human services – Chicago Newstips by Community Media Workshop http://www.newstips.org Chicago Community Stories Mon, 08 Jan 2018 18:45:05 +0000 en-US hourly 1 https://wordpress.org/?v=4.4.13 Medicaid privatization deal called expensive, inefficient http://www.newstips.org/2013/07/medicaid-privatization-deal-called-expensive-inefficient/ http://www.newstips.org/2013/07/medicaid-privatization-deal-called-expensive-inefficient/#comments Thu, 25 Jul 2013 21:12:39 +0000 http://www.newstips.org/?p=7574 The debate over privatization is currently playing out in a dispute over a contract with a private firm to “scrub” the state’s Medicaid rolls.

In fact, contrary to the privatizers’ claims, it looks like the deal is a huge waste of money.

Last month an arbitrator ordered a $76 million, two-year contract with Maximus Inc. cancelled by the end of the year, finding that it violated subcontracting provisions in state welfare workers’ union contract.  Maximus uses data-mining technology to identify ineligible Medicaid recipients.

Last week, the Alliance for Community Services called on the state to immediately cancel the contract, arguing it has resulted in unjustified disqualification of Medicaid recipients.

The editorial board of the Chicago Tribune, meanwhile, has called on Governor Quinn to appeal the arbitratrator’s ruling — or for the General Assembly to enact a legislative fix — saying the privatization deal is the best way to cut Medicaid costs.

But is it?

***

In a June 20 ruling, arbitrator Edwin A. Benn found that the Maximus deal violated provisions in the state’s contract with AFSCME restricting the contracting out of bargaining unit work unless there’s a clear advantage in terms of economy and efficiency.  The state hadn’t demonstrated that, he said.

The state had argued it was required by recent Medicaid reform legislation, called the SMART Act, to contract out Medicaid redeterminations to a private firm; Benn writes that the act allows, but does not require, contracting out.  And though that particular question would have to be settled in court, he says, under AFCME’s contract the state can’t override contractual provisions by passing new laws.

In a June 28 editorial, the Tribune argues that “it would be a huge mistake to dump this contract and try to start over with state employees,” saying “state officials argue that the fastest and most effective way to do this work is through Maximus.”

But in arbitration hearings, state officials didn’t argue that.  They argued that their hands were bound by the SMART Act.

Benn quotes the deputy director for planning of the Department of Healthc and Family Services testifying:

“What I would have preferred is that they held off and let us implement the IES [the Integrated Eligibility System, a new computer system to do just what Maximus is doing, scheduled to roll out over the next few months], which is the long-term solution, rather than having to do [the Maximus] redetermination project on top of this, which has really complicated getting the IES in place.”

Just a week before an earlier Trib editorial with glowing claims for Maximus’s accomplishments, the planning director was testifying that without “a huge increment in productivity” on Maximus’s part, “we’ll have a serious problem.”

***

Benn also notes the state failed to refute the union’s contention moving the work Maximus is doing in-house would save $18 million a year.

Over the two years of the $76 million contract, that’s a savings of $36 million — nearly 50 percent.

You’d think the deficit hawks at the Tribune — arguing that Maximus is needed because “Illinois doesn’t have money to waste” — would take this into account.  They don’t even mention it.

The state has had to hire 200 additional caseworkers to review Maximus’s recommendations for terminating Medicaid clients, according to Anne Irving of AFSCME Council 31.

That’s because federal regulations require decisions about eligibility be made by civil service-protected employees.  (Maximus’s error rate — along with the seriousness of denying someone health care — seems to validate the wisdom of that rule.)

With an additional 100 caseworkers on top of the 200 already on this task, the state could do the whole job itself, AFSCME demonstrated during arbitration.

Maximus has brought less value to the table than state officials might have expected from its sales pitch, Irving said.  The company touted its sophisticated computer algorithms that would mine data to identify ineligible Medicaid beneficiaries.

It turned out that nearly all the data the Maximus used was already available to the state.  In some cases, Irving said, when the company requested birth certificates or citizenship papers, clients turned to their caseworkers, who had the documents on file.

