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Rauner nixes Medicaid funding for heroin treatment

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Illinois

* There was no gubernatorial brick on HB 1 when it zoomed through both legislative chambers with just four total “No” votes and bipartisan sponsorship. The legislation was designed to combat the heroin epidemic without resorting simply to the old ways of toughening up criminal penalties. The governor himself even pointed out yesterday that the bill was “a result of the recommendations of the bi-partisan Heroin Task Force.”

Unfortunately, Rauner said that in his veto message. The governor zeroed out a major funding component…

House Bill 1 mandates that fee-for-service and medical assistance Medicaid programs cover all forms of medication assisted treatment of alcohol or opioid dependence, and it removes utilization controls and prior authorization requirements. These changes would limit our ability to contain rising costs at a time when the State is facing unprecedented fiscal difficulties.

* Daily Herald…

Gov. Bruce Rauner Monday rewrote a sweeping proposal aimed at curbing the heroin abuse that has plagued some suburbs in recent years, saying that while he supports much of it, the plan should be changed to limit costs for the state.

The plan sent to Rauner tried to focus drug courts on treatment instead of jail, and the state would cover treatment for Medicaid users. It also would have required all police and fire departments in the state to stock a heroin antidote that has been shown to save people from overdose deaths, plus train personnel on how to administer it.

Last year, 33 people died in DuPage County from heroin overdoses, helping prompt a response from state lawmakers.

“I support all of the above measures and applaud the multifaceted approach to combating this epidemic in Illinois,” Rauner said in his veto message. “Unfortunately, the bill also includes provisions that will impose a very costly mandate on the state’s Medicaid providers.”

* AP…

House sponsor Skokie Democratic Rep. Lou Lang says the savings from curing addicts would far outweigh the costs and that restricting Medicaid coverage would cut out a sector from treatment.

* NBC 5 has more on the cost angle…

Lang added that Rauner never suggested alternatives that would lessen the plan’s financial impact. Rauner spokeswoman Catherine Kelly pointed to the governor’s message that he supports the idea and hopes Lang “will accept the governor’s changes and move forward.” […]

Roosevelt University released a study this month showing that Illinois’ addiction-treatment capacity fell from 28th in the nation five years ago to third worst. One-quarter of state-funded treatment admissions in Illinois, 35 percent in Chicago and its surrounding counties, are for heroin addiction, compared with 16 percent nationally.

Lead author Kathleen Kane-Willis, director of the Illinois Consortium on Drug Policy, said Illinois is one of the few states in the nation that doesn’t allow Medicaid coverage of addiction treatment with methadone, a proven, effective drug that’s cheaper than counterparts.

“We’re going to pay for not paying,” she said.

* Tribune…

“This is a critical component of this legislation; if the only people you affect are people that have insurance, then you haven’t done that much. There is a whole swath of people out there who need health care from the state who have drug addictions,” said sponsoring Rep. Lou Lang, D-Skokie. “The governor is taking the position that we can’t afford to save these lives.”

We’re looking at about $15 million a year here.

I truly hope the brick wasn’t belatedly applied because of who the House’s chief sponsor is.

posted by Rich Miller
Tuesday, Aug 25, 15 @ 9:27 am

Comments

It will be interesting to see whether or not Rauner works against the override. If so, will the GOP that voted for and spoke in favor of the bill stick with Rauner?

Comment by out of touch Tuesday, Aug 25, 15 @ 9:36 am
Think there is a chance of another override?

Comment by burbanite Tuesday, Aug 25, 15 @ 9:37 am
For crying out loud, the governor has engineered a $6 billion plus deficit in pursuit of his political agenda, which apparently has a constituency of “one.”

As part of that, he’s now going to get tough with junkies looking to get the monkey of their backs? Over chicken feed money?

This ain’t some dorm room debate club. The governor wanted the big chair. Get on with it, already.

