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* Expect numerous updates to this press release…
Governor Bruce Rauner issued an amendatory veto today of House Bill 2482.
Similar to Senate Bill 570, the proposed legislation concerning the Child Care Assistance Program, HB 2482 would have unintended consequences that would negatively impact the state’s long-term ability to serve individuals in need.
“These bills may be well-intentioned, but they are ultimately harmful to the programs they are trying to help,” Rauner spokesman Lance Trover said. “The governor understands and shares the frustration of members who want to fund these programs, but the appropriate way to do so is in the context of a truly balanced budget. As drafted, both pieces of legislation would create serious problems that jeopardize the future of the Child Care Assistance Program as well as services for the elderly.”
House Bill 2482 would lock into statute that an individual who qualifies for assistance is entitled to institutional care. Additionally, the approach contemplated by this legislation puts the state’s compliance with Medicaid waiver regulations and ability to maximize federal match funds at serious risk.
As noted in the governor’s veto message House Bill 2482 “takes a step in the wrong direction… For too long, Illinois has over-prescribed institutional care to lower-need individuals when less expensive and more appropriate care options are available. In order to provide the best particular care for each individual, to ensure that our support services remain affordable, and to maximize the number of individuals served, we must rebalance the services being provided with greater precision. Prescribing institutional care for individuals who do not need it is wrong for the individual and wrong for taxpayers. Moreover, over-prescribing institutional care is inconsistent with the direction being taken across the country.”
Bill No.: HB 2482
An Act Concerning Public Aid
Action: Amendatory Veto
Note: Veto Message BelowVeto Message
To the Honorable Members of
The Illinois Senate,
99th General Assembly:Today I return House Bill 2482 with specific recommendations for change.
The State of Illinois provides important support services to elderly and disabled individuals through the Community Care Program, the Home Services Program, and State-funded nursing care. At a time when the State is struggling to afford its past promises, we have an obligation to make the economic and government reforms needed to continue providing these services to the neediest among us.
Unfortunately, while well-intentioned, House Bill 2482 takes a step in the wrong direction. The bill would lock into statute that an individual with a particular threshold score on the Determination of Need (DON) assessment tool would be eligible for both institutional and home and community-based long term care services. Instead, an individual with the threshold score should be entitled to institutional or home and community-based care. Retaining flexibility to determine whether an individual is eligible for institutional or home and community-based care – as opposed to both – will ensure that the State is compliant with Medicaid waiver regulations and protocols and maximize federal matching funds.
For too long, Illinois has over-prescribed institutional care to lower-need individuals when less expensive and more appropriate care options are available. In order to provide the best particular care for each individual, to ensure that our support services remain affordable, and to maximize the number of individuals served, we must rebalance the services being provided with greater precision. Prescribing institutional care for individuals who do not need it is wrong for the individual and wrong for taxpayers. Moreover, over-prescribing institutional care is inconsistent with the direction being taken across the country.
Therefore, pursuant to Article IV, Section 9(e) of the Illinois Constitution of 1970, I hereby return House Bill 2482, entitled “AN ACT concerning public aid”, with the following specific recommendations for change:
On page 10, line 17, by replacing “institutional and” with “institutional or”; and
On page 21, line 5, by replacing “institutional and” with “institutional or”; and
On page 50, line 21, by replacing “institutional and” with “institutional or”; and
On page 55, line 17, by replacing “institutional and” with “institutional or”.With these changes, House Bill 2482 will have my approval. I respectfully request your concurrence.
Sincerely,
Bruce Rauner
GOVERNOR
…Adding… The bill received 74 votes in the House, including Republicans Batinick, Bryant, Hammond, Jesiel, McAuliffe and Unes.
*** UPDATE 1 *** Rep. Batinick just said that in his opinion, an amendatory veto is better than a total veto, but he won’t make a decision until he talks with supporters about how far-reaching Rauner’s change of “and” to “or” will be.