Then, of course, every recommendation from Maximus to cancel, reduce, or maintain Medicaid benefits had to be reviewed by state workers.  That means the redetermination assessment had to be done not once but twice.  In “a substantial number of cases,” Maximus’s recommendations were found to be in error, Irving said.

***

According to year-to-date numbers reported by the state through mid-June, Maximus recommendations were rejected in 25 percent of cases where they found recipients ineligible; in cases where they recommended changes in benefit levels, fully 50 percent were found to be in error.

(The Tribune was wrong when it wrote in June that Illinois has removed 60,000 people from its Medicaid rolls this year.  That was the number of terminations Maximus had recommended; the number of terminations finalized is significantly lower.)

Many of Maximus’s errors resulted when the company requested irrelevant or unavailable information and then cancelled benefits when it wasn’t provided, Irving said.  In a good number of cases, Maximus recommended cancelling children’s medical cards when their grandparents or other caregivers didn’t provide their own income data — though that’s entirely irrelevant to the children’s eligibility.

Sometimes Maximus recommended cancelling cases because it hadn’t received information that turned out to be in state files, she said.

Many errors reflected the complexity of the state’s human services system — and the importance of professionally-trained caseworkers making judgments with serious impact on people’s lives, said Diane Stokes, a caseworker who is president of AFSCME Local 2858.

Job postings for Maximus workers for the project required a high school diploma, according to documents provided during arbitration  The company’s call center reps on the project earn $12.25 an hour.

According to Fran Tobin of ACS, Maximus is recommending cancellation of benefits when they encounter disconnected phone numbers.  “Having a working telephone is not a requirement for Medicaid eligibility,” he said.

“There are all kinds of reasons we’re seeing for Maximus to recommend cancellations that aren’t legitimate, that don’t demonstrate ineligibility,” he said. “They’re just looking for technicalities to kick people off.”

The Tribune notes with a tone of shock — as evidence of Medicaid “waste” — that 75 percent of terminations recommended by Maximus occurred when “the recipients just did not respond” to requests for information.

Many of those cases are people who may have moved, lost phone service, or live in circumstances where mail delivery is problematic.  Many of them will reapply as soon as they need to see a doctor or end up in a hospital.

Tobin argues people’s health coverage should not be placed at the mercy of a company whose profits depend on slashing the caseload.

***

The Tribune is convinced that “hundreds of millions of dollars” in Medicaid “waste, fraud, and abuse” is at stake if the state doesn’t stick with Maximus.  It’s not clear that’s actually the case.

The great bulk of Medicaid expenditures go to a fairly small number of people with very serious health problems, Irving points out.  They’re probably least likely to get a job or move out of state.

They could have their phone cut off — but if their benefits are cut off on that basis, they’ll be sure to reapply very quickly.

And, of course, people who move out of state aren’t very likely to be using their Illinois medical card.

The state has estimated that “scrubbing” the Medicaid rolls will save $350 million in the first year.  But “no one has ever been able to say where that number comes from or what it’s based on,” Irving said.

***

The Trib has repeatedly marvelled at the state’s inability to police its Medicaid rolls.  In March the editorial board asked, “If Illinois officials knew, or suspected, that thousands of people were improperly receiving Medicaid coverage, why didn’t they act years ago to save hundreds of millions of taxpayer dollars??”

In an editorial just this week — warning of the costs of expanding Medicaid under Obamacare — it charges that “Illinois has never made much of an effort to check if people getting benefits continued to qualify for them.”

That’s not exactly true.

“Maximus isn’t doing anything we weren’t doing for decades,” says Steve Edwards, a retired caseworker who’s active with ACS.

“The caseworkers’ month revolved around the cutoff date,” said Edwards. “We’d put a notice in the mail, and if they didn’t respond the case was cancelled.”

It wasn’t the best system, he says.  It created a lot of “churn” — people being tossed off the rolls, sometimes due to something as simple as misdelivered mail, and forced to reapply when they needed care. (There’s likely to be a good bit of churn in the numbers highlighted by the Tribune.)