Comment by Wordslinger Tuesday, Aug 25, 15 @ 9:39 am
Veto was truly short-sighted and “penny-wise and pound-foolish” (especially given Illinois’ huge and growing problems with heroin). Really praying for an override on this one.

Comment by Crispy Tuesday, Aug 25, 15 @ 9:39 am
There are ways to improve this bill and pass it with all the support it has. I suspect that will occur. This one can be negotiated.

Comment by A guy Tuesday, Aug 25, 15 @ 9:40 am
Makes no sense to have a goal of diverting these individuals from jail through treatment and then vetoing the mechanism to do that. In the past I would have argued against the conspiracy theory of retaliation. Now, I’m not so sure. I wouldn’t put it past the Governor to do this simply as retaliation.

Comment by Demoralized Tuesday, Aug 25, 15 @ 9:42 am
===There are ways to improve this bill and pass it with all the support it has.===

Hmmm…

===* There was no gubernatorial brick on HB 1 when it zoomed through both legislative chambers with just four total “No” votes and bipartisan sponsorship. ===

Ok, - A Guy -…

This doesn’t seem like a bill needing tweaking, but a Sponsor needing the tweaking(?)

Comment by Oswego Willy Tuesday, Aug 25, 15 @ 9:43 am
Willy, I don’t know if that’s part of the thinking here or not. I’m neither accepting or discounting that. I live in DuPage and have followed this scourge and tragedy closely. At least in this particular county, this isn’t necessarily a crisis affecting poor and disadvantaged people. It’s as common to see it affecting privileged kids. I think there may be some small, but palatable tweaks that could be made to it that doesn’t put the entire onus on Medicaid. I would truly like to see a strong version of this bill pass. Like I suggested, I think there’s some room for improvement and everyone can see there’s strong support.

Comment by A guy Tuesday, Aug 25, 15 @ 9:48 am
Ok. Between this veto, the veto of the de-criminalization bill, and the Governor’s proposed cuts to mental health and substance abuse treatment, it is clear that the Governor has no actual public safety policy. He’s said a lot of nice words on the subject, which please the editorial boards and justify their continued water carrying for the Governor, but at the end of the day, his actions speak much louder, and it’s same old same old.

And A guy, here’s a lesson in Governing for you. When these bills pass overwhelmingly, the parliamentarian will deem the AV to be non-compliant with the constitution, and the sponsor will move to override. Most times, there’s not even a debate. But this won’t be negotiated further, it will simply be overridden.

Comment by Juice Tuesday, Aug 25, 15 @ 9:48 am
==that doesn’t put the entire onus on Medicaid==

If you aren’t eligible for Medicaid then Medicaid wouldn’t be paying for it.

Comment by Demoralized Tuesday, Aug 25, 15 @ 9:55 am
===If you aren’t eligible for Medicaid then Medicaid wouldn’t be paying for it.===

How is the Veto helping here again?

Comment by Oswego Willy Tuesday, Aug 25, 15 @ 9:59 am
Bruce,

Since these people will eventually wind up in IDOC custody…please raise taxes to pay for it.

A concerned Illinois citizen,
Jack Stephens

Comment by Jack Stephens Tuesday, Aug 25, 15 @ 10:00 am
=== Said Juice…And A guy, here’s a lesson in Governing for you. When these bills pass overwhelmingly, the parliamentarian will deem the AV to be non-compliant with the constitution…===

Let’s see if this occurs. I’m not seeing any non-compliance with the constitution on this. Since you’re offering lessons today, please illustrate how the AV is non-compliant.

He appears to be saying that no matter how positive the legislation is, there is no funding to pay for it in it’s current form. I understand that it’s “only” $15M. Yet in a budget already overdrawn by $4B, any number would be a problem, wouldn’t it? At the very least, he appears to be looking for an offset. I believe there is room to negotiate. If this is that important to the sponsor (and I think it is), they’ll look at a few options.

