My first year office as a State Representative has reinforced my belief that the urgency with which significant issues are addressed is not commensurate with the magnitude of our State’s fiscal crisis. This is due in part to the glacial pace that business moves in Springfield legislatively. Inordinate amounts of time and effort are spent on matters that are peripheral at best in relation to the real issues facing our State.
Additionally, reforms that have been passed into law by the General Assembly in relation to Medicaid, for example, sit unimplemented due to a lack of will, ability, or in some cases because the good people working in these departments are fighting an uphill struggle with antiquated information systems and protocols.
One of the many lingering repercussions of the ineptness of the Blagojevich Administration was a massive expansion of Medicaid eligibility thresholds without any semblance of a plan to pay for the services. The Director of the Illinois Department of Healthcare and Family Services describes Illinois eligibility standards as among the most generous in the United States.
The reason this subject matter is important is that Medicaid is the most rapidly growing portion of Illinois budget. The liability for Illinois is $700 to $800 million monthly and going north. This, coupled with the fact that the state is only paying about $300 million a month to providers of care will leave us with $2.4 billion in payment delays at the end of FY2012, and the backlog will expand to a staggering $5.4 billion by the end of FY2013.
Prioritizing services based upon need is imperative if we are to make a good faith effort in directing limited resources to those in the margins of society. Political types are excellent at expanding programs, and significantly less adept at facing the reality that the math doesn’t come close to working and serious decisions and reforms are imminent.
Where are we on the reform front? A law commonly referred to at the Medicaid Reform Act passed into law and took effect on 1/25/11. The Act contains comprehensive reforms, including enhanced eligibility verification across all lines of Medicaid. Measures as non-controversial as one must be an Illinois resident to access Illinois Medicaid, and at least one month’s income verification for current and continued eligibility, and the elimination of presumptive eligibility. Other measures called for utilization review of narcotic medication abuse, and providing by rule for dispensing of a 90 day supply of generic, non-narcotic maintenance medications.
To date, none of the above requirements enacted into law over eleven months ago have been implemented. Instead of filing a State Plan Amendment consistent with past protocol, the Department of Healthcare and Family Services filed what amounts to a “mother may I” letter to the federal government, a tactic that almost asks for the reforms to be denied by the feds. One could reasonably argue that this laissez faire tactic is a defacto way of undermining legislative intent by providing bureaucratic cover for measures that some in the current Administration simply do not want to implement.
An analysis by the Senate Republican staff suggests that the State can save in excess of $1 billion annually if the expansion in eligibility of the past few years is reversed. Requiring enhanced verification and eliminating presumptive eligibility represents a major portion of these projected savings.
I personally pressed the Director of HFS in terms of why this measure, in addition to seven other reform laws that have been passed since 2009 that have not been implemented. In totality, over $1.5 billion in savings annually could be realized. The rationale for failure to implement ANY of the reforms is illustrative of how dysfunctional and unaccountable the government is in comparison to my experience in the private sector.
Where else would there be no apparent ramifications for admitting that not only are the reforms not implemented, but that the team of managers on the field in the department “lack the skill set” to facilitate the changes. That is a direct quote. Twenty-one positions are currently open due to cumbersome hiring rules and collective bargaining agreement barriers. In short, the same people who agreed to, lobbied for, and enacted ridiculous hiring protocols, are now using them as an excuse to circumvent legislative intent.
Another reason for the inability to move forward is that the information systems that many of our field offices are using are from a bygone era. The staff at the local human services office in Danville is saddled with a COBAL based system. COBAL was invented in 1959 and taught to programmers in the 1970’s. The last major update of this language was in 1985, centuries ago by modern information technology standards. This revelation is both shocking, and a testament to how perhaps the only thing that rivals the disaster of our finances is the laughable managerial stewardship promulgated by the Executive Branch over the past decade. To saddle the employees of our state offices with technology akin to a bag phone in an era of 4G capabilities underscores the total lack of a comprehensive management and personnel strategy.
