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New Report Points to Barriers to Mental Health, Addiction Coverage

Sep 19, 2017

Today, Health & Medicine in collaboration with a group of organizations including the Kennedy Forum, the Illinois Psychiatric Society, the Community Behavioral Healthcare Association, and others who seek to improve mental health and addiction treatment released a new report pointing to significant barriers to coverage. The report highlights the results of a provider survey asking hospitals, psychiatrists and community providers about their experiences with reimbursement for mental health and addiction services. The survey findings raise red flags about a number of potential barriers to services that families may face and whether Illinois’ health plans are providing mental health and addiction treatment on par with other types of medical conditions, which is required by state and federal parity laws for most plans.

The report makes recommendations for policymakers, regulators, health plans, providers and consumers to ensure that Illinois residents have access to the services they need.

In response, State Representatives Steve Andersson, Deb Conroy, Sara Feigenholtz and Lou Lang have introduced a resolution to address these issues, HR 607. Rep. Conroy, chairwoman of the Mental Health Committee, has pledged to hold hearings.

Attorney General Lisa Madigan said, “This report raises important questions about whether consumers can access mental health and addiction insurance coverage when they need it. My office is committed to holding insurance companies accountable to our state’s mental health parity laws. Anyone who has problems with their health insurance coverage should contact my Health Care Bureau for help at 1-877-305-5145.”

The survey and report were conducted jointly by The Kennedy Forum Illinois, the Illinois Psychiatric Society, Illinois Association for Behavioral Health, IARF, the Community Behavioral Healthcare Association of Illinois, the Illinois Health and Hospital Association, and Health & Medicine Policy Research Group, and in partnership with members of the Illinois Parity Coalition.


Finding highlights:
  • Upwards of 75 percent of responding providers reported that Medicaid managed care organizations (MCOs) sometimes/often/always denied coverage for inpatient treatment, partial hospitalization, intensive outpatient treatment, and medication-assisted treatment. Nearly half of responding providers reported commercial insurers at least sometimes denied inpatient treatment.
  • More than 60 percent of responding providers reported that Medicaid MCOs sometimes/often/ always refused to cover the requested level of care and instead approved only a lower level of care, while 54 percent of responding providers reported commercial insurers did the same.
  • With Medicaid MCOs, nearly 65 percent of responding providers reported that they were told often or always that networks were simply closed. Nearly half of responding providers were told this often or always with commercial plans. The result: with mental health and addiction care providers unable to join plan networks, patients have more difficulty accessing care, due to the narrow network.
  • More than 90 percent of responding providers report that both Medicaid MCOs and commercial plans have refused to provide requested medical necessity criteria, despite clear legal requirements that plans do so.

Health & Medicine Stands with Dreamers

Sep 05, 2017

Health & Medicine stands with Illinois' over 40,000 Dreamers and the thousands more across the country.

The young people affected by the decision of this Administration to end DACA are our neighbors, our friends, and our co-workers including the many young doctors, nurses, and health professionals who are Dreamers and now, after years of hard work, could lose everything. These young people contribute to the vibrancy of their neighborhoods and strengthen the fabric and health of our communities.

The decision to end DACA hurts Illinois families, communities, and our economy. We all must stand up for Dreamers. Tell Congress and the administration to defend the DREAM Act. It’s the right thing to do.

Health & Medicine, Public Health Woke Coalition Testify Before CCCHHS Board on Protecting Immigrant Health

Sep 01, 2017

On September 1, 2017 Health & Medicine's Director of Health Equity Wesley Epplin and Board Member Linda Murray, MD, MPH testified at the Cook County Health and Hospitals Systems (CCHHS) Board meeting on ensuring that the system’s hospitals and clinics are welcoming and affirming spaces for all patients, especially immigrants. Both Epplin and Murray reiterated the policy recommendations of the Public Health Woke Coaltion, of which Health & Medicine is a lead member, which outline steps CCHHS should take to ensure their facilities are truly safe for all patients:

1. Place clear signage. Place abundant and clear signage in multiple languages assuring a welcoming institution.
2. Provide staff training. Staff training and resources addressing needs of marginalized patients and families.
3. Implement a legal referrals system. Establish referral systems for legal services, know-your-rights information, and other necessary resources.
4. Strengthen internal policies and procedures. Clarify, revise, and strengthen policies & procedures that focus on protecting immigrant & marginalized patients.
5. Monitor community stress. Identify and monitor indicators and neighborhood stress in immigrant & marginalized communities.
6. Ensure best practices for patients facing increased stress and trauma. Design & implement best practices for clinical and public health providers to deliver appropriate care.

To learn more, click here to read Epplin's testimony and click here to review Murray's statement.

Health & Medicine Testifies in Support of Fully Funded Public Hospital and Health System

Aug 31, 2017

On Tuesday, August 29th, Health & Medicine Executive Director Margie Schaps testified before the Cook County Health and Hospitals System with regards to their proposed 2018 budget.

Good evening, and thank you for the opportunity to provide testimony on the proposed 2018 health system budget.  I’m Margie Schaps, the Executive Director of the Health and Medicine Policy Research Group, a policy, research and advocacy organization founded by Quentin Young in 1981 to create policies and systems that support the public’s health.

Between Quentin and myself, I daresay it’s likely that not a year has gone by since 1981 that we haven’t testified on the health system budget and the strategic direction of the system.

Health and Medicine has been steadfast in our commitment to a strong, vibrant and fully funded public hospital and health system that serves all in need in our County.

I want to applaud the system for the many  accomplishments over the last year, increasing mental health and substance use services, movement toward integration of primary care and behavioral health, a more extensive care coordination program including the deployment of community health workers, being awarded one of the state’s new MCO contracts, expanding oral health services, beginning to address social determinants of health through the new transportation program, housing initiatives and farmers markets, and aggressively beginning to pursue being a welcoming institution for all.

As threats at the federal level mount to unravel the ACA, undermine basic civil liberties and destroy funding and services for all, but particularly the most marginalized, this health system bears and extra burden to lift up the community and support equity in whatever ways it can.

With that in mind, I urge the health system to:

  • Work with the county commissioners, the President of the county board and the Sheriff’s office to move the newly created mental health positions at the County Jail under the Health system budget, rather than the public safety budget.  This will ensure greater coordination and continuity for the patients
  • Use whatever leverage is possible to demand that other local hospitals do not “dump” high need, uninsured patients into the county system, but rather share the burden of taking care of high need patients
  • Ensure that the new plans for training staff and implementing policies to become a welcoming institution for all are adequately and fully implemented, and continuously monitored for implementation and outcomes.
  • Continue to build upon the already begun programs addressing social determinants of health by coordinating with advocacy and policy and service organizations in a transparent way to address root causes of ill health—one opportunity for collaboration right now would be advocacy for safe zones for opiod and other drug users.  Safe zones exist in other cities and countries and have shown dramatic reductions in drug use among people served in these setting.
  • Advocate for a fully funded health system that supports public health and population health, and expanded community based services, in particular full dental care at all CCHHS facilities
  • And finally, commit to becoming a trauma informed institution and begin the process of training staff to become trauma informed providers.  This will reap enormous benefits for patients and staff and has been shown repeatedly to reduce health care costs.

Thank you very much for the opportunity to address this body.  Health and Medicine stands ready, as always, to partner with CCHHS in the difficult tasks that will advance health equity