WBEZ | Thresholds http://www.wbez.org/tags/thresholds Latest from WBEZ Chicago Public Radio en Illinois Medicaid expansion may leave out mental-health teams http://www.wbez.org/news/illinois-medicaid-expansion-may-leave-out-mental-health-teams-108892 <img typeof="foaf:Image" src="http://llnw.wbez.org/main-images/CountyCareSCALED.jpg" alt="" /><p><p>An Illinois Medicaid expansion enabled by the nation&rsquo;s health-care overhaul might not cover some mental health services designed to keep people from landing in psychiatric hospitals, nursing homes and jails, WBEZ has learned.</p><p>&ldquo;We don&rsquo;t have a final answer,&rdquo; confirmed Mike Claffey, a spokesman for the Illinois <a href="http://www2.illinois.gov/hfs/Pages/default.aspx">Department of Healthcare and Family Services</a>, which manages Medicaid in the state. &ldquo;It&rsquo;s not a simple question.&rdquo;</p><p>The services include &ldquo;assertive community treatment&rdquo; and the less intensive &ldquo;community support treatment,&rdquo; both designed for outpatients (often homeless) who have a hard time reaching mental-health clinics and keeping appointments due to severe depression, bipolar disorder, schizophrenia and other conditions.</p><p>ACT and CST feature specialist teams with low caseloads and around-the-clock availability. Every team member works with each of the team&rsquo;s &ldquo;participants,&rdquo; as the persons with the illnesses are known. The teams meet the participants wherever necessary to help with all aspects of recovery, from medication and counseling to nutrition, hygiene and money management.</p><p>Team members range from social workers to substance-abuse experts, from occupational therapists to peer counselors. ACT teams, as <a href="http://www.dhs.state.il.us/page.aspx?item=56754">defined</a> by the Illinois Department of Human Services, also include a psychiatrist and registered nurse.</p><p>An Illinois failure to cover ACT and CST in the Medicaid expansion &ldquo;will cost the state in the short and the long run,&rdquo; according to a letter that Gov. Pat Quinn&rsquo;s administration received from leaders of <a href="http://www.thresholds.org/">Thresholds</a>, a Chicago-based nonprofit agency that set up some of the nation&rsquo;s first ACT teams more than three decades ago. &ldquo;Many individuals with a serious mental illness will be unable to get the services they need to stabilize their lives, costing the state millions of dollars in preventable hospitalizations and nursing-home stays.&rdquo;</p><p>Most ACT and CST teams in Illinois are run by nonprofits such as Thresholds, Trilogy Inc. and Community Counseling Centers of Chicago Inc., better known as C4.</p><p>For decades, the funding for ACT and other community mental-health services consisted largely of state grants. In recent years, Illinois has switched to financing the care through Medicaid, a fee-for-service insurance partially bankrolled by the federal government. An Illinois budget crisis, meanwhile, has led to deep cuts in the state grants since 2009, making it difficult for the nonprofit providers to continue serving people who lack Medicaid and can&rsquo;t afford any other insurance.</p><p>&ldquo;These overwhelmingly are the folks that end up in one of the state&rsquo;s seven psychiatric hospitals,&rdquo; said Mark Heyrman, a University of Chicago clinical professor of law who defends the rights of people with mental disabilities.</p><p>Many of these uninsured people also seem to have cycled through the emergency departments of hospitals across the state. Those departments treated almost 220,000 people with a primary diagnosis of mental illness or substance-abuse disorder in 2012, according to unpublished figures from the Illinois Hospital Association. That was 19.1 percent more than the 2009 total. By comparison, according to the association, emergency-department visits during the period overall increased by 6.4 percent.</p><p>As part of the federal Affordable Care Act, Illinois is among 24 states that have chosen to expand their Medicaid programs to more of the uninsured low-income population. The plan, signed into law by Quinn in July and set to take effect in January, will be available to people with income up to 138 percent of the federal poverty level &mdash; $15,415 for an individual this year.</p><p>The state expects 342,000 Illinois residents to sign up for the Medicaid expansion by 2017. The federal government is planning to finance 100 percent of the coverage through 2016 and no less than 90 percent in later years.</p><p>&ldquo;This can be the biggest improvement in mental-health services that the state has seen in decades,&rdquo; Heyrman said, &ldquo;but only if all of the services that are needed by this very sick population are afforded to them.&rdquo;</p><p>The Quinn administration, questioned by WBEZ, said it had yet to determine whether the state&rsquo;s Medicaid expansion would cover the community-based teams.