Chicagoans who attended a recent town hall meeting about mental health services are worried about what will happen to the city's existing mental health clinics and its clients after Medicaid managed care is expanded in Illinois.
In 2012, six of Chicago's 12 mental health clinics were shut down. And city residents seeking community mental health services might soon face another potential blow, according to speakers at Thursday night's discussion, hosted by the Mental Health Movement coalition at the United Electrical Workers Hall.
The issue involves Medicaid reform legislation signed by Gov. Pat Quinn in 2011, under which half of Illinois' Medicaid recipients have to be enrolled in risk-based managed care, also known as coordinated care, by 2015. The state's effort to move away from a primarily fee-for-service Medicaid system to a more integrated health care delivery method is designed to cut costs and improve patient care.
Anne Irving, director of public policy for AFSCME Council 31, the labor union representing city mental health clinic staff, said Medicaid recipients in Chicago are set to be put under a managed care entity this year. The Chicago Department of Public Health has not yet joined a Medicaid managed care network in order to become a coordinated care mental health provider, and falling to do so "will starve the mental health clinics by cutting off all revenue to the clinics," mental health care advocates argued.
The city's failure to join a provider network is the "most immediate threat to mental health services" in Chicago because services might be terminated for Medicaid patients as the state makes the shift to managed care, according to organizers with the Mental Health Movement, a fierce opponent of the clinic closings in 2012.
It is presumed, Irving said, that more clients at the mental health clinics who are currently uninsured will be able to get health coverage through the state's expanded Medicaid program as part of the Affordable Care Act. The city, she said, would receive more funds for serving Medicaid recipients than what it currently gets from the state for providing mental health services to uninsured clients.
"Although it would make total fiscal sense for the city to serve those [Medicaid] clients, unfortunately the Chicago Department of Public Health appears to want to reduce the number of people that are being served at its public mental health clinics," she said.
Irving and others at the event said they are convinced that the city is working to push out Medicaid clients from the mental health clinics.
To back up that claim, Irving noted that the city has not joined the provider network with CountyCare, Cook County's Medicaid program for adults that launched in 2012 as part of the Affordable Care Act. Staff at the city's community mental health clinics have reportedly been told to not accept new clients who are enrolled in CountyCare, Irving said. They have also been instructed to refer existing patients who joined CountyCare to other providers in the program's network, Irving said.
And more recently, Irving said staff have been told that the remaining Medicaid clients at the city's public mental health clinics should be transitioned out of the facilities due to expanded managed care in Illinois.
"Pushing out Medicaid clients is bad policy," she stressed. "It's going to undermine the future of our city mental health clinics. It's clearly bad for the clients if they have a relationship with a therapist, and [if] they want to continue with that therapist, they're not going to be able to."
A Department of Public Health spokesman did not return Progress Illinois' request for comment. But the city has said that its mental health services at the six community clinics place a focus on serving the uninsured.
"Uninsured clients have fewer options than those with insurance," the public health department's website reads. "That is why it is important for the city to focus care on this vulnerable population. Due to Medicaid reimbursement changes at the state-level, community mental health providers are able to see more clients with Medicaid/Medicare. Over the last couple of years many CDPH clients with Medicaid/Medicare have transferred their care to community providers that offer similar or more robust services."
N'Dana Carter with the Mental Health Movement and Southside Together Organizing for Power said she is concerned that the city will shutter its remaining clinics "because there will be no patients there."
"If those clinics close, there will be nowhere for people to go," she said.
Irving also added that public mental health clinics are a fundamental component of the social safety net. And "ignoring" the Medicaid population is not a good way to make sure that the social safety net is strong, she said.
In addition to their call for the city to join a provider network, those at the town hall said the city's public health department should develop more mental health programs targeting underserved populations, such as the formerly incarcerated and the homeless.
Cook County Sheriff Tom Dart attended the town hall and noted that at least 3,500 inmates currently in the Cook County jail system have some form of mental illness, including about half of the female detainees.
"When I talk to the detainees in the mental health units, which I do frequently, they will tell me over and over again that they're happy to be in my jail because it's the only place they can go and get the proper care, and that's horrible," Dart said. "I mean what type of society are we?"
He added that a significant number of the detainees with mental illness ended up in Cook County Jail for relatively minor things, such as stealing food or sleeping in train stations.
"These are people who are suffering from mental illness, but because people ... in leadership positions don't care, this is what happens," Dart stressed. "So when people are shutting things down, not funding things properly, they are affirmatively saying, 'We don't care,' and that's what's happening."
Carter said activists plan to hold an evening vigil outside of Cook County Jail on March 24. The vigil is designed to raise awareness about the need for increased community mental health services to help prevent individuals with mental illness from unnecessarily ending up in jail.
Mark Heyrman, board member at Mental Health America Illinois and a clinical professor at the University of Chicago Law School, boiled down the concerns raised at the town hall to a key point. There needs to be a better coordinated system of mental health care in Chicago so that people in every neighborhood are able to be connected to services, he stressed.
"If the city doesn't want to run their clinic, then they need to make sure that there is someone else who's available there, and if that means putting more of the city's money into that, they have to do that," Heyrman said. "But they have to have either a city-run clinic or some other arrangement. They have to be responsible ... As we have lost these clinics, no one has taken charge and said, 'I'm really going to be responsible to keep mentally ill people out of the jail, to keep mentally ill people from needless hospitalization.'"
UPDATE (3/6/14): Chicago's Department of Public Health issued the following statement to Progress Illinois:
The implementation of the Affordable Care Act (ACA) provides unprecedented access to private and public health insurance options for many Chicago residents. Uninsured clients have very limited options for mental health services when compared to those who are insured. As a safety net provider, CDPH continues to remain focused on serving the uninsured. As part of our ongoing effort to maintain capacity for uninsured residents, we will continue to counsel our clients who are eligible for new healthcare options on what those are and assist them if they wish to transition to service providers that may provide a more robust level of service.
Staff have been instructed that any current client who wishes to remain at a CDPH clinic after learning of these additional benefits may do so. If a new client with insurance requests their mental health care still be provided at a CDPH clinic after being counseled on other options, we will work with them. No one will be turned away.