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Developmental Disability Managed Care

The administration of Illinois Governor Patrick Quinn announced plans to create a Managed Care System to administer all health care, acute medical and long-term residential, day program and other support services for individuals with autism, cerebral palsy, Down Syndrome and other intellectual, physical, behavioral health and developmental disabilities. 

According to Jim Parker, Deputy Administrator for Medical Programs at the Illinois Department of Healthcare and Family Services, the overall goal of this initiative is to create a “truly integrated health system” for 40,000 individuals with disabilities.  One or more Managed Care Organizations (MCO) would be placed between the state and current service providers to eliminate inefficiencies and reduce the costs of providing health care and other state funded support services for Illinois residents with disabilities. 

The MCO would be paid by the state to establish contracts and manage payments to local hospitals, physician groups and other medical providers for traditional and acute medical care.  Additional contracts would be let out for bid to provide long-term residential, day programs and other specialized support services for individuals with disabilities. 

Similar to Health Maintenance Organizations (HMOs), medical and human service organizations would provide their respective services within certain geographic boundaries, at a specific, capped dollar amount as established by the MCO.  According to Parker, the Governor has a target date of July 1, 2010 for implementation of the program. 

All of the Advocates for persons with disabilities were caught off guard by the direction and speed of the Governor’s proposal.  It was our understanding that the original charge of the Medicaid Task Force was only to manage costs within the health and acute care system.  This alone is a monumental task.  How Healthcare and Family Services can do this, plus include the entire long-term DD support system by July, 2010 is inconceivable.   

For persons with disabilities, cutting the already barebones costs of long-term residential, day and other specialized support services will create even more hardships.  The Healthcare and Family Service people have no inkling of what individuals with disabilities in Illinois have been through during the last 15 years.  Our community disability funding is already 25% behind the rest of the country.  If the MCO manages out any more costs, services will decline and, just as in the state institutions, the Feds could move to decertify our community developmental disability system.  The resulting loss of federal match would accelerate our race to the bottom. 

While health and acute care have the established medical HMO model to guide them, there are no managed care templates that are viable given Illinois' history of underfunding its long term, community support services for persons with disabilities.  If, after 10+ years, Illinois still has not developed a viable plan to modernize its state institutions; how does it expect to radically change the community system in 6 months?  Plus, Health and Family Services have not even made attempts to inform the people with disabilities who will be impacted by these actions.   

Participants at the December 2^nd meeting asked but did not receive answers on why the Governor thinks another level of bureaucracy is a necessity; why the pilot program was limited to certain Chicago suburbs; and who will oversee the operations of the MCO.   

Given these uncertainties, advocates for persons with disabilities are asking for an open hearing from the State’s Managed Care Task Force so that Legislators and the Governor can receive input from those persons who will be most affected.  Additionally, they will look to change the announced timetable to better reflect the state’s ability to truly implement just the health and acute care portions of the managed care process. 

Lastly, given the complexity of the health care portion of this plan, elimination of community long-term residential, day and other disability support services from inclusion in the initial phase of managed care must be considered.