* ACLU of Illinois…

Illinois is not meeting its promise to ensure children and families who receive health care through a new managed care system are not receiving the medical, psychiatric, and other health care they need in a timely fashion, according to testimony offered to an Illinois Senate committee today. The Senate Human Services Committee hosted a hearing today to update members on the experience of DCFS youth and families are faring with transition to a managed health care system known as YouthCare.

In testimony offered by the ACLU of Illinois, which has represented children in the care of DCFS through the B.H. litigation for nearly twenty years, the organization noted that while problems with access to health care for DCFS wards did not begin with the transition to YouthCare, the managed care system has not solved longstanding problems.

“Many of Illinois’ foster children simply are not receiving the care that they need at the time when they need it,” Heidi Dalenberg, Director of the Institutional Reform Project, ACLU of Illinois. “That was true before the rollout of the YouthCare plan. It remains true today.”

The ACLU pointed out that some flaws in the YouthCare system and network is creating real harm for children in DCFS care. Ms. Dalenberg related the story of one teen taken to a local emergency room in the midst of a mental health crisis, in true distress. Although all the medical professionals at the hospital agreed that the teen needed to be admitted to a psychiatric hospital, DCFS and YouthCare could not find a hospital for the teen to enter. After ten days, waiting in the emergency room, the youth was determined to be ready to be released – but never was provided the necessary psychiatric care.

“It would be sad if this were the only instance of this harm to a teen,” added Dalenberg. “It is not. We know that in the month of September alone, at least ten other foster children who experienced similar circumstances– being stuck at an emergency room because a placement was not found for them. YouthCare needs to address this today.”

The ACLU also shared results of a project it conducted in recent weeks to test the experience of families with finding care under YouthCare by calling physician offices in Belleville, Peoria and suburban Harvey. The ACLU tests revealed that a family calling a provider’s office for the first time would be able to secure an appointment for a child to see a physician in just 3 out of 10 calls during that first call.

Among other reasons that appointments were not available:

• Phone numbers were out of service;
• Doctor offices had closed;
• Offices indicated that they had never heard of YouthCare;
• Offices said they would not accept YouthCare (in error);
• Offices said that they would not schedule new patients until after the COVID pandemic was ended; and,
• Offices said they needed complete medical records – not in possession of the parents – before scheduling an appointment.

“The network cannot serve children if physicians can’t or won’t respond to the needs of these families. YouthCare and DCFS needs to fix this soon – so that no family gets unnecessarily refused,” said Dalenberg.

*** UPDATE 1 *** Evan Fazio, Director of Communications, IL Dept. of Healthcare and Family Services…

The ACLU testimony offered today failed to capture the full picture of what YouthCare has brought to the table in its first month and a half since launching with current Youth in Care. It is unacceptable that even a single child has trouble receiving appropriate medical care. The state has been working on this issue for quite some time, which is why having another partner in YouthCare is of enormous value to our vulnerable youth. YouthCare’s care coordinators are there every step of the way, working to solve the problem, making calls to providers so families don’t have to, and coordinating every aspect of care. In fact, YouthCare has resolved 98% of all rapid response inquiries. By any measure, families have far more opportunities for support and access to needed services for the children under their care with YouthCare than before.

Regarding the ACLU’s hypothetical network exercise, YouthCare members’ real-life experiences have not demonstrated any notable problems in this area. YouthCare continues to exceed network adequacy standards with over 52,000 providers, more than three times the number of providers under the previous system. And again, there is an added resource to help families when there are issues. When a foster parent needs to make an appointment or find a doctor for their child, they now have a care coordinator that they can call to get the appropriate care for their child. Before YouthCare, these families were forced to try to do all of this on their own.

All healthcare systems have challenges with providers not updating their information or front desk staff not knowing the provider is in network. YouthCare has been and continues to proactively address this topic through a multi-platform provider education campaign to reach and educate provider staff and collect demographic updates. To date, YouthCare has proactively completed 25,125 calls to collect provider updates to ensure the provider directory is updated. This issue is also alleviated through personal care coordinators, dedicated provider teams, and a six-month continuity of care period where providers do not need to be in network to be paid.

As today’s testimony from families working with the YouthCare system showed, this care has already provided tangible improvements in a number of children’s lives and in real time situations.

*** UPDATE 2 *** Ed Yohnka at the ACLU…

It is a little puzzling to see actual calls made to physician offices over several weeks labeled as “hypothetical.” The calls happened. They were real and they revealed a range of obstacles to parents and families in getting access to the care their children need. Is it surprising that faced with these obstacles, busy families and parents have not leapt immediately to report their frustrations and problems to the State. And, we would note that our findings confirmed earlier evidence developed by the Cook County Public Guardian’s Office.

The hearing would have benefited from a comprehensive report from YouthCare acknowledging that the transition did not go smoothly for everyone, and that while there are many more providers available for many children, there remain critical shortage areas that require cooperation and collaboration to remedy.