Comment by A guy Tuesday, Aug 25, 15 @ 10:00 am
Well, hey on the bright side if these folks do manage to get themselves clean they can always take motorcycle training classes. For FREE. So there’s that.

Comment by How Ironic Tuesday, Aug 25, 15 @ 10:01 am
Penny wise and pound foolish. In the mid 1990s, the State of IL “opted out” of providing perhaps 15 or 20 optional services under Title XIX Medicaid, ostensibly as an attempt to reduce expenses. Title XIX Medicaid entailed a 50/50 match with Federal dollars for most optional services, many of which involved preventative procedures for adults. The result was increased ER admissions, notably for dental extractions performed by oral surgeons, paid for by Medicaid. Timely check-ups and dental fillings would have cost much less than what was paid for oral surgeons. In less than a year, the optional Medicaid services were restored. No net funding was saved and at a cost of unnecessary pain and suffering. This situation is frighteningly similar. This veto should be overridden.

Comment by kitty Tuesday, Aug 25, 15 @ 10:02 am
==I believe there is room to negotiate.==

Why negotiate when you have plenty of votes to override? I’d tell the Governor to go pound sand on this one.

Comment by Demoralized Tuesday, Aug 25, 15 @ 10:04 am
+++ Demoralized - Tuesday, Aug 25, 15 @ 9:55 am:

==that doesn’t put the entire onus on Medicaid==

If you aren’t eligible for Medicaid then Medicaid wouldn’t be paying for it.++++

Demo, I’ve read some conflicting info about this, but I’d tend to take your word for this. The ages of many of the people I’ve read about in DuPage put a lot of these people in a category where they are still eligible to be on the parent’s insurance.

Comment by A guy Tuesday, Aug 25, 15 @ 10:06 am
Social Darwinism portrayed to perfection in this AV.

Comment by Jorge Tuesday, Aug 25, 15 @ 10:08 am
Demo, Or provide the offset. Everyone comes out on top in that scenario. These kinds of things start at one level of funding and have a tendency to go up drastically. If we’re looking for ways to work together, this would seem to be an opportunity.

Comment by A guy Tuesday, Aug 25, 15 @ 10:09 am
A guy, I didn’t say the AV was not compliant with the constitution. I actually think the Governor’s powers are quite broad on this subject. But my opinion doesn’t matter. It’s the opinion of HWV who matters, and I am sure she will follow the path laid by Ellis where she will offer an advisory ruling and she’ll say it’s not compliant. This is this process they’ve gone through ever since Rod’s rewrite to do right fiasco. If there is a legitimate need for a change in the legislation, they would much rather do a trailer bill then accept a Governor’s AV at this point. I’m sure the superstars are well aware of this already though.

Comment by Juice Tuesday, Aug 25, 15 @ 10:12 am
from the ‘net, “The actual cost of methadone is very cheap. When bought in bulk (tens of thousands of mgs) the cost per dose is only pennies, pills for individual consumption only a few dollars.”

Meanwhile, the effectiveness of methadone, when given in a large enough dose to eliminate cravings, has been demonstrated in more than 100 peer reviewed papers. Its use decreases death, decreases criminal activity and jail, and increases the ability to work, to be engaged in social bonds. It is about as close to a miracle drug as possible. It is underused because of the stigma associated. Plus it does not enrich big Pharma.

Comment by Groundhog Day Tuesday, Aug 25, 15 @ 10:14 am
==- A guy - Tuesday, Aug 25, 15 @ 10:06 am:==

Can you share this conflicting info?

Comment by Precinct Captain Tuesday, Aug 25, 15 @ 10:21 am
This veto override could will be close to unanimous in both Houses. We’ll see how far Rauner’s reach really extends.

Comment by walker Tuesday, Aug 25, 15 @ 10:21 am
As someone who personally witnessed and lost someone because of this drug; what a disappointment but not surprising at all. This drug is so serious and takes people down extremely fast.