Churn creates inconvenience and anxiety for clients, and it creates administrative inefficiencies when caseworkers have to help people reapply.

In any case, for many years annual redeterminations of eligibility proceeded apace.  But then the state started cutting caseworkers, even as demand for public benefits grew dramatically, with Medicaid expansion early in the last decade, and then the Great Recession.

Caseloads grew to three or four times the size of previous decades, said Stokes.  “When I started I had a caseload of 450,” she says.  “Now it’s 1,700.”

So the backlog in redeterminations of Medicaid eligibility was due to extreme staff shortages.

“The problem was created by the state when it failed to have enough workers,” said Edwards.  “They created this crisis, and now they say there’s no way out except to pay a private company $75 million.”

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Human services in the Age of Austerity http://www.newstips.org/2013/07/human-services-in-the-age-of-austerity/ Sun, 07 Jul 2013 20:05:10 +0000 http://www.newstips.org/?p=7557 Clients and welfare workers from the state’s human services system will discuss attacks on public services coming under the guise of austerity — including a privatization contract that an artbitrator recently ordered shut down — at a public meeting Monday.

The Alliance for Community Services is sponsoring the meeting on health care and human services at 6:30 p.m, Monday, July 8, at Teamster City, 300 S. Ashland.

Ralph Martire of the Center for Tax and Budget Accountability will discuss the state’s fiscal crisis.

“The reality is, we’re not broke,” said Fran Tobin of Northside Action For Justice, one of the initiators of the alliance.  “There’s lots of wealth in the state, but our regressive revenue system is failing to tap into it.”

Human service clients and welfare workers will tell stories of difficulties caused by a chronically understaffed system, said Steve Edwards, a retired union activist.

One source of problems is a new DHS pilot program — poised for expansion — that shifts from case-based to task-based organization of office work.  Under the program, caseworkers have been shifted to “teams” devoted to specific tasks.

“You have former caseworkers — who have college degrees in specific fields and a year of additional training — spending all day opening mail,” he said.  Everyone’s work goes into a single pile, with no one responsible for the ultimate disposition of particular cases.  It means clients no longer have a caseworker who they can call to address problems.

“They’ve blown up accountability,” Edwards said.  “It looks to me like sabotage.”

“Under the rhetoric of increasing efficiency, they’re clearly making things worse,” Tobin said.  “It’s insane.”

AFSCME Council 31, which represents state human service workers, has filed a grievance charging DHS with eroding job titles, said Edwards, a former AFSCME local president.

AFCME recently won an arbitration charging that a contract with a private firm to review Medicaid recipients’ eligibility violated contract language on contracting out.  An arbitrator ordered the state to cancel its contract with the consulting firm Maximus at the end of the year, according to the union.

Edwards estimated that for the cost of the $75 million contract, the state could have hired 1,500 additional caseworkers, increasing the workforce by something like 50 percent.

He said some caseworkers currently have caseloads of more than 2,000 individuals or families — far above the recommended caseload of 400 to 500.

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Cappleman protest called http://www.newstips.org/2013/03/cappleman-protest-called/ Wed, 06 Mar 2013 02:51:20 +0000 http://www.newstips.org/?p=7015 An ad-hoc group of activists will protest — and offer free soup — outside 46th Ward Alderman James Cappleman’s office on Wednesday, March 6 (5 p.m., 4544 N. Broadway), while two community organizations have invited the controversial alderman to a town hall on March 21 to discuss affordable housing and other issues.

Food Not Bombs will be providing soup for anyone who’s hungry outside Cappleman’s office on Wednesday.

Cappleman has been getting plenty of attention lately from Mark Brown and DNAinfo for his attempts to ban low-rent cubicle hotels, kick the Salvation Army soup truck out of his ward, and most recently, make it a crime to be in a bus stop if you’re not waiting for a bus.

On top of it, with a wave of developers  gobbling up affordable rentals across the north lakefront, Capplemen has shown no interest in preserving housing options for his low-income constituents — in some cases, critics say, almost certainly adding to the number of homeless.

