 Audit Report of the Delta Dental Contract with Public Aid. Just take all the dollar amounts and add two decimal points and you will understand the kind of issues involved and scope of the problem. Just another scheme to profit off a program purported to serve the poor.


  7. - otherwise - Thursday, Jan 30, 20 @ 11:40 am:

    Really Al - you’re citing something from 28 years ago as relevant? Not even the same companies involved. Relevance please


  8. - Dotnonymous - Thursday, Jan 30, 20 @ 11:43 am:

    Monthly payments for each child regardless of medical need…instead of fee for each actual service… is the money catch…every client… every month… regardless.


  9. - Stuff Happens - Thursday, Jan 30, 20 @ 11:56 am:

    @Perrid
    And in many cases, it’s a devil’s deal. Many children don’t have all of their providers in any one plan, so they will have to lose access to a therapist or a doctor no matter which plan they pick.

    Most of these former youth in care have experienced significant trauma, so changing therapists or doctors can set them back. Girls may not be ready or able to worth with a new obstetrician, for example. What seems like a minor change is frightening and triggering.

    Another issue is that parents were required to pick a primary care physician (PCP) before even choosing a plan. If they couldn’t, they were defaulted into IlliniCare.

    My favorite was the letter sent yesterday indicating that DCFS was linking to a draft version of the IlliniCare members handbook that contained confidential information and plan options that violated Illinois law.


  10. - Perrid - Thursday, Jan 30, 20 @ 12:26 pm:

    @NIU Grad, I believe Sol Flores oversees the human services agencies.


  11. - Alisa Sorensen - Thursday, Jan 30, 20 @ 12:27 pm:

    My son and foster daughters lives will be at risk if HFS and DCFS continue with this process. Thank you Mr Gilbert for standing up for our most vulnerable children. I am a bio/adopt/med spec needs foster parent of 20 years. I’m also an RN and previous Healthworks of Illinois Coordinator. The process that is being attempted to move these kids to managed care plain and simply cannot work as it is. My current foster daughter is only alive today because I sought services from appropriate physicians for treatment. She has fifteen providers who have offices in St Louis, Indianapolis, Peoria, Bloomington, Washington, Champaign and Springfield. It is impossible for her to get the care she needs in any one location from any one provider group. I have driven over 24,000 medical only miles in her short life (I won’t even push the issue that I’ve never been reimbursed for mileage) I do it because she needs it and I refuse to allow her to go without appropriate medical care. I have also adopted a boy who is eight now and has severe Cerebral Palsy. He too is in a similar position. I’ve tried everything I know to speak to someone involved about how detrimental it will be to have to find all new providers for my kids. I don’t get replies. Please listen to those of us who provide direct care for the most complex kids. It is impossible for the plan to work as it is currently being described. Please talk to us and walk in our shoes to gain a better understanding of our concerns. The other frustrating part of this is that it is a blatant violation of the Consent Decree that was put in place because of the poor care Illinois’ children were receiving. Please please grandfather in the kids currently in care and let them continue with their current providers until and begin with children new to care or newborns. Yes, I realize that transition will take a very long time but it will not render families like mine vulnerable because they cannot receive the care required. Please please hear our pleas!


  12. - Robert the Bruce - Thursday, Jan 30, 20 @ 12:35 pm:

    The grandfathering in that Ms. Sorensen suggests seems both wise and humane. I hope someone in power hears her pleas.


  13. - Charlie Brown - Thursday, Jan 30, 20 @ 12:46 pm:

    As @KyleHillman pointed out, no mention of DCFS in the governor’s speech yesterday.

    Not one word.

    Heartbreaking.

    If you want to “wresle” the conversation back, put some people in DCFS who know what they are doing.


  14. - Iris - Thursday, Jan 30, 20 @ 12:47 pm:

    Although I’m aware of the transfer and have followed the issue (talked to state reps office, participated in state wide conference calls etc), I still haven’t received written notification from DCFS or HFS about the MCO changes. I was told BY Illinicare that we could choose whichever MCO we wanted. Got our first call from an Illinicare coordinator Monday. She couldn’t answer my questions about the fact that Illinicare has a very narrow network and none of our childrens’ providers are in network. We have special needs children for crying out loud. Get it together HFS and DCFS. Enough is enough.


  15. - Wow - Thursday, Jan 30, 20 @ 12:56 pm:

    MCO’s in general are an unmitigated disaster that offer no added value. Poor information systems, and outrageously slow responsiveness to issues render them little more than a conduit to deny and delay payment to providers.


  16. - Interested... - Thursday, Jan 30, 20 @ 1:14 pm:

    God bless Ms. Sorensen! Can you imagine the lives that vulnerable children in our state would face absent she and the thousands of others who step up and provide care and love?????? The Governor’s Office should reach out to Jess McDonald and beg him to return!


  17. - Dotnonymous - Thursday, Jan 30, 20 @ 1:31 pm:

    - Alisa Sorensen - Thursday, Jan 30, 20 @ 12:27 pm:

    I hear the desperation in your plea, Ms. Sorensen.

    I hope our Governor heard too?

    MCO’s are a way to save money…by denying care…from those who need it most.


  18. - Kyle Hillman - Thursday, Jan 30, 20 @ 2:16 pm:

    “Everyone knows this is a train wreck waiting to happen.”

    With all do respect to Mr. Golbert, Gov Pritzker’s YouthCare shift already is a train wreck - there are just more trains coming down the same track who appear to be not stopping.


  19. - dbk - Thursday, Jan 30, 20 @ 3:28 pm:

    If anyone with any power to do anything about this is reading - please, halt the shift now before it gets even worse than it already is.

    Time to do a 100% re-think of the level of Medicaid coverage the children who are/have been under the state’s protection receive.

    Ms. Sorenson’s comment is heart-breaking: 15 providers in 7 different cities? How can this be just/right/possible, even?

    Her suggestion to grandfather foster/adoptive children formerly under DCFS sounds reasonable.

    But these children need enhanced services and the broadest possible provider network, not the narrowest one.

    What about a Medicaid+ program?

    When I was commenting on “Question of the Day” a while ago, I almost wrote “I’m afraid DCFS could become JB’s Quincy Veterans Home.”

    This sounds like the Quincy Veterans Home on speed, frankly.


  20. - Alisa Sorensen - Thursday, Feb 6, 20 @ 6:08 pm:

    If anyone can help me reach the Governor or the heads of DCFS or HFS to share what this situation is really going to do to foster and adoptive families please contact me. My letters and attempts have been unsuccessful. Our children desperately need to maintain their physicians. Any help is so appreciated.


Sorry, comments for this post are now closed.


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