</p><p>&ldquo;State agencies have been working with federal authorities to explore all the options for mental-health coverage, including ACT and CST,&rdquo; Claffey, the spokesman, said in a statement. &ldquo;We are still finalizing the policy and do not know at this time what, if any, rulemaking will be required. As always, in accordance with federal rules, we will formally post the service plan for public comment prior to implementation. We hope to have a better idea of when that will take place in the coming weeks.&rdquo;</p><p>The uncertainty puzzles Jennifer Mathis, deputy legal director of the Washington-based <a href="http://www.bazelon.org/">Judge David L. Bazelon Center for Mental Health Law</a>. &ldquo;States are always cautious about adding services to their Medicaid plans,&rdquo; she said. &ldquo;But many of these people with serious mental illnesses are already in their systems. The states are already paying for them as they cycle in and out of hospitals, jails and nursing homes.&rdquo;</p><p>If Illinois chooses not to include ACT and CST in the Medicaid expansion benefits, mental-health advocates say their Plan B is a <a href="http://www.gpo.gov/fdsys/pkg/FR-2013-07-15/html/2013-16271.htm">federal rule</a> about state-level expansions that allows the &ldquo;medically frail,&rdquo; a group defined as including people with a serious mental illness, to receive all the services of the state&rsquo;s traditional Medicaid.</p><p>&ldquo;So anyone enrolled in the Illinois Medicaid expansion who has a serious mental illness &mdash; which would include anyone eligible for ACT and many people eligible for CST &mdash; must be given the option of receiving the full scope of benefits covered under the state&rsquo;s regular Medicaid plan,&rdquo; Mathis said.</p><p>But winning the right to a service isn&rsquo;t the same as receiving it. In Cook County, where a Medicaid expansion began a year early under a federal waiver, some providers say they have had a hard time getting ACT payments from Evanston-based <a href="http://www.psychealthltd.com/">PsycHealth Ltd.</a>, which has a county contract to manage the expansion&rsquo;s mental-health care.</p><p>&ldquo;Some of the larger nonprofits are turning away clients because they know they won&rsquo;t be reimbursed,&rdquo; said Heyrman, the law professor. &ldquo;The county is not providing services that the state was providing for many years.&rdquo;</p><p>Cook County Health and Hospitals System officials insist that their Medicaid expansion program, dubbed <a href="http://www.cookcountyhhs.org/patient-services/county-care/?">CountyCare</a>, covers ACT and CST. Officials of both the health system and PsycHealth say they have received no formal complaints from providers alleging inappropriate denial of reimbursement for the services.</p><p>&ldquo;The community-based facilities are used to getting whatever they want from the state,&rdquo; said Cathryn Shemroske, the PsycHealth official who manages CountyCare&rsquo;s mental-health provider network. &ldquo;The state is bankrupt for a reason. This is definitely something contributing to that.&rdquo;</p><p>Shemroske also voiced a perspective on ACT effectiveness that conflicts with at least some academic research on the topic. &ldquo;Often I&rsquo;m hearing that the model doesn&rsquo;t necessarily keep members well,&rdquo; she said. &ldquo;The treatment outside the hospital isn&rsquo;t always what gets people healthy.&rdquo;</p><p>PsycHealth&rsquo;s lack of enthusiasm for ACT owes partly to its lack of accountability for &ldquo;all of the things that can go badly if they don&rsquo;t provide enough services,&rdquo; Heyrman said. &ldquo;The costs will not be borne by PsycHealth if, for example, [patients] commit a low-level crime and end up in a jail or a state psychiatric hospital.&rdquo;</p><p><em><a href="http://www.wbez.org/users/cmitchell-0">Chip Mitchell</a> is WBEZ&rsquo;s West Side bureau reporter. Follow him on Twitter <a href="https://twitter.com/ChipMitchell1">@ChipMitchell1</a> and <a href="https://twitter.com/WBEZoutloud">@WBEZoutloud</a>, and connect with him through <a href="https://www.facebook.com/chipmitchell1">Facebook</a> and <a href="http://www.linkedin.com/in/ChipMitchell1">LinkedIn</a>.</em></p></p> Thu, 10 Oct 2013 12:28:00 -0500 http://www.wbez.org/news/illinois-medicaid-expansion-may-leave-out-mental-health-teams-108892 The tricky transition to adulthood http://www.wbez.org/story/tricky-transition-adulthood-93294 <img typeof="foaf:Image" src="http://llnw.wbez.org/story/photo/2011-October/2011-10-19/Ana Thresholds FInal.jpg" alt="" /><p><p>People between the ages of 18 and 25 are the most likely&nbsp;of any age group&nbsp;to experience mental illness. They’re also&nbsp;the least likely&nbsp;age group to get adequate services, and often have difficulty navigating the complex transformation into adulthood known as “the transition cliff.”