February 16, 2017
Sullivan’s Salvos 2/21/17
In this edition:
*Congratulations, Andy Chappell!
*MH/DS Targeted Case Managers
*Did You Know?
*Congratulations, Andy Chappell!
I have good news and bad news… Governor Branstad has appointed Assistant Johnson County Attorney Andrew Chappell to be a judge in Iowa's Sixth Judicial District. (The Sixth Judicial District includes Johnson, Benton, Iowa, Jones, Linn and Tama counties.)
This is good news for Andy – he is a brilliant, wise, ethical, outstanding attorney. He will make a fantastic judge! The bad news is for those of us who Andy work with him all the time. He will be incredibly difficult to replace!
Congratulations, Judge Chappell! I will miss you tremendously, both personally and professionally!
*MH/DS Targeted Case Managers
Friday, February 9, 2017 was a rotten day. The Board of Supervisors sat down with a room full of MH/DS Targeted Case Managers and told them most of them will be losing their jobs. I have been a Supervisor for 12 years, and this was the single worst thing I have ever had to do. And trust me – it was much worse for the folks getting the news than for the people delivering it!
First, some background: Johnson County has employed social workers for decades. In the old days, these social workers were generalists. As Medicaid expanded over the years, most people with disabilities became eligible for Medicaid programs. These Medicaid programs required a service they called, “Targeted Case Management.” The idea is that Case Managers would assist people in accessing resources, and ensure that Medicaid dollars were being spent wisely. For 20+ years, that is exactly what happened. About 20 of the 25 social workers employed by Johnson County were Targeted Case Managers, funded 100% by Medicaid. 5 or so social workers are funded through our Mental Health Region.
The system was working fine – until Governor Branstad decided to privatize Medicaid by going to a system of Managed Care Organizations, or MCOs.
The role of an MCO in a health care system is very simple: reduce the amount of money being spent on services, and keep some for yourself. I wrote the following in Salvos in August of 2015:
Medicaid just celebrated its’ 50th birthday. Medicaid and Medicare were among the greatest achievements in the history of our great nation. Health care for the poor… we have been called to provide this at least since Jesus walked the earth. The US finally got around to it in 1965.
Iowa will soon be embarking upon a system of “managed care” for folks enrolled in Iowa’s Medicaid program. I do NOT believe this will be a good thing for our poorest residents.
Managed care is a pretty simple notion. The idea is that healthcare is full of waste and fraud, and managed care companies will root that out. Without all this waste and fraud, the costs will go down.
The problem is, managed care companies rarely root out waste or fraud. They take an easier route. They simply cap services, and let the rest of the healthcare system sort it out. The managed care companies make their millions, and patients and providers fight over what is left. In my opinion, managed care is nothing more than a transfer of public tax dollars to private companies who are GUARANTEED to hurt the poor. Rather than being encouraged, managed care by private companies should be illegal. But that is not the environment in which we live.
Allow me to back up a moment. Medicaid (often referred to as Title 19) is the federal program that provides government health insurance to our poorest residents. Medicaid was passed in 1965 as an addition to the Social Security Act, a key component in President Lyndon Johnson’s “War on Poverty”.
While the vast majority of the funding for Medicaid is federal, each state pays a portion based upon the relative wealth of that state. Connecticut pays the most, Mississippi the least. Iowa is in the top half when it comes to relative wealth; in fact, our state match just went up because of the recent good years enjoyed by the ag industry.
Over time, states have argued for and received greater flexibility in designing state Medicaid programs. This is where the managed care concept began, and how it is spreading to states with Republican governors. In fairness, over the years, Medicaid has become a bigger and bigger piece of each state’s budget.
While many conservatives will try to tell you Medicaid has “not worked,” the reality is a very different story. In fact, 72 million Americans received some type of Medicaid service last year, almost 1 in 4. These services were provided at an average cost lower than private insurance, and at an average administrative cost MUCH lower than private insurance.
Will managed care improve things? No, it will not. Unless you own one of the firms that is about to suck millions of our tax dollars from our poorest residents. If you own one of those, you’ll be fine.
Unfortunately, I was correct. The chickens are coming home to roost. One of the three MCOs – Amerihealth Caritas – has pulled a bait and switch. Amerihealth guaranteed people they could keep their case managers, so folks signed on with them. A year later, after lining up most of the business, Amerihealth tells us they will begin doing case management themselves. That means the Medicaid money that used to pay for Johnson County staff will now flow to them.
Obviously, this gives Johnson County few options. We cannot continue to pay 20 salaries with no source of income. The writing is on the wall.
It should be noted, however, that no one has lost her/his job yet. Amerihealth will slowly bleed away clients until Johnson County is forced to make layoffs; after a while, there won’t be enough income to keep anyone on. Johnson County will gladly retain our workers so long as their services are being reimbursed. This process may be quick, or it may take several months. We simply do not know.
The 5 positions funded by the Mental Health Region should be safe. Since these are all union (AFSCME) positions, this creates a “bumping” scenario. The most senior person in the unit is asked if she wants a job. If not, they move to the second most senior. The process continues, based upon seniority, until all available jobs are filled. Once all the jobs are filled, the rest of the employees are laid off.
And let’s not forget the people who use Medicaid services. About 500 of our poorest people with disabilities – the most vulnerable among us – are left hanging. These are but the first cuts they will suffer.
So, Terry Branstad gets to enjoy his finest moment: services are cut for poor people with disabilities, and 20 AFSCME workers in Johnson County get laid off. I’m sure he is upstairs at Terrace Hill masturbating with joy! I also believe that some day he will be judged by a much higher power than the people of Iowa… and I don’t think he will fare very well.
Meanwhile, if you have an opening and a Johnson County Case Manager applies, hire her/him! This group is smart, hardworking, detail oriented, compassionate, and has done tremendous work. I will personally vouch for any and all of them!
Seriously – I am a social worker by trade. I worked for the Iowa Medicaid program. I have known some of these folks since the late 1980s. They deserve better. Clients deserve better. This is a sad, sad, sad day.
And remember this whole fiasco the next time you vote!
*DID YOU KNOW? More than 500,000 Iowans – one in every six – is on Medicaid.
Anyone interested in learning more about County government should take a look at the County website-
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