Winger's Weekly Wrap-Up for May 14th

Behavioral Health Initiative Announced

Gov. Bruce Rauner announced this week that Illinois has received federal approval to launch a sweeping $2 billion behavioral health initiative designed to deliver better outcomes for Medicaid beneficiaries suffering from mental health and substance abuse disorders.

The Better Care Illinois Behavioral Health Initiative is the culmination of a 30-month long effort to involve state health agencies, legislators and behavioral health organizations in a coordinated plan to help people with disorders that require treatment of the whole person.

"The Better Care Illinois effort is one the most significant developments in the history of Illinois' health programs," Governor Rauner said. "For the first time here in Illinois, we are in a position to devote massive integrated resources to the devastating effects - personal and societal - of behavioral health problems."

"This effort puts a strong new focus on prevention and public health; pays for value and outcomes rather than volume and services; makes evidence-based and data driven decisions; and moves individuals from institutions to community care, to keep them more closely connected with their families and communities."

"The waiver will allow the state to care for its most vulnerable citizens earlier and more efficiently," Rauner continued. "Better Care Illinois will use an integrated approach, so we can focus on helping the whole person and get the right services to the right person in the right setting at the right time."

The waiver is not a grant but rather an opportunity to use $2 billion Medicaid dollars differently to increase the efficiency and quality of care for Medicaid populations. The state got the go-ahead to launch the initiative from the Centers for Medicare and Medicaid Services (CMS) which approved the state's application for an 1115 Waiver.

The waiver means that beginning July 1, 2018, Illinois can begin investing $2 billion of federal funds in 10 pilots to demonstrate better care alternatives and outcomes. The pilots will feature newly-created delivery systems designed to improve care, increase the value of patient experiences, and produce better outcomes for the dollar. The federal government has also been approving related innovations called state plan amendments.

Better Care Illinois is a win for state taxpayers who over time will see better health outcomes without spending more state dollars. The demonstrations will result in more early help for beneficiaries, so savings can eventually be invested in more cost-effective services.  More than 750,000 beneficiaries, 25 percent of Illinois' Medicaid population, have behavioral health conditions, and they account for 52 percent of Medicaid spending.

The application process was led by the Illinois Department of Healthcare and Family Services (HFS), the state's Medicaid agency. Thirteen state agencies participated in the development of the approved application.

"The opioid crisis and violence in our communities call on us to find better ways to help those in need, and that is what we are accomplishing with this transformation," said HFS Director Felicia Norwood. "Smarter spending will lead to healthier lives and safer communities. By bringing state agencies and medical providers into closer cooperation for our members, we ensure stronger whole-person care for vulnerable individuals."

According to the Governor, the pilots will help Illinois address a variety of vexing societal problems that are impacted by behavioral disorders: mental health, violence, public safety, and opioid abuse among them.

The 10 CMS-approved pilot projects involve a variety of treatment, intervention, case management and home health programs. Summaries of the 10 pilots in the Better Care Illinois Behavioral Health Initiative can be accessed here.

State Budget

For more than 24 months, from the end of June 2015 until mid-July 2017, the state of Illinois spent taxpayers’ money without an approved budget.  The partial withdrawal of Illinois’ legislative branch from the job of overseeing and controlling Illinois spending effectively kicked this oversight power over to the federal and state judiciary, and created wide gaps between Illinois spending areas.  Although the General Assembly maintained partial oversight of state spending through continuous public hearings and discussions of spending programs and issues, this partial oversight fell short of the mandate contained in subsection 2(b) of Article VIII of the state Constitution.  This subsection requires the General Assembly to make annual formal appropriations for all expenditures based upon funds estimated to be available in the approaching fiscal year. 

Despite the explicit language of the state Constitution, as the spring 2018 session of the Illinois General Assembly moves towards its mandated May 31 adjournment once again no action has been taken to adopt a binding revenue estimate or to pass appropriations and a budget for FY19.  FY19 will begin on July 1, 2018.  The more than two dozen members of the House Republican Caucus who are currently freshmen or serving their second term in office have never seen the Illinois House adopt a binding revenue estimate as required by constitutional law.  House Republicans continue to demand that the House and Senate come together, discuss the State’s spending challenges in FY19, and adopt a binding revenue estimate in line with the demands of the Constitution.              