*** UPDATE 2 *** Chief House sponsor Rep. Greg Harris via text…
The Rules Committee will first have to determine if the Amendatory Veto is compliant with constitutional requirements. I will carefully review the language to see if the changes protect the needs of all of our seniors and persons with disabilities in community based, supportive living, nursing homes and other care settings. It is critically important that fragile and vulnerable people are not put at risk.
*** UPDATE 3 *** From Denise Gaines, legislative director, SEIU Healthcare Illinois…
“Bruce Rauner’s own history of abuse and neglect when it comes to nursing homes under his control should strike fear in the hearts of anyone affected by these changes, which ultimately limit choice for Illinois seniors and preserve Rauner’s own power to arbitrarily kick people off the program.
“Once again, Rauner is taking vulnerable Illinoisans hostage in pursuit of his extreme, non-budgetary political agenda. Today, it’s nursing home residents. This amendatory veto is unacceptable and we call on legislators to override it when they convene on Nov. 10th.”
*** UPDATE 4 *** Sen. Daniel Biss via text…
HB2482, which passed with strong support in both chambers, is provided needed protections to seniors and people with disabilities. While we are still reviewing Governor Rauner’s language, I will be watching closely to ensure that we protect the ability of those who most need long term care to choose the most appropriate services.
…Adding More… So, here is what the original bill said…
Individuals with a score of 29 or higher based on the determination of need (DON) assessment tool shall be eligible to receive institutional and home and community-based long term care services until such time that the State receives federal approval and implements an updated assessment tool.
So, under this AV, people would be eligible to receive institutional or home and community-based long term care services.
The trouble is, lots of seniors bounce around between those services. They’re receiving home care, they fall and break their hip, they go to the hospital and are released to a nursing home, then they eventually head back home.
How can you make this a purely “or” situation? Do they have to reapply? Do they just get one and not the other?
I have a call into the governor’s office to explain this. I’ll let you know what they’re saying.
*** UPDATE 5 *** So, according to the governor’s office, the example I used above wouldn’t be covered by their AV. This is for permanent care, not temporary bouncing around, I’m told. They also claim to have the support of several advocates for home and community-based care, which might explain the muted response so far from Democrats.
*** UPDATE 6 *** From the Health Care Council of Illinois (nursing home lobby)…
Governor Rauner’s Amendatory Veto of House Bill 2482 eliminates medical care for Illinois’ most vulnerable citizens. Rauner’s view of the future of long term care for people who cannot dress themselves or manage their own medication is to keep them isolated in an apartment with assistance of a part-time housekeeper.
Rauner’s amendatory veto strips away 24-hour skilled medical care and replaces it with a few hours a week of housekeeping chores. This move is strictly about money and politics, and not about the care needs of elderly people. With one pen stroke, elderly people and their families lost the right to choose the best health care setting based on their individual health care needs and family circumstances.
The Health Care Council of Illinois calls on members of the General Assembly to override this Amendatory Veto and uphold dignified medical care for our most vulnerable citizens.
Pat Comstock
Executive Director
Health Care Council of Illinois
posted by Rich Miller
Friday, Nov 6, 15 @ 12:27 pm
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This… is definitely not the amendment I was expecting.
Comment by Sick & Tired Friday, Nov 6, 15 @ 12:34 pm
Several GOP voted for this bill. Will they be for it, then against it? Tuesday will be interesting.
Comment by Unspun Friday, Nov 6, 15 @ 12:37 pm
===“These bills may be well-intentioned, but they are ultimately harmful to the programs they are trying to help,” Rauner spokesman Lance Trover said. “The governor understands and shares the frustration of members who want to fund these programs, but the appropriate way to do so is in the context of a truly balanced budget. As drafted, both pieces of legislation would create serious problems that jeopardize the future of the Child Care Assistance Program as well as services for the elderly.”===
Reasonable tone, clear message, justifiable rationale and, most importantly, no snark and no hyperbole.
Well done Mr. Trover.