</p><p>Ana lives in one of those unassuming buildings peppered throughout Chicago that don’t quite look like the homes and apartments surrounding them. These are assisted living facilities.&nbsp;She’s been living here with her cat, Snowball, and a handful of other adults with mental illness for a few years.&nbsp;</p><p>ANA: I turned 21 on a Sunday, and that Friday I was emancipated from DCFS. I had no guardian; I was my own guardian. I knew I wasn’t going to have anymore help. I was scared when I was put into my own apartment because thought I was going to end up doing something really bad to myself.</p><p>Ana’s diagnosis is borderline personality disorder, depression, chronic PTSD and schizoaffective disorder. Since she was 13, she’s bounced between dozens of hospitals and nursing homes. Ana has family in Chicago, but none she could turn to for help.</p><p>ANA: Unfortunately my dad doesn’t believe in mental illness so it’s kind of hard to talk to him. He doesn’t believe I need medication. He has a thing about throwing my pills in the garbage and I have to go scavenge hunting after them. It’s hard to make him comprehend I can’t help it – he thinks I do it on purpose.&nbsp;</p><p><img alt="" class="caption" src="http://llnw.wbez.org/story/insert-image/2011-October/2011-10-19/Marc Fagan Thresholds Final.jpg" style="width: 300px; height: 568px; float: right; margin: 8px;" title="Dr. Marc Fagan leads a training on crisis management for young adults with mental health issues to adolescent and youth service providers. (Photo courtesy of Thresholds)">Ana says her dad didn’t believe her mom’s mental illness was legitimate, either. Her mom is schizophrenic.</p><p>ANA: Unfortunately she jumped off 7th floor building, and crushed her leg. She’s permanently in a wheelchair. I just learned this last year. My&nbsp;family kept that from me. Before that I thought my mom was dead.</p><p>Her mother is now living in an assisted care facility in Texas. Ana arrived at her facility with the help of Thresholds. Her supplemental security income – or SSI – pays the rent. She’s been doing well here, even holding down part time jobs at Radio Shack and Target. But she wants more.</p><p>ANA: I don’t want to be here such a long time, you know? There are people here who’ve been here 10 years, 13 years, you know? And I don’t want to do that. I don’t want to be here the rest of my life.</p><p>Mark Fagan is the associate director of youth programs at Thresholds. The non-profit mental health agency provides treatment and housing.</p><p>FAGAN: With our state in Illinois, we know that it’s increasingly very seriously difficult to get any kind of mental health services if you don’t have really good insurance or if you don’t have Medicaid.&nbsp;</p><p>He says even though the law says adulthood starts at 18, insurance and Medicaid coverage don’t necessary follow that marker.&nbsp;So Fagan says that young adults experiencing a mental health condition tend not to qualify for those services at exactly when they need it the most.</p><p>Adding to that problem is the fact that the mental healthcare system is designed for independent adults or for dependent children. There’s not much out there for those who fall in between.&nbsp;</p><p>Vanessa Vorhies is a researcher who works with young adults at Thresholds. She says that research shows that true adulthood actually starts around 30 years old.</p><p>VORHIES: You know if we think about any other developmental phase across a lifespan - this one is what I find is most interesting - is the amount of change. The young people tend to move a lot, they tend to be under a lot of stress because they have to pick college or a career or something. And you can become a parent. Also young people are most likely to get or develop serious mental health conditions during this time.</p><p>Because hormonal changes affect brain development, many disorders don’t physiologically show up until these in between ages. By the time these symptoms are identified, Fagan says the services that match with them don’t follow along, and that’s where we get into what we call a “transition cliff.”</p><p><img alt="" class="caption" src="http://llnw.wbez.org/story/insert-image/2011-October/2011-10-27/RS4487_Marco and Corey Final-scr.jpg" style="width: 397px; height: 250px; margin: 8px; float: left;" title="Marco (left) and Corey both receive assistance from C4 Chicago - a behavioral health and social service provider. (Photo courtesy of C4 Chicago)">COREY: Being honest you know, independence is hard.</p><p>Corey is&nbsp;21 years old. He suffers from schizophrenia and lives with his family in Roscoe Village.</p><p>COREY: My family thought that it was like a phase or a funk - that it would go away eventually. But unfortunately it didn't happen and they decided I needed professional help.