Comment by LBR Tuesday, Aug 25, 15 @ 10:21 am
Guy, what are you talking about, “offsets?” From his actions to date, what makes you think deficits are a concern of the governor?

The current FY16 deficit is $6 billion-plus, yet the budget is not on the governor’s radar as he pursues his political agenda.

He signed the K-12 bill, he went to court to get employees paid without an approp. How does that translate into a concern for fiscal responsibility?

Comment by Wordslinger Tuesday, Aug 25, 15 @ 10:22 am
===This veto override could will be close to unanimous in both Houses===

You’ve been away too long.

Comment by Rich Miller Tuesday, Aug 25, 15 @ 10:26 am
I went thru this many times when I worked on the budget. For better or worse, many times the savings foreseen from investment in programs are down the road, frequently years down the road, and the investment is up front. That’s perfectly understandable from a programmatic perspective. However, it’s meaningless from a short term budget or cash flow perspective (see Munger above). Here, the cost is so de minimis as to not matter, but the problem from a budget point of view is still there on many such expenditures.

Comment by steve schnorf Tuesday, Aug 25, 15 @ 10:33 am
+++ Precinct Captain - Tuesday, Aug 25, 15 @ 10:21 am:

==- A guy - Tuesday, Aug 25, 15 @ 10:06 am:==

Can you share this conflicting info?+++

Do your own research dude. I’ve been reading about this for over 2 years in DuPage. The coroner has made this a huge priority. Go to the Daily Herald and use the Search key by adding “heroin”. You’ll get tons of articles. 4-5 per month over the last 2 years.

Comment by A guy Tuesday, Aug 25, 15 @ 10:36 am
==You’ve been away too long.==

Hah! That’s becoming obvious. Way too optimistic.

Comment by walker Tuesday, Aug 25, 15 @ 10:37 am
Steve, I agree with that assessment. But then the Governor needs to quit with his charade of wanting to reform the criminal justice system. The simple reality is that to reform the system, investments need to be made today in order to save money over the long term. If this Governor is not willing to make those short term investments, then he should stop talking like he cares about reform. Plus, given that many of the people we’re talking about are likely eligible under the Obamacare rules and not the pre-existing rules, the State’s share of this costs would likely be truly de minimis.

Comment by Juice Tuesday, Aug 25, 15 @ 10:40 am
– The coroner has made this a huge priority.–

It’s a little late by the time it gets to the county coroner. Better the governor should step up and demonstrate some leadership on a statewide scourge.

Comment by Wordslinger Tuesday, Aug 25, 15 @ 10:43 am
===Go to the Daily Herald and use the Search key by adding “heroin”.===

- A Guy -,

Since you know there is indeed conflicting, if you’d like to start with finding it, since you made it your argument, that would be great…

Comment by Oswego Willy Tuesday, Aug 25, 15 @ 10:46 am
Too busy right now Willy. Maybe later. Last 2 weeks slammed at the office. You missed me, didn’t you? lol

Comment by A guy Tuesday, Aug 25, 15 @ 10:53 am
- A Guy -,

Try to cite if ya could in the first place.

Thanks.

Comment by Oswego Willy Tuesday, Aug 25, 15 @ 10:57 am
===Demo, I’ve read some conflicting info about this, but I’d tend to take your word for this.===

I have followed this and haven’t seen any stories from the herald that claim Medicaid would front the bill even if you are insured. Also, the legislation seems pretty clear that Medicaid only pays for drug treatment of people that qualify for Medicaid. If you make a claim that runs counter to a consensus, then you should cite some evidence. It’s not on us to fact check your claims…

I’ve seen conflicting info that the sky is red. Look into if you don’t believe me. /s

Comment by MurMan Tuesday, Aug 25, 15 @ 10:59 am
“investments need to be made today in order to save money over the long term”

I agree. The cost doesn’t seem that high, and the federal government will pick up much of the tab for many. I say the veto is “Ardouin-ish,” that is, punitive to the poor.