Comment by 47th Ward Friday, Nov 6, 15 @ 12:38 pm
To quote other commenters - “Governors own it” and “He Does Not Care” - ok, who is having their first shot after reading these comments?
It is Friday afternoon, so go for it!
Comment by illini Friday, Nov 6, 15 @ 12:38 pm
===The governor understands and shares the frustration of members who want to fund these programs, but the appropriate way to do so is in the context of a truly balanced budget.===
Two points;
A veto is only a Governor’s choice, even an AV is a choice too.
The balanced budget ruse is debunked in this sentence;
“The governor understands and shares the frustration of members who want to fund these programs, but the appropriate way to do so is in the context of a truly balanced budget.”
The ruse is, budget first, then the funding…
The turnaround agenda first, then a budget.
The AV is… ensuring that the Turnaround Agenda… has its hostages.
The rest?
The rest is trying to explain away that decimating social services is fine, no matter “who” Candidate Rauner got to vouch for him that he has “no social agenda”.
This AV is framed for me as ensuring hostages stay put, the budget itself is a hostage to Ideals, and people, and Illinois, are non-factors in this… “in equation”.
The hostage of a budget… begat this AV… making the goal of Dismantling Unions have a price, again… and we all can see the “score”
Comment by Oswego Willy Friday, Nov 6, 15 @ 12:40 pm
The statement said the appropriate funding mechanism is in the context of a budget, but Brucie is willing to sign with one change anyway? Interesting. Might this signal a decline is rhetoric and actual compromise? Dare I dream?
Comment by Ferris Wheel Friday, Nov 6, 15 @ 12:43 pm
Wowzer.
Comment by Dome Gnome Friday, Nov 6, 15 @ 12:44 pm
Trover is like his chief of staff, now we have two lapdogs.
“House Bill 2482 would lock into statute that an individual who qualifies for assistance is entitled to institutional care. Additionally, the approach contemplated by this legislation puts the state’s compliance with Medicaid waiver regulations and ability to maximize federal match funds at serious risk.”
No it doesn’t, it means that people who want home health care should be able to have it, not Rauner helping his nursing home buddies gain more customers. By going Rauner’s route, he wants to institutionalize more people and deciminate the HSP program. Tell the truth for once already. Who is Rauner to play “god” with people’s lives?
Comment by Anonymous Friday, Nov 6, 15 @ 12:46 pm
Question to the post:
Two words- “and” and “or”. Does the “and” allow for more flexibility by the families and doctors concerned with the care of the individual? For instance, if an individual has a high DON but needs some longer term care to recover from a health incident, then goes to home care. Do they have to choose one or the other right away? Is the “or” instead too constraining?
Comment by Anon221 Friday, Nov 6, 15 @ 12:46 pm
While on the surface, this is great and I do appreciate the acknowledgement of the worth of home and community based services, there’s a problem. The current Medicaid waiver mandates that the assessment score needed to enter institutional care be the same as needed for home and community based services. The purpose of the Medicaid waiver is to deflect nursing home placement. If the score for institutional care is higher than needed for HCBS, no deflection happens. So either the governor’s people didn’t do their homework, which is possible, or they’re using this way to actually raise eligibility levels for all.
Comment by CCP Hostage Friday, Nov 6, 15 @ 12:47 pm
Not surprised they didn’t go over the top with this one. He couldn’t sign it after he threw GOP members under the bus on the K-12 approp. But he couldn’t go to war over it. Haven’t seen the cross tabs on it, but my guess is the elderly are still pretty solidly with the Governor. And thousands of middle class suburban families move their parents assets around to get the state to chip in for these services when the time comes that they’re needed, so another key base of his would be impacted.
The change seems entirely semantic, but reasonable.
The Speaker will probably still move to override, just out of spite.
Comment by Juice Friday, Nov 6, 15 @ 12:51 pm
In bargaining language it’s the difference of “may” and “shall”..