Ironically, what will happen in the spring of 2012 is that many who will not advocate for simple reforms being implemented (and by definition will not have the intestinal fortitude to discuss major reforms over the next 24 months), will attempt to shove a huge decrease in reimbursement down the throats of our hospitals, nursing homes and physicians, most of whom are already providing services at a loss and waiting 150 days or more for payment. Why? Because simply cutting the providers off at the knees is easier than changing the culture of how we do business in Springfield – unconscionable in my view.
When I, and over 50 members of the General Assembly wrote a letter dated 10/11/11 to the federal Super Committee, imploring our Washington brethren to allow our simple Medicaid reforms to move forward, even a vote on the non-binding resolution was blocked by House Democrats.
These are the easy decisions in the context of budgetary reform in Illinois. Compared to the extraordinarily tough votes that will come with the 2012 and 2013 budgets, history will judge these changes as perfunctory.
The public is increasingly, and appropriately, frustrated by what they perceive as either the inability, or what I suggest is the unwillingness, of many involved with the process to act with the purpose and urgency that our enormous challenges demand.
It can be done. I had the privilege of working in healthcare over an extended period of time in a faith based organization that faced many of the same challenges that our State currently confronts. Moving large organizations towards efficiency and accountability while providing services at a high level is not easy. Too many in government see this exercise as a destination of incremental decisions with short term durations. Reality suggests a change of culture that demands creativity, efficiency, utilization of technology, and using attrition as an organizational friend.
The bottom line is this: every citizen in our state understands that if their government were a private sector entity it would be bankrupt with many of its leaders either in jail for corruptness, or at minimum unemployed due to being convicted on the charge of being ill equipped to address age old problems with modern solutions.
Incremental decisions and foot dragging over the implementation of the baseline changes and low hanging fruit will not get us to the promised land. Straight talk, common sense, and a willingness to tear down silos and barriers is required.
Illinois is in an economic emergency. We need to start acting accordingly.
My first year office as a State Representative has reinforced my belief that the urgency with which significant issues are addressed is not commensurate with the magnitude of our State’s fiscal crisis. This is due in part to the glacial pace that business moves in Springfield legislatively. Inordinate amounts of time and effort are spent on matters that are peripheral at best in relation to the real issues facing our State.
Additionally, reforms that have been passed into law by the General Assembly in relation to Medicaid, for example, sit unimplemented due to a lack of will, ability, or in some cases because the good people working in these departments are fighting an uphill struggle with antiquated information systems and protocols.
One of the many lingering repercussions of the ineptness of the Blagojevich Administration was a massive expansion of Medicaid eligibility thresholds without any semblance of a plan to pay for the services. The Director of the Illinois Department of Healthcare and Family Services describes Illinois eligibility standards as among the most generous in the United States.
The reason this subject matter is important is that Medicaid is the most rapidly growing portion of Illinois budget. The liability for Illinois is $700 to $800 million monthly and going north. This, coupled with the fact that the state is only paying about $300 million a month to providers of care will leave us with $2.4 billion in payment delays at the end of FY2012, and the backlog will expand to a staggering $5.4 billion by the end of FY2013.
Prioritizing services based upon need is imperative if we are to make a good faith effort in directing limited resources to those in the margins of society. Political types are excellent at expanding programs, and significantly less adept at facing the reality that the math doesn’t come close to working and serious decisions and reforms are imminent.
Where are we on the reform front? A law commonly referred to at the Medicaid Reform Act passed into law and took effect on 1/25/11. The Act contains comprehensive reforms, including enhanced eligibility verification across all lines of Medicaid. Measures as non-controversial as one must be an Illinois resident to access Illinois Medicaid, and at least one month’s income verification for current and continued eligibility, and the elimination of presumptive eligibility. Other measures called for utilization review of narcotic medication abuse, and providing by rule for dispensing of a 90 day supply of generic, non-narcotic maintenance medications.