Repeatedly citing his background as a social worker, Cappleman has claimed sympathy with the poor and sad he wants more effective delivery of services.

But “it’s not enough to say there should be grants, there should be programs,” said Thomas Weisgard, an Occupy activist and organizer of Wednesday’s protest.  “Here there are hundreds and hundreds of people who now have a place to live, who have a place to get food, and he’s shutting them down.

“It’s winter, it’s Chicago, we’re getting ten inches of snow, and he’s putting people out in the street.”

‘Classic Cappleman’

“It’s classic Cappleman stuff,” said Fran Tobin of Northside Action for Justice.  “He says he’s looking out for poor people by not feeding them — providing them with food makes them dependent.  It’s what he’s been saying for years.”

“We’re seeing a pattern where [Cappleman’s] actions don’t jibe with his words,” said Erin Ryan, president of the board of Lakeview Action Coalition.

A social worker who works with homeless people, Ryan said Cappleman’s assertion that feeding people is a “disincentive” to getting them “sustained help” is “perplexing” and “just not in line with best practices.”

LAC and Organization of the Northeast have invited Cappleman to a community meeting on March 21 on the subject, “Who Is Welcome in the 46th Ward?”

“We want to lay out how we’d like to work together on these issues and give [Cappleman] an opportunity to speak publicly about whether he wants to work with us,” said Jennifer Ritter, LAC’s executive director.

As reported here last month, Cappleman is among the alderman that LAC has called on to help preserve SRO housing where residents are threatened with eviction.  Attention in his ward has focused on the Hotel Chateau, 3838 N. Broadway, where 30-day notices of lease termination are coming due.

Hands off

Cappleman has declined to use his influence to press developers to maintain affordability, or even to make a public statement in favor of preserving affordability, organizers say.  Residents say he’s referred them to agencies that provide homeless services.

“There’s not a lot of room in the homeless system,” said Ryan, who’s executive director of the Lincoln Park Community Shelter.  “You’re taking people who are living independently” — and in many cases accessing social services near where they live — “and putting them in shelters….It’s going to be difficult to get them back in permanent housing.”

She adds: “No one is better off in a shelter.”

Ryan points out that while the city is united behind an amibitous plan to end homelessness — which calls for preserving and expanding affordable housing — Cappleman is “working against that plan, and working to displace people and make them homeless.”

In Uptown and Rogers Park, ONE has been focused on a developer who’s bought up seven buildings with 800 units of affordable studio apartments with plans to make them upscale.  ONE has been calling for a portion of the units to be preserved as affordable.

Cappleman has refused to discuss the matter with the community organization, taking the remarkable position that an alderman has no influence over a developer in his ward, said interim director Angie Lobo.  She said it’s clear that in fact Cappleman is working with the developer.

Safety net

“These buildings provide an important safety-net level of very affordable housing,  and if they are lost, many of their resident will become homeless,” said Ryan.  “We can’t afford to lose them.

“There’s no question they should be well-managed and safe, but we think there is a way to keep the buildings affordable and make them assets to the community,” she said.

LAC has succeeded in preserving a number of SROs as updated, low-income housing, most recently bringing in a nonprofit developer for the Diplomat Hotel, 3208 N. Sheffield, where Thresholds now operates the building and provides services on site.

In that case Alderman Tom Tunney (44th) took a clear public position that he wanted the building’s affordability preserved, and he worked with LAC and city agencies to make that happen.  “An alderman’s support can be tremendously helpful,” said Ryan.

“We’re trying to work with the developers and the alderman, but there are so many backroom deals, and we have not been welcome at the table,” she said.

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Bronzeville youth, community leaders to speak on violence http://www.newstips.org/2013/02/bronzeville-youth-community-leaders-to-speak-on-violence/ http://www.newstips.org/2013/02/bronzeville-youth-community-leaders-to-speak-on-violence/#comments Wed, 13 Feb 2013 23:47:30 +0000 http://www.newstips.org/?p=6968 While politicians push tougher law enforcement to address youth violence, community leaders and youth in Bronzeville are demanding that the root causes of violence — including unemployment, disinvestment, and school closings — be put at the top of the agenda.