Comment by Mouthy Friday, Nov 6, 15 @ 12:53 pm
Also, the waiver was put into place to keep more people living in their homes, not in a nursing home. Your separating individuals by mental, physical, and age, essentially raising the score to save more funding by preventing people with getting services and increasing those admissions into a nursing home. Also, cut with the balanced budget BS already. Your going to have to raise taxes because court decent decrees are making the state pay for certain services in the absence of a budget. Like OW says, you own your decision, now start telling the truth.
Comment by Anonymous Friday, Nov 6, 15 @ 12:56 pm
I am very unimpressed with the Superstars.
I would think that this determination between the institution or the home-based care should be made a Doctor and/or a highly qualified state professional.
Must be needing to build a case to increase the number of nursing home beds licensed in the state. /s
Seriously, it is important to try to maintain a little hope that this Administration has good intentions.
What does the industry say? It will be interesting, especially regarding the validity of the Federal impacts.
Comment by cdog Friday, Nov 6, 15 @ 12:57 pm
So the GA can by simple majority accept changes. Supermajority override his changes. Not do anything and let the bill die. And the Governor is on the record AV’ing DON score bill (could be blamed for killing it). Not a total veto, but Joe Blow doesn’t know the difference. this will be interesting to watch.
Comment by 360 Degree TurnAround Friday, Nov 6, 15 @ 1:00 pm
/snark
Rauner simply puts it this way, override my veto, money will be spent by my campaign through extortion like techniques to make sure you don’t get elected as I now make each one of you a wholly owned subsidiary of me.
Comment by Anonymous Friday, Nov 6, 15 @ 1:07 pm
To Greg Harris update: My bet is now that they don’t call it. Let Governor wear the AV collar. Superstars may have to brush up on how all this works.
Comment by 360 Degree TurnAround Friday, Nov 6, 15 @ 1:08 pm
Looks like a way to save face. People can’t be in a nursing home AND get community services at the same time. By design it functions as “or”. The bill protects the current 29 level to get NH or community services. The Governor’s message says he’d like to keep low need people out of nursing homes. His DON changes would have NOT done that at all. Instead it would have decreased access to the very services he says he supports in the AV.
This is a way to get off the bad path WITHOUT a fll veto override. It gets to the same place as the original bill BUT now some GOPers who voted NO on the original can know vote YES ot accept the AV.
But here is the $64,000 question…will Madigan let the AV be voted on to accept or will he push to override? Then he has GOPers on bad vote.
Does the public good get done here? It can by simply accepting the AV. Simple majority to accept. Or is this another issue for the larger Rauner-Madigan war?
Comment by Hoping for Rational Thought Friday, Nov 6, 15 @ 1:08 pm
Now this is a team effort. 47th is right - Trover really went back to basics and kept it clean. The rest of the team put together a thoughtful and well-reasoned delineation of the AV.
At the federal level, this is how Medicare operates. Your amount of time allowed in a nursing home is limited, and Part D and Advantage providers work with beneficiaries to determine a course of action that is both beneficial to the patient and is not cost-prohibitive. Hospitals and long-term care facilities are encouraged by HHS-CMS to follow similar guidelines and arrangements.
Comment by Anonymous Friday, Nov 6, 15 @ 1:10 pm
Prescribing institutional care for individuals who do not need it is wrong for the individual and wrong for taxpayers.
Once again, we see that this administration sees people needing government service as different from taxpayers.
We are all citizens eligible for government services due to our citizenship, not based upon our ability to pay our taxes. Paying taxes does not entitle citizens to deny those who do not pay taxes, (if there really are any citizens who do not pay taxes - that is), their citizen’s government services.
This administration’s press release does not demonstrate an understanding of government service. The purpose of government is to serve citizens. This administration clearly doesn’t understand the role of governor, or government.
Comment by VanillaMan Friday, Nov 6, 15 @ 1:11 pm
Hoping that further politics stays out of this, and leaders and members let their conscience be their guide. Well past time for that to happen.
