FY22 Health & Human Services Virtual Budget Briefing Q & A

Department of Public Health
Department of Children & Family Services
Department on Aging
Department of Human Services
Department of Healthcare & Family Services

Department of Public Health

Alzheimer's disease outreach more information
1. IDPH has worked with the Alzheimer's Association to develop a program to coordinate care, use data to improve health outcomes, increase awareness and develop dementia-related training.
I'm concerned that much of the process for signing up for vaccination appointments relies on online access. Many who either do not have internet or do not have a computer or smart phone could miss out on this coveted vaccine to protect themselves against COVID. What is being done to make sure all Illinoisians have the opportunity to sign up for vaccination appointments? Are there plans to spin up call centers and other things to make this happen?
1. IDPH is working to establish a state-wide call center in the very near future.
Deputy Governor Flores mentioned funds for suicide prevention. Historically, in times of financial recession suicide rates have doubled. Will any of the funds be utilized proactively with education for crisis prevention OR will the State limit funding to crisis intervention? Will prosumer organizations (aka, Consumer-Operated Service Providers) have opportunity to compete for funds?
1. IDPH is building out the harm reduction program at IDPH, funding will be utilized to create a robust program at IDPH and further examine the fiscal and other needs required to work with community groups and other organizations to address suicide in Illinois.
Has there been any studies that have resulted in known side effects of either vaccinations and persons currently receiving chemotherapy for cancer? If so, please share.
1. IDPH is not aware of any studies relating specifically to chemotherapy, remember these vaccines are very new and will receive additional study as time goes on.
When do you think we'll have vaccines for children under 16 years of age? This is important as we think about our children returning to school face to face.
1. a. Various manufacturers are continuing to work on vaccines for all ages. We are relying on the federal government for review and approval of new vaccines. We unfortunately do not know when a child appropriate vaccine will be available.
The Governor said that Phase 1B would expand to people with comorbidities AND people with disabilities. What about the latter group?
1. Those residents with disabilities living in congregate settings are already receiving vaccine. Those with disabilities but not in congregate settings will follow the phased criteria published by IDPH. The state is currently in Phase 1B Part I. Residents in 1B Part II will be able to register for vaccination beginning February 25th.
We have random people who need either first or second dose (due to cancellation for the latter.) These are people in 1a and 1b. How can we access the vaccines? All the sites never have any openings. We try several times a day at different sites ...County, Walgreens, Jewel, CVS, etc. It will get even harder when eligibility expands. II will be able to register for vaccination beginning February 25th.
1. The state adds new providers daily, however vaccine supplies are limited. We advise that 1st dose recipients return to the provider for help with a 2nd dose. While supplies are very constrained right now, we do expect the outlook to improve in March and beyond.
When can people with autism and all developmental Disabilities expect to get the covid-19 vaccine?
1. Those residents with disabilities living in congregate settings are already receiving vaccine. Those with disabilities but not in congregate settings will follow the phased criteria published by IDPH. The state is currently in Phase 1B Part I. Residents in 1B Part II will be able to register for vaccination beginning March 25th.
Is COVID testing available for all folks with disabilities (IE) blindness, deafness, etc.?
1. COVID testing is available to all residents and to those with disabilities.
Is there a plan for Nursing Homes to open? My grandmother, who is in a nursing home, has declined rapidly this last year. She is hard of hearing and has dementia so she does not understand FaceTime calls and when we were able to visit she could not understand us because of the masks. Her nursing home has had both vaccines but still no change of when things will loosen up. She has not left the nursing home in almost a year. Seems to us she is in prison!
1. All regions of Illinois are in Phase 4, meaning that congregate settings may allow for visitation. Even so, facilities may establish more stringent guidelines for visitors. We recommend that families work with the facility manager to understand visitation requirements, especially for those loved ones with unique challenges like dementia and Alzheimer's.
While HIV/AIDS programs receive $138 million in total funding, can you please break down that amount by funding source (federal government, state General Fund)? Also, was the African-American HIV/AIDS Response Act Fund removed from this year's budget funding?
1. The breakdown is as follows: GRF: $27,500,400, Other State Funds: 1,000,000, Federal: 110,000,000. The total is the same as the FY21 budget except a requested $720,000 in GRF for HOPWA to go to the legacy housing providers. There is still no cash in or revenue for the African-American HIV/AIDS Response Act Fund (#326), so this has been replaced by a $1.2 million GRF line again, which is the same amount since FY18.
When will the major hospital systems be given the go ahead to begin vaccinations for their patients?
1. a. Major hospital systems are already engaged and have been since the first doses came to IL. Many hospitals are receiving allocations of vaccine for patients and residents from the local health departments.
13) What is the new Men's Health Program under IDPH?
1. The goal of this program is to raise awareness and promote early detection and treatment of disease among men and boys.
When the mass covid19 vaccination will be available for public?
1. There are mass vaccination sites in place now, including the State Fairgrounds in Springfield as the Governor announced on 2/17. There will be more established as vaccine availability improves.
I'm from an AAA in Southeastern Illinois; we work to implement and deliver services to the older adults in our 9 counties. We have strong relationships with the Health Departments in some of our areas and would like stronger collaboration 9 county wide. Some respond back to us quickly and others are more delayed. Is there any better means of contact our Health Departments can make to outreach updates, clinics and communication to the AAA weekly? We understand their time is very valuable and limited but would love to have weekly calls and updates from all of them in regards to Vaccinations and Pandemic information from the IDPH and local level.
1. IDPH will be happy to work on better communications between Area Agencies on Aging and the local health departments. My staff have ongoing discussions with Department on Aging and will collaborate to increase and improve communications at the local level.