At 4 p.m. on Thursday, February 12 14, youth leaders from five high schools — including King College Prep, where Hadiya Pendleton was a student, and where one of the suspects in her murder graduated – will hold a press conference at 4 p.m. at Dyett High School, 555 E. 51st Street.  They’re part of Leaders Investing For Equality (LIFE), which for several years has pushed for restoration of funding cut from youth employment programs.

At 6 p.m. on Thursday, the Bronzeville Alliance and Centers for New Horizons will hold a press conference at the Ellis Childcare Center, 4301 S. Cottage, to launch a community initiative to coordinate social services for community youth and families and to advocate for a reversal of cutbacks they say have destabilized the community.

In media coverage of youth violence, “there doesn’t seem to be much discussion of the root causes of these problems and the responsiblity of government and the private sector for years of disinvestment in minority communities,” said John Owens of CNH.

“We’ve had many years of jobs being lost and cutbacks in a whole range of social services – and the whole idea of closing schools is just another form of cutbacks,” he said.

“There’s been no discussion of youth employment, no discussion of the destabilization of families when jobs are lost and parents are working odd hours, no discussion of afterschool programs that are relevant,” Owens said.  “The bottom line is that we need to understand what it means to build community and we need to start building it – with the kind of resources that are needed for a community in crisis.”

Owen said CNH and other Bronzeville agencies are trying to provide developmental social services, “but everybody is barely keeping their doors open. There are not enough of us and we are not funded anywhere near what would be adequate to reach the number of youth and families out there who are in need.”

The new coalition, dubbed SAVE (Stop Armed Violence Everywhere), is calling on the city and state to work with residents to restore employment, educational, mental health and recreational resources in Bronzeville.  They are demanding meetings with Governor Quinn and Mayor Emanuel.

The coalition includes local schools, social service agencies, community groups, and business and veterans groups, Owens said.

The Bronzeville Alliance issued a call to the media “to avoid body-count journalism and drive-by reporting that criminalizes our community and tends to look at this very complex problem in narrow, counter-productive terms.”

It calls for an approach that is “pro-active, holistic, and sustainable.”

Youth leaders from LIFE will highlight public school closings, reduced funding for summer youth employment and limited recreational opportunities as”catalysts of community destabilization,” according to a statement from Shannon Bennett of the Kenwood Oakland Community Organization, which backs LIFE.

“Policy decisions made without consultation with the people directly impacted have led to destabilization of communities and increased violence in neighborhoods, particularly communities of color,” according to the statement.

“Summer youth employment was decimated over the last 20 years, and only one-third of the youth who apply each year for summer jobs find work. There is very little teen-specific programming in communities around Chicago serving out-of-school and severely at-risk youth.

“School actions implemented by the Chicago Board of Education have led to the creation of new youth gangs and the 300 percent increase in homicides in north Kenwood-Oakland.”

[See previous Newstips on LIFE from 2008, 2009, 2010, and 2011]

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Unity Challenge http://www.newstips.org/2009/12/unity-challenge/ Wed, 09 Dec 2009 17:41:25 +0000 http://communitymediaworkshop.org/newstips/?p=1051 The Chicago Community Trust has announced Unity Challenge 2010, with CCT  providing a one-on-one match for new donor contributions toward a fund to help nonprofit organizations struggling to meet growing demands for human services, including food and shelter.

Last year, the inaugural Unity Fund provided $4 million to support agencies meeting basic human needs, exceeding its goal by $1 million.

Last year CCT also launched its monthly Metro Chicago Vital Signs report, tracking statistics on unemployment, foreclosures, homelessness and hunger.

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New approach to ending prostitution http://www.newstips.org/2009/09/new-approach-to-ending-prostitution/ Wed, 16 Sep 2009 20:33:55 +0000 http://communitymediaworkshop.org/newstips/?p=728 A campaign aiming for “a 180 degree shift” in the state’s response to prostitution will be launched tomorrow morning with a conference featuring Cook County Sheriff Tom Dart, the former director of the U.S. State Department’s Trafficking in Persons program, and survivors of prostitution and sex trafficking.