Comment by Lincoln Lad Friday, Nov 6, 15 @ 1:14 pm
For many elderly, the question becomes too often, can you adequately recover in 100 days to go back home? After the 100 days, Medicare is done. Then you either have to have another form of insurance (if you could afford to have already invested in such) or go the Medicaid route until you are well enough to go home. It seems like Rauner wants a stark line drawn- you’re either in a nursing home or you are at home. Unfortunately life doesn’t always deal the cards that way. Maybe he’s never had a family member in his world that had to sit at the table and be dealt a losing hand once in a while.
http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/long-term-services-and-supports.html
Comment by Anon221 Friday, Nov 6, 15 @ 1:18 pm
1:10 is me.
Comment by Team Sleep Friday, Nov 6, 15 @ 1:19 pm
Was this considered in the AV???? The Feds have been working on this since Jan 2014 I believe:
https://www.federalregister.gov/articles/2015/11/02/2015-27697/medicaid-program-methods-for-assuring-access-to-covered-medicaid-services
http://www.medicaid.gov/medicaid-chip-program-information/by-topics/access-to-care/downloads/access-fact-sheet.pdf
Comment by Anon221 Friday, Nov 6, 15 @ 1:28 pm
So the Governor knows how to use the AV after all.
Comment by The Dude Abides Friday, Nov 6, 15 @ 1:32 pm
=== … but the appropriate way to do so is in the context of a truly balanced budget. ===
And given Rauner’s hostage strategy when will this be. Meaningless words to obfuscate the issue and placate those allies who voted against him.
Comment by Norseman Friday, Nov 6, 15 @ 1:36 pm
The K-12 approp the govenor signed wasn’t “in the context of a truly balanced budget.” In fact, he said he wanted to spend more.
Neither are the state salaries the governor made a big show of going to court to get funded (the superstars weren’t going to do their magic for nothing).
Nor are the tax credits he’s been raining down on Fortune 500 companies.
Let’s not pretend you’re getting all fiscal responsible all of a sudden, Lance. Not with a political strategy that created a $6 to $8 billion FY16 deficit.
We’ll get around to that in January, right?
Pace yourself. No hurry.
Comment by Wordslinger Friday, Nov 6, 15 @ 1:45 pm
All of these decisions are supposedly based on the budget but the Governor says he refuses to talk about the budget before his Turnaround Agenda is passed. He only seems to be focused on the budget when it’s convenient.
Comment by Demoralized Friday, Nov 6, 15 @ 1:58 pm
In the world of eldercare, the big variable is the so called “informal social supports” which equates to unpaid help. Like a wife who cares for her husband, or a daughter who cares for a parent. Individuals not blessed with available informal caregivers even with lower DON scores tend to end up in institutions, unless they have a lot of money on reserve. And these informal caregivers provide something like 85% of all care to the elderly. I am not sure how the substitution of “or” for “and” exactly plays out, but it is still generally true that “no one” wants to go to a nursing home if they have other options.
Comment by Groundhog Day Friday, Nov 6, 15 @ 2:07 pm
The biggest problem I see with changing “and” to “or” is that if a person can only be approved for one program at a time (either home-based “or” nursing home care), they would have to go through the application/approval process all over again if they switch from one to the other (e.g. from home care to a nursing home, or vice versa). If they can qualify for both home care “and” institutional care at the same time, only one application process would be needed.
Comment by Secret Square Friday, Nov 6, 15 @ 2:10 pm
Is it me or was that jab at Rauner’s nursing home failures a bit over the top?
Comment by Skeptic Friday, Nov 6, 15 @ 2:17 pm
Skeptic, it ain’t you.
lol
Comment by Rich Miller Friday, Nov 6, 15 @ 2:19 pm
What CCP Hostage said. I am pleased to hear that Rauner is not a supporter of institutions. Not sure the Murray parents are happy to hear that after his campaign pledge to keep it open.
Comment by Earnest Friday, Nov 6, 15 @ 2:21 pm
Maybe the Illinois Policy Institute can start a GoFundMe account for all of Rauner’s victims. Their Capitol light campaign has $50 as of this morning.