Department of Children & Family Services

$ increase in DCFS budget?
1. Total increase to the DCFS budget was $114 million which is 7.9%.
Is DCFS have Residential places for minors with dual diagnosis, Mental Illness and Developmental Delay? Where guardians can find their rights and receive services from DCFS?
1. The primary partners for DCFS in this area include: Northern Illinois Academy (NIA); Willowglen Academy; Hoyleton Youth & Family Services; Little City and Hope School. These providers have specialized expertise and are an excellent source of either treatment recommendations and/or information and referral.
  For guardians seeking mental health or developmental delay related services, in instances where abuse and neglect are not a factor, the best source of information would be the Illinois Department of Human Services' Division of Mental Health or the Division of Developmental Disabilities which both have extensive resources listed on their websites. Another critical resource is always the school district in which the child or youth resides and the very important Individualized Education Program (IEP) that may be available that describes the special education instruction, supports, and services that students with disabilities are legally entitled to receive.
What programs or grants is DCFS doing in regards to the adolescents being left in mental hospital acute settings instead of foster care or residential facilities for months at a time?
1. The Department is taking a multi-systems approach to addressing the issues related to discharging adolescents from psychiatric hospitals more efficiently. The Department is working on revisions to its internal systems to improve the flow of communication between psychiatric hospital and the Department. It is also working with hospital associations and provider networks to address factors that impact the discharge planning for youth. DCFS continues to work with existing and new residential providers to develop residential resources that address youth with acute behavioral health needs. During the past 2 years, the Department has worked diligently with providers to increase the residential placement capacity for youth in care through contract development or Capital Grants. In the past year the Department has added 37 new beds with an additional 50 in process.
  DCFS continues to work with existing and new residential providers to develop residential resources that address youth with acute behavioral health needs. During the past 2 years, the Department has worked diligently with providers to increase the residential placement capacity for youth in care through contract development or Capital Grants. In the past year the Department has added 37 new beds with an additional 50 in process.
Regarding Expanded Investments in Youth Care and self-direction, were youth given a choice as to whether or not they aged out of the system or was this decision made for them? It seems to be a good investment during this pandemic...but am curious about choice.
1. Yes, absolutely. All legally capable youth aged 18 and over have a choice to remain with DCFS within allowable timeframes or age out of the system. While we encourage youth to remain with DCFS for the additional supports and services, we honor their choice. By statute youth can remain under DCFS until they are 21 and if their case is closed between 18-21 they can reenter the system by reopening their court case. The COVID pandemic allows youth to receive services consistent with federal guidance, even though their court case closes at age 21 by statute.
When will Intact and Foster Care Workers be able to receive vaccinations.
1. While it is currently anticipated that intact and foster care workers that don't qualify under Phase 1 will be able to receive vaccinations after the phase 1C population, DCFS will continue to coordinate closely with IDPH on the vaccination timetable and will continue to share that information through the existing COVID related communications.
DCFS allocated roughly $8M for 8 months of service for Family First services in FY21. Why the cut to $3M for Family First services in FY22?
1. The $3M in requested FY22 GRF Counseling funds is in addition to the $7M DCFS received in FY21 to implement the Family First prevention services and represents the full annualized cost. There are no reductions in Family First services. It should be noted that DCFS continues to prioritize available behavioral health funding to support evidenced-based interventions.
In terms of licensing requirements of teachers in child care programs, would it be possible for DCFS and IBoE to coordinate their efforts and streamline the requirements?
1. Yes, the Department will reach out to ISBE, in consultation with the Governor's Office of Early Childhood Education, to discuss opportunities to streamline requirements.