Comment by Grandson of Man Tuesday, Aug 25, 15 @ 11:01 am
Here is a good story from earlier this month from NPR: http://www.npr.org/2015/08/18/432683627/heroin-crisis-ups-demand-for-treatment-as-program-funding-is-cut

Comment by G'Kar Tuesday, Aug 25, 15 @ 11:15 am
A no win situation for society as a whole as well as the taxpayers whether it be a the federal or state level.

People know better than to take these drugs but they do it anyway. They get hooked and are eventually useless and detrimental to society. Throwing them into jail solves nothing and having to pay for ever expanding drug treatment costs is an insult to the rest of the people who do not choose this lifestyle but end up paying for it.

Wish I had an answer, but I don’t. Meanwhile a significant segment of society continues to decline and it apppears to be escalating.

Comment by Fedralist Tuesday, Aug 25, 15 @ 11:20 am
http://www.mywebtimes.com/life/from-tragedy-to-triumph-annual-overdose-awareness-walk-aims-to/article_71b80cce-2c36-5fad-8fba-407a469f039e.html

AV just in time for a heroin overdose walk in LaSalle County.

Comment by Huh? Tuesday, Aug 25, 15 @ 11:50 am
This bill is purely the sponsors. No other reason to do this. If he wanted to AV it so as not to cost a big upfront dollar why not AV the effective date until next budget year?

Comment by DuPage Bard Tuesday, Aug 25, 15 @ 11:53 am
Did that cost catch him by surprise? This was only the highest profile bill, HB 1, for the entire session. Was he here this year?

Can he claim he didn’t know about the cost? His Medicaid agency, HFS, did not oppose the bill. They knew about the cost. Why not speak up before? Because he doesn’t like to collaborate - or know how. His way or the highway.

Does not play well with others. BRUCE - why did you even want this job - you clearly don’t like doing it.

Comment by siriusly Tuesday, Aug 25, 15 @ 12:16 pm
Wouldn’t this apply to Fee for Service Medicaid only? The way I understand Medicaid Managed Care is that if the person has Medicaid but is enrolled in a Managed Care Plan that covers the cost of treating heroin addiction, that person could still get the service. The state gives the insurance company receives a fixed payment and the private insurance then determines what is covered. As long as the plan offers what the state requires the plan has the freedom to offer more than the base. They currently do this on some services (such as weight loss programs) as they find providing the treatment in the long run saves money. If the plans could still offer this type of addiction service, then we are creating a two tier system of Medicaid in Illinois.

Comment by illinifan Tuesday, Aug 25, 15 @ 12:34 pm
So is Rauner really going to muscle GOP legislators to flip on an override vote?

The Frat Boys might want to take a break from concocting juvenile letters and tweets and get a little more personally involved in the nuts-and-bolts of their jobs.

Geez, they treat those GOP caucuses like a rented mule.

Comment by Wordslinger Tuesday, Aug 25, 15 @ 12:34 pm
===Geez, they treat those GOP caucuses like a rented mule.===

- Wordslinger -, they are just colored lights on the tally boards. Nothing more, nothing less. Sadly.

Comment by Oswego Willy Tuesday, Aug 25, 15 @ 12:41 pm
co-sign
________
- siriusly - Tuesday, Aug 25, 15 @ 12:16 pm:

Did that cost catch him by surprise? This was only the highest profile bill, HB 1, for the entire session. Was he here this year?

Can he claim he didn’t know about the cost? His Medicaid agency, HFS, did not oppose the bill. They knew about the cost. Why not speak up before? Because he doesn’t like to collaborate - or know how. His way or the highway.

Does not play well with others. BRUCE - why did you even want this job - you clearly don’t like doing it.