</p><p>Corey is lucky to have parents that recognized his illness and who still want him to keep living with them. Because many parents, after years of incredible difficulty raising a child with illness, are overwhelmed to the point of saying, “You know what? You’re 18 – you’re on your own.”</p><div><p>COREY: One of my pills was $400. Another was $200. Two of them were over $100. Pills are very expensive, that's why people need health insurance.</p><p>While his family offers emotional support, he says they’re not in a position to fully support him financially. Corey’s monthly cost of medication comes to nearly $1,000. And like so many navigating insurance beaurocracy, he had a lapse in services.</p><p>COREY: We have Medicaid, and then they sent me a notice in the mail that at 19 they cut me off my insurance, but they never gave me a chance to apply for my own medical card. I didn’t have insurance for a month and a half. I had to pay for my medications completely and medications are so expensive. I completely broke the bank, I had no money in my account whatsoever.</p></div><p>Shannon Garrison is a therapist working with Corey and many other young adults at C4 Chicago. She says she sees gaps in services like his all the time.</p><p><img alt="" class="caption" src="http://llnw.wbez.org/story/insert-image/2011-October/2011-10-27/RS4488_Shannon Garrison Final-scr.jpg" style="width: 395px; height: 287px; margin: 8px; float: right;" title="Shannon Garrison, a therapist at C4 Chicago (Photo courtesy of C4 Chicago)">GARRISON: I’m still trying to figure out how this process works because there doesn't seem to be rhyme or reason. I have quite a few clients that have the same mental health diagnosis, the same kind of delays or deficits in functioning and one has gotten approved for a medical card, and has gotten approved for SSI, but a kid in a similar situation can't get either one.</p><p>With this lack of medication and therapy, Garrison says young adults end up back in the hospital, or worse.</p><p>GARRISON: So it actually ends up costing more without these services because you're going to see a lot higher rates in psychiatric institutions and in unfortunately the criminal justice system.</p><p>Garrison’s program, just like the other rare programs like it across the state,&nbsp;lost a $100,000 dollar grant to fund their young adult services. They had been teaching scores of struggling youth everything from balancing a checkbook to job readiness. And it’s dealing with some of that daily grind that makes life so hard for people like Corey.</p><p>COREY: Ever since my mental disorder, when I’m stressed out, I get under pressure I do have little breakdowns. I get angry, I cry. I just feel like if I still went back to school I’m afraid I couldn’t finish because to this day I still crack down under pressure. &nbsp;</p><p>Both Corey and Ana have had it rough. But in a way, they’re fortunate – because they found help. Studies show that about one out of every five youth has a diagnosable mental health disorder. And of those – 70 percent never get treatment.&nbsp;Consider this: If one in five Chicago public school students had an undiagnosed mental disorder, there would be more than 57,000 ill children without mental health care in this city alone.</p><p>Corey and Ana’s lives illustrate just a few ways in which this phase of life is treacherous. Despite advances in medicine and therapy, the immense social stigma of mental health conditions remain immune to science. In considering everything, it’s easy to feel hopeless. But Mark Fagan, who we heard from a while back, says the very instability of this period is actually where there’s hope, too.</p><p><img alt="" class="caption" src="http://llnw.wbez.org/story/insert-image/2011-October/2011-10-27/RS4485_Vanessa and Ana Final.jpg" style="width: 388px; height: 244px; float: left; margin: 8px;" title="Researcher Vanessa Vorhies meets with Ana. (Photo courtesy of Thresholds)">FAGAN: Young adulthood is also a time where we’re able to have some pretty serious influence. &nbsp;You know often times their brains are not fully developed and that’s what’s great. Because we still have that opportunity to provide some influence in terms of both their biological structure as well as their social and emotional structure. So even though it’s an incredibly difficult time, it also provides us with a lot of opportunity for hope and support and for the ability to create healthy transitions along their lifetime.</p><div><p>What are your hopes for the future?&nbsp;</p><p>ANA: I want to become a social worker or therapist. I want to be someone that helps other people.</p><p>COREY: I don't want to throw my life away - I have dreams for myself.</p></div></p> Thu, 27 Oct 2011 11:00:00 -0500 http://www.wbez.org/story/tricky-transition-adulthood-93294