Department on Aging

Why will the ADS and Trans rate increase go into effect? Is it still waiting for final approval?
1. These rate changes will occur January 1, 2022. Aging will work with HFS to submit the rate change for Federal approval.
The aging network has been under great strain during the pandemic. No doubt some lives have been saved and many seniors made safer and more comfortable through the efforts of the network. State funding is largely going down not up. Can the administration identify all new federal funds that might be received for use in the aging network, to help the program participants and to keep provider organizations afloat financially? Help is needed and could improve services and stabilize the existing network.
1. The State has invested in the FY22 Introduced Budget GRF, which will assist the Aging network in the form of additional funding for meals and rate increases to assist with changes to minimum wage and to address stabilization of the Network.
When you provided assistive technology to older individuals, what training was provided to insure they knew how to use it?
1. Yes, the Illinois Assistive Technology Program is providing technical assistance to those who receive devices, along with a step by guide "how-to" guide.
ESS is a much welcome program, giving CCUs needed flexibility. However, in many cases, it is costing CCUs more money than has been allowed for administration and delivery costs. Can this amount perhaps be increased to a more realistic level for the remaining expenditures?
1. The Department did make changes to the administrative portions of the grants for FY21, this can be revisited again in FY22 as it was this year.
Will PPE offset payments continue throughout FY22?
1. No
Is the minimum rate of $24.96/hour for CCP providers employees or INH providers which is effective on 1/1/2022?
1. The rate increase is for Community Care Program in-home care rates which are paid to providers that employ the in-home care workers.

Department of Human Services

Is there any anticipation that cuts can impact or delay reimbursements to organizations?
1. There are some FY21 named grant appropriations which are discontinued in the proposed FY22 budget. The Governor introduced a balanced budget; changes in the timeliness of payments are not anticipated.
Will cuts impact both FY2021 as well as FY2022?
1. There are a handful of FY21 programs that are not being fully expended due to changes in service utilization. Those include Early Intervention, Child Care, and SUPR DCFS client services. The FY22 proposed budget reflects funding to support the estimated liability for each of these programs.
Will the State of Illinois fund prosumer organizations in the FY2022 budget? If so, what kind of services will be presented in NOFA's?
1. IDHS values the voices and agency of people with lived experience in services, programming, and policy development. There are various areas in our department where this will be embedded.
  IDHS/DMH is open to funding prosumer organizations and they are welcome to apply for any grant or contract opportunities for which they are equipped to perform the scope and deliverables.
  