Comment by zonz Tuesday, Aug 25, 15 @ 1:13 pm
Total garbage, just like the cannabis AV. Though this one will actually mean human death, not just destruction of human potential.

I thought “courage” was supposed to be the one thing this putz had going for him?

Seems like he’s developing a habit of flip-flopping his own positions.

Sure would hate to be his “friend.”

Comment by crazybleedingheart Tuesday, Aug 25, 15 @ 1:36 pm
The man addicted to money, is surprisingly lacking in empathetic to other addictions.

Comment by VanillaMan Tuesday, Aug 25, 15 @ 3:31 pm
==Last year, 33 people died in DuPage County from heroin overdoses==

It could be helpful to know how many of those people were on Medicaid.

Comment by Formerly Known As... Tuesday, Aug 25, 15 @ 4:59 pm
It doesn’t matter how many were on Medicaid. The issue over the long time is, who will be treated for disease, all disease, in our society. Increasingly, the answer will be, everyone. It’s the right answer, but it’s going to be expensive.
Politicians may have to cut back on other expenses-graft and political patronage, for example.

Comment by Cassandra Tuesday, Aug 25, 15 @ 7:12 pm
This one’s really been bothering me all day.

If the governor and the frat boys want to tune up Lou Lang for partisan stuff, salud…. politics, ….I get it. No worries here.

Tnere must be some playground equipment or pothole-fills they could delay in his district.

But, Gov. Rauner, please, don’t take it out on the junkies across tne state trying to kick, and pretend it’s a fiscal issue.

You’re more than $6 billion short in your FY16 plan to date; $15 million for sick junkies looking to kick is oogats.

To play the “fiscally responsible” card with this veto is profoundly cynical.

It’s literally life and death for these junkies, and their families and loved ones. For fhe statewide community that you serve and were elected to lead.

The junkies didn’t want to be this way. Tney probably got hooked on prescription pain killers from tneir doctors. When the scripts ran out, they lied, stole and robbed to cop on the street.

Governor, they’re sick, out of their minds and physically sick. Lost to reason. Some can get well, but some need their community through the offices of their government to make it happen.

You yourself, in your veto message, called the problem an “epidemic.”

An epidemic, govermor.

Bruce Rauner, as a governor, you must know that you don’t go cheap on an epidemic. You bring the house.

That, as govermor, is your job, as the one and only leader of this state, right now.

The heroin epidemic you describe might not be the problem you wanted to deal with, but it is right in front of your face right now, and you don’t have the option of looking away.

Step. Up. Govermor.

Call off your half-wit political crew on the coming override vote.

They’re the ones who screwed this up in the first place, giving a green light to every GOP legislator on a bill you ended up vetoing. It’s not supposed to,happen that way.

Govermor, like the K-12 bill, that’s a bad way to treat your friends.

Govermor, the vote in the GA was almost unanimous. Like you said, heroin abuse is an epidemic in this state,

Govermor, it’s time to start doing your job.

Comment by Wordslinger Tuesday, Aug 25, 15 @ 7:53 pm
Enough already about the governor’s kid. He’s a civilian who didn’t sign up to be a public figure. Leave him alone.

Comment by Wordslinger Tuesday, Aug 25, 15 @ 7:59 pm
several hundred lives have been saved by the Il Overdose Prevention Program - over 5,000 police are trained to administer naloxone - reversals by police reversed more than 30 in Lake and close to 70 opioid od’s in DuPage Co.’s - their families say thank you - and some of the families where they did not survive lead the way

Comment by tweedle Wednesday, Aug 26, 15 @ 10:07 am
While some people dwell on the $ - $40.00 for naloxone is a lot cheaper than emergency rooms/ICU’s - funeral parlors - we had once been a leader - Ohio is doing over the counter pharmacy distribution of naloxone - California is moving that way also - this is a national movement - Oh well if they have money they can buy it.

Comment by tweedle Wednesday, Aug 26, 15 @ 10:17 am