Testimony given to House Committee on Medicaid Reform

Medicaid Reform in Illinois

The State of Illinois is in the process of undergoing Medicaid Reform. The House and Senate have convened committees to hear testimony and to propose a reform plan. Many people with disabilities worry that “reform” is code for cuts in services. In order to protect services, and to stress that any reform should include a strong emphasis on community based services, disability advocates have been submitting testimony before the house and senate committees. Below is testimony from Tom Wilson delivered to the House Committee on December 9.

Comments from Tom Wilson
Community Development Organizer–Healthcare at Access Living

1. Go Slow! Many mistakes are possible with too fast of reform that will be costly in human lives and in financial resources. Illinois is involved in adopting it's version of the Affordable Health Care Act (ACA) which will take several years. Decisions made in implementing this overlap and impact Medicaid deeply so we need to study the many moving parts before making drastic changes.

2. Illinois already has a low cost Medicaid system.
According to the Sargent Shriver National Center on Poverty Law's online publication ”The Shriver Brief,” Illinois' Medicaid billings grew slower than the national average, from 2008 to 2009, at 4.2 percent and only 4.4 percent during the last four years. In FY 2010, the projected national average of medical costs was 7.7 percent, while Illinois was only expected to grow by 7.0 percent. Among all states, Illinois ranks 42nd in per Medicaid beneficiary expenditures. The national average is $4,575 per Medicaid beneficiary, and Illinois spends $4,129 per beneficiary. Overall, Illinois effectively minimizes Medicaid cost to the taxpayers and maximizes, for the most part, the federal dollars available.

We are not overspending on Medicaid, we are overspending on institutions. We are aware that Director Hamos and Michael Gelder from the Governor's office are cognizant of this aspect. Obvious savings come from following the Americans with Disabilities Act (ADA) and Money Follows the Person laws that would rebalance Long Term Care by emphasizing Home and Community Based Services over institutional settings. Many states have and are pursuing this because they know it is mandated by the Supreme Court's Olmstead decision. It can also have real monetary savings. The state is arguing or settling 4 different federal court cases that are focused on Olmstead compliance in which Access Living has been one of the litigants.

3. There needs to be ADA compliance in all medical settings including clinics and hospitals and the state needs to enforce these standards in all of it contracts and role of supervision of Medicaid. People with disabilities have received poor care due to access issues in medical settings. ADA compliance is not restricted to how buildings are constructed; it includes examining equipment and communications access. We are working with the Access Board on determining exact standards for providers. Illinois needs to be ADA compliant and while it may make providers leery of Medicaid, it is the law and this is a standard for all health care providers.

4. The state needs to explore models of delivery that use locally based entities that are not insurance companies. There needs to be a focus on not for profit organizations to do care coordination. Studies show that not for profits generally provide better quality care than for profit entities, whether in hospitals or nursing homes settings.

5. Consumer control or consumer directed care is essential for people with disabilities in all aspects of health care. This is not an optional consideration. Self determination is a UN recognized human right. Even people who under guardianship need to have input into all the decisions made about their health care. They (people with disabilities) often know more about their medical needs than their providers. People with disabilities want a voice in all decisions that are made about their health. Consumer directed home care is the gold standard in providing quality affordable Long Term Care.

6. Complexity is a problem in US health care. Adding more complexity to our health systems means more errors and more expense. Simplicity is just more people friendly. People need simple ways to access and retain health care.

7. People with disabilities want to see their doctors. They have had to look around and compare providers to find primary doctors that they trust, specialists that understand them and their disabilities and hospitals with quality programs. If you need heart surgery you want to go to the hospital that does high numbers because their experience means better outcomes. People with disabilities want access to the specialists who have experience with their condition.

8. Preventative and Maintenance health therapies are important. Some conditions are progressive but their effects can be mitigated with ongoing therapy.

9. Durable Medical Equipment (DME) is expensive, but getting the right DME is essential for a good quality of life for many people with disabilities.

10. State health dollars should go to providing health care not to other functions.

11. Health care is a human right. When will our state treat it as such?

12. The most economical high quality health care system that truly delivers universal coverage is a single payer system. The states own study using Navigant Consulting showed single payer to be the superior alternative.

And I would like to honor the memory of Elizabeth Edwards today. She spoke clearly about the need for health care justice and guaranteed Health care for All..

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