  In addition, the IDHS/ Division of Substance Use Prevention and Recovery (IDHS-SUPR) will continue to fund Recovery Oriented Systems of Care (ROSC) Councils for SFY22. IDHS/SUPR will also provide funding for Recovery Community Organizations (RCOs). RCOs are peer-run community-based organizations that support people in long-term recovery through providing supportive services and a substance-free environment.
Will treatment providers be incentivized to sub-contract with prosumer agencies? Can NOFOA's for treatment providers include a higher score for treatment providers who sub-contract with prosumer agencies?
1. Pursuant to the Grants Accountability Transparence Act (GATA), a program can prioritize a type of provider if it is well defined and objectively stated in the Notice of Funding Opportunity.
There is an increase in "BH Special Projects" from $11M last year to $22M for FY22. What is this item and why was it increased?
1. This line was increased in anticipation of a one-time revenue from Medicaid back claiming. This appropriation is used to support facility operational costs.
You mentioned a site to make it easier to find additional grants?
1. Interested parties can find Notice of Funding Opportunities at https://www2.illinois.gov/sites/GATA/Pages/default.aspx. In addition, the GATA Technical Assistance Learning Management System is available at https://www.dhs.state.il.us/page.aspx?item=131528 . The training system provides self-paced online learning with an instructor in a physical classroom or virtual classroom online.
Do State Departments plan to reclaim any PPP funds from private agencies?
1. PPP funds were awarded by the U.S. Small Business Administration, and they will be reclaiming any PPP funds, as applicable. However, State departments will be reviewing audited financials to verify that there are not expenditures that are being charged to both PPP and State funding.

Division of Developmental Disabilities

What actions will the state be making in the future to reach the goals of the State Rate Reform report for Developmental Disabilities? Including maximizing applying for more federal money like the federal 1115 waiver?
1. The FY22 proposed budget does include funding to support a $77.0M investment for partial implementation of the Guidehouse DD rate study recommendations. The funding requested supports changes to residential services, community day services, and employment services. The overarching goal is to address minimum wage issues and pressures in our rate methodologies and reimbursements, moving towards compliance with Ligas Consent Decree deficiencies, and to encourage movement towards competitive integrated employment, and improvement in the system structure to ensure that all programs and services are on a rate methodology.
What is the anticipated timeline for closures of SODCs in Illinois? The hundreds of thousands of dollars to sustain an unethical and economically inefficient system can be used to create diverse, accessible, inclusive, affordable community-based living for people with intellectual and developmental disabilities.
1. The FY22 proposed budget does not reflect any SODC closures, however, IDHS continues to work with individuals on a 1:1 basis to support more community placements. IDHS/DD is working with the Arc of Illinois, Independent Service Coordination Agencies, and Equip for Equality on transfers and identifying barriers and solutions for individuals interested in transitioning.
While most of the system provides Medicaid-matched services, there remains a significant number of grants that are vital to individuals served and families - dental, epilepsy services, the Autism Program of Illinois. How does the proposed budget seek to fund those grants relative to last year?
1. Dental, epilepsy services, Autism Program of Illinois, and other DD grants are proposed at the same level as FY21 estimated spending.
With respect to individuals with I/DD, families, and service providers, does the DHS proposed budget seek to make use of or operationalize federal funding for pandemic related priorities - testing, contact tracing, vaccination, etc?
1. The FY22 proposed budget does not include funding for testing, contact tracing, or vaccinations. The funding for those priorities would be included in the Department of Public Health and IEMA budget requests.
  IDHS is working with IEMA to provide PPE to community providers, as supply is available. IDHS has been able to procure gowns, gloves, face shields, masks, and a few other PPE items. If you have any questions, please email DHS.PPE@illinois.gov.
  