Comment by 360 Degree Turnaround Friday, Nov 6, 15 @ 2:29 pm
And to add to CCP–the institutional eligibility requirement has to do with federal matching funds and the Medicaid Waiver. Knowing things like this is a matter of basic understanding in managing the state. If he weren’t so far out there with his wedge strategy, these errors would be more prominent.
Comment by Earnest Friday, Nov 6, 15 @ 2:35 pm
=Is it me or was that jab at Rauner’s nursing home failures a bit over the top?=
It was more than a “bit” over the top. This is where unions fail too often. The over the top rhetoric makes them look bad not Rauner.
His record with nursing homes is what it is, but for a moment it looked like there was going to be some civility to the process and then SEIU chimes in. Sheesh.
Comment by JS Mill Friday, Nov 6, 15 @ 2:36 pm
Governor Rauner is governor now.
Rauner’s own choices are now. The “nursing home” but takes away from the governing narrative, good or bad.
Being mock on the hyperbole isn’t helping.
Comment by Oswego Willy Friday, Nov 6, 15 @ 2:40 pm
Maybe Bruce is waiting for Barry Saacks to hurry up and buy out the $6B? After all, Barry has been there before to bail him out. Why not this time too?
Comment by How Ironic Friday, Nov 6, 15 @ 2:43 pm
What @47th Ward said.
Reasonable. ==Doable==.
Comment by Formerly Known As... Friday, Nov 6, 15 @ 2:49 pm
“Being mock on the hyperbole isn’t helping.” Exactly. As you know, there are few that like Rauner less than me, but come on man, that ain’t helping.
Comment by Skeptic Friday, Nov 6, 15 @ 2:52 pm
Institutional care under Medicaid is an entitlement. If people meet the eligibility criteria, they get funding to receive those services.
A Medicaid Waiver allows you to provide services in a different way to help people avoid the need for institutional care. It is not an entitlement, so that is where you get the long waiting lists for services in the developmental disabilities system. One requirement from the feds is that Medicaid Waiver services must be less expensive than Medicaid services.
Comment by Earnest Friday, Nov 6, 15 @ 3:06 pm
==Individuals with a score of 29 or higher based on the determination of need (DON) assessment tool shall be eligible to receive institutional and home and community-based long term care services==
The determination for institutional and home and community care is the same. So how does the “or” change that? It doesn’t. A person can be in only one place at a time, so what’s Rauner’s problem?
Comment by Wensicia Friday, Nov 6, 15 @ 3:09 pm
Every so often Rauner does something reasonable. If he would just drop the extremist tactics and advance his “turnaround agenda” through the normal legislative process, he could still turn out to be as successful as past Republican governors who worked with Democratic majorities in the state House and Senate.
Comment by olddog Friday, Nov 6, 15 @ 3:17 pm
I would like to see the Federal response to the possible consequences of this AV change especially in light of the FED’s CMS current ruling.
Comment by Anon221 Friday, Nov 6, 15 @ 3:19 pm
Trust Harris’ review. He won’t play games with this. If it were trivial, there wouldn’t be an AV.
Comment by walker Friday, Nov 6, 15 @ 3:35 pm
Earnest, we at Murray Center are alive and well. The Murray Parents Association has ALWAYS advocated for choice….whether it be a state center or in a family home. This is what the federal ruling Olmstead says….there will ALWAYS be some disabled residents who will need the special services of an institution. Gov. Rauner absolutely understands this….he knows some people do better in the community, but many do better in a state center. His changes do not take away that right….that is what we have been fighting for….the right to choice, and that is what all our rulings in federal court have upheld.
Comment by Anonymous Friday, Nov 6, 15 @ 4:28 pm
Actually, anon - Rauners changes here absolutely appear to be designed to take away choice for lower need consumers.
Comment by AlabamaShake Friday, Nov 6, 15 @ 4:37 pm