Economic Growth in 2017

The U.S. Bureau of Economic Analysis has published state gross domestic product (GDP) numbers for 2017 as compared with 2016.  The federal data table has mixed numbers for Illinois.  On the one hand, Illinois’ economy grew in real terms in 2017, with real (inflation-adjusted) GDP rising 1.2% as compared with 2016.  The Land of Lincoln’s per capita numbers were even better, with Illinois residents enjoying real GDP in 2017 that was 1.5% greater than that of 2016.  

On the other hand, most U.S. states continued to outperform Illinois.  The Prairie State scored 33rd in real 2017 GDP growth among the 50 states, with 32 states outperforming Illinois’ growth rate.  Furthermore, Illinois’ good per-capita GDP numbers were helped out by our State’s declining population, with a smaller number of people sharing a slightly larger pie.

Several neighboring states had faster 2017 real GDP growth than was enjoyed here in Illinois.  Examples included Indiana (2.1%), Kentucky (1.8%), and Wisconsin (1.7%).  Other Midwestern states that border Illinois had slower growth, with Missouri (1.1%) and Iowa (0.5%) not scoring well last year.  

As in previous years, the fastest-growing states tended to be in the so-called “Sunbelt,” with the top six states in terms of real 2017 GDP growth being Washington, Colorado, Nevada, Arizona, Utah, and California, in that order.  These are states that are highly correlated with high-tech investment and in-migration by highly educated young professionals. 

FOID Card Renewal

State Police warn of spike in firearm license renewal requests starting in summer 2018.  FOID cards are required for the legal possession or purchase of a firearm in Illinois.  People seeking to renew these cards should submit their applications in a timely manner.  Since June 1, 2008, an Illinois FOID card has been valid for 10 years (the General Assembly lengthened the life of an FOID card from its previous lifespan of 5 years).  In the summer of 2008 many Illinois residents applied for 10-year cards, and these cards are all expiring this summer. 

The Illinois State Police urges Illinois current and prospective gun owners who are looking towards applying for or renewing a FOID card this summer to submit their application as soon as possible.  The vast majority of applications are submitted online.  Delays could happen as the State Police works through the statistical bulge of applications that are expected to come in this summer.       

In addition, persons looking to acquire or renew their Concealed Carry Licenses this summer are being urged to prepare to submit their applications in a timely manner.  The concealed-carry law, which authorizes permitted Illinois residents to carry a concealed firearm for a period of five years from the date of issuance, was enacted over the veto of former Gov. Pat Quinn in July 2013.  More than 240,000 concealed carry licenses have been issued in Illinois.  The license cycle started in March 2014.  These five-year concealed carry licenses will start to expire in March, April, and May of 2019, and there may be a spike of renewal requests.  Concealed carry license renewals will require attendance at 3 hours of hands-on training. 

Pension Debt Continues to Threaten Illinois’ Credit Rating

The burden of unpaid Illinois pensions continues to mount on state and local taxpayers.  Illinois’ state-managed pensions should have over $130 billion more funds under investment than they currently have.  This shortfall is called the “unfunded pension liability.”  These monies are required to pay mandated benefits to local teachers and state employees.  Unfunded pensions for local workers, including local police officers and firefighters, add additional billions to this debt.       

House Republicans continue to warn about the situation and demand true, long-term pension reforms.  These warnings have been joined by Senate Republicans and by Gov. Bruce Rauner.  Every Illinois man, woman, and child owes $11,000 in unfunded pension obligations.  These burdens will have a seriously detrimental effect on Illinois’ prospects for future economic growth unless reforms are enacted.   

Governor’s Hometown Awards

Applications are being accepted for the Governor’s Hometown Awards, the annual recognition program in honor of community leadership programs that maintain the quality of life in the places where the program participants live and work.  Past winners include programs that engage in food drives, tutoring, senior welfare awareness, the war against opioids, and exercise and trail maintenance.  The Hometown Awards will be celebrated this year in conjunction with the Illinois Bicentennial.  This year’s cycle will celebrate community projects that took place in calendar year 2017.  Applications are due no later than August 1, 2018.        

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