SULLIVAN'S SALVOS
February 22, 2018
Sullivan’s
Salvos 2/27/18
In this edition:
*Prairie Preview
*Crisis Center Pancakes
*MH/DS Layoffs
*Did You Know?
*Prairie
Preview
Bur Oak Land Trust presents
Prairie Preview XXXV, a free, open to the public environmental forum that
traditionally attracts over 200 attendees. Exhibitors will be set up by 6:30
p.m.
Mark Hirsch, author of That Tree
will be this year’s speaker beginning at 7:30 p.m. His talk is titled “Shades
of wisdom, lessons learned from a lonely Bur Oak.”
A $25 45-minute photo workshop –
A simple approach to smart phone photography, will be given by Mark at 4:30 pm.
Mark will also have a meet and greet and book signing.
More than 45 exhibitors will
be set up to showcase their organization, provide information and answer any
questions that attendees may have. Refreshments provided by Four Seasons Garden
Club.
Sponsored by Iowa Living Roadway
Trust, Project GREEN, Western Fraternal Life, and City of Coralville. Sponsorship
opportunities are still available. For information please contact Tammy Wright,
Bur Oak Land Trust executive director, at info@buroaklandtrust.org or
319-338-7030.
*Crisis Center Pancakes
Saturday, March 5, from 7 a.m. to 1 p.m. at Our Redeemer
Lutheran Church, 2301 E. Court Street in Iowa City.
Tickets are available at the door - $6 for adults, $3 for
children. Breakfast includes all-you-can-eat pancakes, sausage, coffee, and
milk, in addition to gourmet pancake toppings.
This is The Crisis Center's biggest annual fundraising event!
Please come support local families in need and get a wonderful breakfast at the
same time!
*MH/DS Layoffs
If
you read Salvos regularly, you know that I used to work in the Medicaid
program. Medicaid is a tremendously important program, caring for the poorest
and sickest among us. You have heard me complain at length about the Governor’s
decision to privatize Iowa’s Medicaid program. (Privatization is also known as turning
it over to Managed Care Organizations, or MCOs.) Privatization has led to
predictably disastrous results for the poorest, sickest Iowans and those who
care about them.
There
are other people also hurt by these changes that I have yet to mention.
Unfortunately, on February 28, Johnson County says goodbye to most of our
Medicaid Case Managers. We will be down to about ten employees in a Department
that was once home to 30. And the Governor’s decision to move to MCOs is 100%
to blame.
Let
me back up and explain what a Medicaid Case Manager does. Many of the people
who access Medicaid are not in a position to line up their own services. Many
Medicaid recipients have dementia, or serious and persistent mental illness, or
intellectual disabilities, or a brain injury, or one of many other conditions
that can affect decision-making. In these situations, a Medicaid Case Manager
walks the client through her choices, helps her apply for services, refers her
to community resources, and then monitors those services for quality and cost
effectiveness. Medicaid Case Managers serve as advocates for people who may be
unable to advocate for themselves.
Johnson
County has provided assistance to people in need since the County was formed in
the 1830s. So when Medicaid Case Management came about, Johnson was one of
dozens of counties that went into the Medicaid Case Management business.
In
some counties, private nonprofits did the Medicaid Case Management. In some
counties, the Department of Human Services (DHS) did it. In most counties, the
counties themselves provided the service. And this was a really good
arrangement. Since private nonprofits did most of the services, you had a
dispassionate third party who could judge how things were going. Similarly,
since most Medicaid funding runs through DHS, county-based Case Managers
maintained a critical professional distance.
Medicaid
Case Managers would each have a caseload; rules changed over time, but this
caseload was generally between 25 and 45 clients. Medicaid Case Managers were
required to have a couple contacts per month with each of their clients in
order to bill for the service. A great deal of documentation was required in
order to be able to bill; Medicaid Case Managers were required to write detailed
“narratives” to describe what they did with their clients.
As you might imagine, some clients required very little effort.
Other clients called several times per day, every day. Still others required
the Medicaid Case Manager to literally look under bridges to find them. Some
faced serious problems like addictions, sexual abuse, and any other issue you
can imagine. The job could be a lot of things, but boring it was not!
The
Medicaid Case Management system was historically victimized by poor decisions
in the Iowa Legislature and poor leadership at Iowa DHS. Those in charge
routinely made decisions that overemphasized paperwork and underemphasized the
social work function. It became more and more bureaucratic, and more and more
difficult just to do the job. Still, most Medicaid Case Managers stuck with it,
because they legitimately care about helping those in need.
Then
along came the MCOs. These organizations do not give a damn about anyone but
their shareholders. So the MCOs refuse to pay Johnson and other counties to
provide Medicaid Case Management. In some cases, they simply decide the client
does not “need” the service. In other cases, the MCOs say they will provide the
service “in-house.”
This
made it impossible for Johnson County to maintain all the Medicaid Case
Management jobs. Some people saw the writing on the wall, and there has been a
slow trickle of employees leaving over the past year. Finally, the MCOs
demanded all cases be turned over to them. Johnson County was forced to refer
to the layoff provisions in the contract we had bargained with our Medicaid
Case Managers (a unit of AFSMCE). Per the contract provisions, the Medicaid
Case Managers would get 20 working days’ notice, then be laid off. Notice
occurred February 1st. The last day of work for these folks is
February 28th. It sucks.
As
I mentioned at the beginning of this piece, privatization has been horrible for
people who use Medicaid and their families. Through it all, Johnson County’s
Medicaid Case Managers have worked tirelessly to make a bad situation better.
They have spent hours consoling people, and many additional hours trying to
figure things out. Through it all, they have kept the needs of the clients
first. They have been thorough and professional. And now their jobs are gone, a
casualty of the Governor putting public money in private pockets.
My
hat is off to our Medicaid Case Managers. These are great employees and great
people who deserve so much better. My thanks go out to them, and also to
Johnson County’s Human Resources Department and AFSCME, who made a difficult
situation much better with their professionalism.
So,
what can you do? The answer is simple: VOTE OUT THIS GOVERNOR! She needs to be
held accountable!
*DID YOU KNOW?
One in Six Iowans is served by a Medicaid program. (Source: Iowa
Department of Human Services.)
Anyone
interested in learning more about County government should take a look at the
County website-
"Sullivan’s
Salvos" is sent once per week to any interested party. It will give a
brief update on issues of interest to Johnson County residents.
These messages
come solely from Rod Sullivan, and neither represents the viewpoints of the
whole Board of Supervisors nor those of groups or individuals otherwise
mentioned.
If you do NOT
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anyone else who might be interested, just forward this message. They can E-mail
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As always,
feel free to contact me at 354-7199 or rodsullivan@mchsi.com. I look forward to
serving you!
---Rod
posted by Rod Sullivan @ 2:24 PM
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