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* 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.
posted by Rich Miller
Thursday, Oct 22, 20 @ 10:48 am
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So why did the ACLU agree to let it go forward?
Comment by Be Real Thursday, Oct 22, 20 @ 11:26 am
Does YouthCare pay Medicaid rates? Or Medicare?
Comment by Dan Johnson Thursday, Oct 22, 20 @ 11:56 am
@Dan Johnson, Medicaid.
Comment by Andrea Durbin Thursday, Oct 22, 20 @ 12:01 pm
Andrea, it’s a little more complicated than that. MCOs have to pay at least Medicaid rates for most services now, that used to be different but the GA has passed several laws mandating that. I don’t know if ALL services have to be paid at least at the Medicaid rate. They could theoretically pay more for certain services, if they wanted to incentivize them, such as preventative services. And they can pay for some things that Medicaid in IL usually doesn’t, like extra dental services. But yes, generally they would pay Medicaid rates.
Comment by Perrid Thursday, Oct 22, 20 @ 12:45 pm
It’s not just youth in care; former youth in care have been moved to the same system and have the same problems (these are children who have been adopted or are under guardianship with someone other than the state).
Comment by Stuff Happens Thursday, Oct 22, 20 @ 12:54 pm
Baloney. Children with Blue Cross Blue Shield PPO are waiting in emergency rooms for up to one week as well. This has NOTHING to do with YouthCare. It’s lack of psychiatric hospitals. PERIOD.
Comment by Insider Thursday, Oct 22, 20 @ 2:09 pm
Perhaps the ACLU should advocate for the funding of more psychiatric facilities instead of defending pedophile members of NAMBLA Man-Boy Love groups. The ACLU doesn’t give a crap about these kids. It’s all show.
Comment by TruthHurts Thursday, Oct 22, 20 @ 2:14 pm
The ACLU is barking up the wrong tree. High acuity children and adolescents are frequently deflected from inpatient psych facilities under the guise of lack of bed availability. In reality, psych facilities lie because they don’t want to deal with the financial and psychological stress of dealing with high needs children who may languish for months when their foster or adoptive parents refuse to take them back. When will the ACLU address that?
Comment by Paralegal2021 Thursday, Oct 22, 20 @ 2:38 pm
YouthCare cannot force providers to (a) join their network (b) notify of office closings / provider changes (c) accept any patients. Until the ACLU gets their way with socialized medicine, facilities and doctors cannot be forced to treat. This is not an insurance issue. At least managed care reduces the risk of Medicaid fraud.
Comment by Mommy2014 Thursday, Oct 22, 20 @ 2:45 pm
Does the ACLU care about the kids with private insurance who sit in emergency rooms waiting for inpatient psych beds? This is a statewide problem, not exclusive to Medicaid patients. This problem has been going on for years and the Illinois ACLU is very late to the party.
Comment by EDRN Thursday, Oct 22, 20 @ 3:04 pm
Inpatient psychiatric hospitals will tell you they don’t have a “clinically appropriate bed”. This is code for “We have a bed, but not for THAT kid.”
Comment by uknowthis Thursday, Oct 22, 20 @ 3:37 pm
What would we do without the ACLU and their ivory tower elitist activist leftist lawyers? Henry VI, Part 2, Act IV, Scene 2.
Comment by waitwut Thursday, Oct 22, 20 @ 3:47 pm
Remember when fee-for-service IL Medicaid got all these kids’ needs met? LOL.
Comment by edattheaclu Thursday, Oct 22, 20 @ 4:28 pm
“We’re part of the problem.” - IL ACLU
Comment by Giggidy Thursday, Oct 22, 20 @ 4:46 pm
The fact that the ACLU has not responded to any of these comments speaks volumes.
Comment by ShakingMyHead Thursday, Oct 22, 20 @ 5:14 pm
Thanks Andrea Durbin and Perrid.
Are most psychiatric hospitals private? For-profit or non-profit? And sustainable on Medicaid rates or not really?
Comment by Dan Johnson Thursday, Oct 22, 20 @ 5:19 pm
Ed Yohnka at the ACLU: What exactly do you propose as a solution? How would YOU address a provider shortage? Will YOU pay for medical degrees in return for a promise to practice in a provider desert? You have a lot of gripes and no solutions. That helps no one.
Comment by GoSox05 Thursday, Oct 22, 20 @ 5:24 pm
“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.” REALLY? WHY WOULD ANYONE BOTHER? “I’M FROM THE GOVERNMENT AND I’M HERE TO HELP.”
Comment by TheDude Thursday, Oct 22, 20 @ 5:34 pm
So here is a controversial question: is the State achieving better outcomes under the new / current system of paid / private providers … or were better outcomes achieved by the old, old State Mental Health hospital system with State hired staff which were pretty much dismantled over the prior decades?
Comment by RNUG Thursday, Oct 22, 20 @ 6:29 pm
RNUG - That remains to be seen. IL YouthCare has been managing health care for DCFS wards only since 9/1/20, less than 2 months, so statistics are not yet available. Also, DCFS wards were NEVER placed in state hospitals. IL state facilities are for uninsured adults. DCFS kids have always received inpatient medical and psychiatric treatment in community hospitals.
Comment by Monica76 Friday, Oct 23, 20 @ 10:12 am