To date, none of the above requirements enacted into law over eleven months ago have been implemented. Instead of filing a State Plan Amendment consistent with past protocol, the Department of Healthcare and Family Services filed what amounts to a “mother may I” letter to the federal government, a tactic that almost asks for the reforms to be denied by the feds. One could reasonably argue that this laissez faire tactic is a defacto way of undermining legislative intent by providing bureaucratic cover for measures that some in the current Administration simply do not want to implement.
An analysis by the Senate Republican staff suggests that the State can save in excess of $1 billion annually if the expansion in eligibility of the past few years is reversed. Requiring enhanced verification and eliminating presumptive eligibility represents a major portion of these projected savings.
I personally pressed the Director of HFS in terms of why this measure, in addition to seven other reform laws that have been passed since 2009 that have not been implemented. In totality, over $1.5 billion in savings annually could be realized. The rationale for failure to implement ANY of the reforms is illustrative of how dysfunctional and unaccountable the government is in comparison to my experience in the private sector.
Where else would there be no apparent ramifications for admitting that not only are the reforms not implemented, but that the team of managers on the field in the department “lack the skill set” to facilitate the changes. That is a direct quote. Twenty-one positions are currently open due to cumbersome hiring rules and collective bargaining agreement barriers. In short, the same people who agreed to, lobbied for, and enacted ridiculous hiring protocols, are now using them as an excuse to circumvent legislative intent.
Another reason for the inability to move forward is that the information systems that many of our field offices are using are from a bygone era. The staff at the local human services office in Danville is saddled with a COBAL based system. COBAL was invented in 1959 and taught to programmers in the 1970’s. The last major update of this language was in 1985, centuries ago by modern information technology standards. This revelation is both shocking, and a testament to how perhaps the only thing that rivals the disaster of our finances is the laughable managerial stewardship promulgated by the Executive Branch over the past decade. To saddle the employees of our state offices with technology akin to a bag phone in an era of 4G capabilities underscores the total lack of a comprehensive management and personnel strategy.
Ironically, what will happen in the spring of 2012 is that many who will not advocate for simple reforms being implemented (and by definition will not have the intestinal fortitude to discuss major reforms over the next 24 months), will attempt to shove a huge decrease in reimbursement down the throats of our hospitals, nursing homes and physicians, most of whom are already providing services at a loss and waiting 150 days or more for payment. Why? Because simply cutting the providers off at the knees is easier than changing the culture of how we do business in Springfield – unconscionable in my view.
When I, and over 50 members of the General Assembly wrote a letter dated 10/11/11 to the federal Super Committee, imploring our Washington brethren to allow our simple Medicaid reforms to move forward, even a vote on the non-binding resolution was blocked by House Democrats.
These are the easy decisions in the context of budgetary reform in Illinois. Compared to the extraordinarily tough votes that will come with the 2012 and 2013 budgets, history will judge these changes as perfunctory.
The public is increasingly, and appropriately, frustrated by what they perceive as either the inability, or what I suggest is the unwillingness, of many involved with the process to act with the purpose and urgency that our enormous challenges demand.
It can be done. I had the privilege of working in healthcare over an extended period of time in a faith based organization that faced many of the same challenges that our State currently confronts. Moving large organizations towards efficiency and accountability while providing services at a high level is not easy. Too many in government see this exercise as a destination of incremental decisions with short term durations. Reality suggests a change of culture that demands creativity, efficiency, utilization of technology, and using attrition as an organizational friend.
The bottom line is this: every citizen in our state understands that if their government were a private sector entity it would be bankrupt with many of its leaders either in jail for corruptness, or at minimum unemployed due to being convicted on the charge of being ill equipped to address age old problems with modern solutions.
Incremental decisions and foot dragging over the implementation of the baseline changes and low hanging fruit will not get us to the promised land. Straight talk, common sense, and a willingness to tear down silos and barriers is required.
Illinois is in an economic emergency. We need to start acting accordingly.