Instead of repeatedly jailing prostitutes, letting johns go, and overlooking pimps and traffickers, End Demand Illinois will press for services for victims of prostitution along with aggressive prosecution of their exploiters, said Samir Goswami, policy director of the Chicago Alliance Against Sexual Exploitation.

CAASE is convening the End Demand coalition with a $550,000, three-year grant from the Novo Foundation.

One goal is to “create a funding stream for an infrastructure of care for people victimized by sexual trafficking and prostitution,” Goswami said.

An estimated 16,000 women and girls are regularly prostituted in Chicago, the vast majority of them recruited as minors, said Lynne Johnson, CAASE’s advocacy director, and they commonly face issues of substance abuse, homelessness, and extreme violence.

“Arresting them over and over is the exact opposite of what’s going to solve the problem,” she said.

CAASE has been advising Dart’s Trafficking Response Team, which employs former prostitutes to offer women arrested for prostitution the option of recovery programs and support services.

It’s also one of the only groups in the nation to focus on reducing demand for prostitution, Johnson said. One of its initiatives is a curriculum for young males about why they should not buy sex, she said.

Survivors of prostitution are are being trained to lead and represent the End Demand Illinois campaign, Johnson said. Among the speakers tomorrow morning will be Olivia Howard, a former prostitute who was the subject of Jody Raphael’s book, Listening to Olivia.

The End Demand Illinois launch takes place Thursday, September 17, starting at 8:50 a.m. at the Hyatt Regency, 151 E. Wacker. Catharine MacKinnon of the University of Michigan law school will give a keynote, followed by a panel discussion and a media availability from 10:30 to 11 a.m.

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No to ‘doomsday’ budget http://www.newstips.org/2009/06/no-to-doomsday-budget/ Wed, 03 Jun 2009 20:17:59 +0000 http://communitymediaworkshop.org/newstips/?p=625 The stopgap budget passed in Springfield this weekend will mean the loss of 100,000 human service jobs, including homecare workers serving 40,000 seniors, critics say.

According to Action For Children, 80,000 low-income mothers will lose childcare that helps them keep working. 

Other cuts will affect domestic violence shelters, community mental health services, college scholarships, drug and alcohol treatment, and on and on.

The Campaign for Illinois’ Future notes several articles on social service organizations around the state preparing for their own budget disasters.  

Action Now is one of a number of groups opposed to the budget that are calling an emergency rally for Thursday at 11:30 a.m. at the Thompson Center — timed to coincide with Governor Quinn’s meeting with legislative leaders.

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Hungry for Justice http://www.newstips.org/2009/05/hungry-for-justice/ Fri, 29 May 2009 04:14:46 +0000 http://communitymediaworkshop.org/newstips/?p=617

Five hunger strikers in the state capitol — demanding a state budget that increases revenues and protects the safety net — are being joined by new fast participants every day, until the legislative session ends (or a humane budget is passed).  They’re backed by a coalition including Action Now, American Friends Service Committee, Brighton Park Neighborhood Council, Chicago Coalition for the Homeless, Logan Square Neighborhood Association, and  Organization of the Northeast, according to Michael McConnell of AFSC.  

“Slashing core programs such as home care services for seniors and people with disabilities; prevention programs that reduce violence, teen pregnancies, and substance abuse; and education and safety programs such as parent patrols and Grow Your Own teachers is unacceptable,” said the ad-hoc Hungry for Justice coalition in a statement.  “An estimated five million Illinois families depend on these programs.  At a time of economic crisis, cuts to our safety net are the worst possible action the legislature can take.”

“I’m not worried about my health,” said hunger striker Mahaley Somerville, 87. “I’m worried about the health of my communities if we try and fix this budget by removing these programs.”

The hunger strikers have introduced an element of moral clarity to an environment where it been missing for some time. 

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