  In addition, IDHS recently released an RFP to procure contractual staff to provide vaccinations clinics for CILAs, Home Services workers and their clients, substance abuse and mental health programs, and our 1b staff.
Why so little funding for DD?
1. When many other State entities are having to stay flat, the FY22 proposed budget reflects a $77M additional investment, all funds. Of that, $57M is in additional general revenue funds over FY21, a 4% increase. The overall proposed investment in the Division of Development Disabilities is over $2.0 billion.
How much money is DHS going to get for I/dd Service?
1. The overall proposed investment in the Division of Development Disabilities is over $2.0 billion.
Can you speak to any investments that will help people who want to transition out of institutions (SODCS, nursing homes, ICFS etc) and into smaller community living options especially considering the pandemic? Can you speak to ways you are addressing Olmstead Consent Decrees?
1. The Division of Developmental Disabilities: There are approximately 100 residents of our SODCs are interested in transitioning out of the SODCs to community services. Any individual who wants to transition from an SODC is automatically awarded waiver funding.
What is the plan for maximizing obtaining federal dollars to better fund autism and all developmental Disabilities to meet the needs of the Ligas Decree and the state reform report by 2025?
1. The State is committed to maximizing federal match for all waiver provided services. The Guidehouse Rate Study identified areas where match could be received for services provided, and IDHS/DD intends to maximize these opportunities.
Please restate the maximum time on the PUNS list and indicate what will be necessary to decrease if further?
1. The State has committed, as part of the Ligas Consent Decree, that by 2025 no individual will be on the PUNS list longer than 60 months. IDHS is meeting this requirement in FY21 and expects to continue to reduce time waiting on the PUNS list each year. Recent improvements and changes in the PUNS list and better tracking of individuals on the list will allow DD to continue to improve the wait time.
How many are currently on the PUNS list needing housing services?
1. The PUNS list does not directly track housing needs. This is done at the individual ISC level. Currently, approximately 80% of PUNS selectees are choosing home-based services, and 20% are choosing CILA services. Over the last few years, the trend is a priority towards home-based, and this is expected to continue.
With the announcement of a 60 month waiting list for services for individuals with disabilities, what are you suggesting they do while they are waiting for that period of time?
1. In the past, the wait for waiver funded services for individuals with intellectual and developmental disabilities has been much longer than 60 months. IDHS/DD has worked hard over the past several years to pull additional individuals off the PUNS list for services to meet the goal of 60 months. IDHS/DD would also like to ensure any individual with I/DD in a crisis situation is eligible for services.
If there is now an appropriation of 77 million to support provider increases determined by the Guidehouse study will this now cease the Home Based Waiver Recipients who have been responsible for paying the increase? Their waiver fees for CDS has increased from $11.63 March 2020 and is now at a staggering rate of $15.30 which has had a major impact on reducing the services they're able to purchase
1. Home Based Waiver recipient budgets are set in statute at 3 times the Social Security Income (SSI) monthly amount for adults and two times the SSI monthly amount for children. Annual raises to the SSI amount, which occur in January, result in raises for the HBS budget for individuals.

Division of Family & Community Services

Will YEEP be included in the FY22 budget?
1. In FY21, YEEP, the Youth Education and Employment Program was funded with CURES funds. At this time, IDHS does not have funds to support this program in FY22.
Specific funding for employment training and job placement in Black communities.
1. IDHS continues to prioritize employment and training in Black communities in a variety of ways with two recent examples in FY'21.
  With pandemic funds, IDHS worked with faith-based organizations to provide employment and training support in areas hardest hit by COVID. IDHS used CURES funds to develop a subsidized work experience program to support small and local businesses in the City of Chicago and Rockford through stipends for people who were unemployed or lost their job due to COVID-19.
  
  For youth, IDHS launched the Illinois Youth Investment Program (IYIP) in FY21 to support young people along their path toward long-term and career employment. Recognizing both the negative effects of COVID on youth employment and the inequities that disproportionately impact black and brown communities, IYIP was designed to ensure communities most impacted would receive funding. All providers are required to address the racial disparities within youth employment, specifically for black youth, ages 16-24 by developing an Employment Equity Plan (EEP) and demonstrating how their proposed program design will reduce these disparities. Further, Black-led organizations were given priority when applying for funding; This resulted in 23 Black-led organizations receiving funding, 59% of all funded applicants. These programs are expected to be continued in FY22.
How will IDHS deal with the hiring freeze? In particular-the staffing at the FCRC as caseloads continue to increase.
1. IDHS will continue to hire essential employees during the hiring freeze to maintain meeting federal requirements on Medicaid determinations, re-determinations, and eligibility determinations for other benefits.
What is the amount allocated to domestic violence services in the budget?
1. The GRF FY22 requested funding level is $20.5M.
Can you please comment on FY22 budget impact to TeenREACH, CCBYS, IDHS Homelessness Prevention or Homeless Youth Grants?
1. The FY22 proposed budget includes $14.5M for Teen REACH, $18.9M for Comprehensive Community Based Youth Services, $5.0M for Homelessness Prevention (GRF), and Homeless Youth services at $6.3M.
Will there be any reductions to the CCAP parent co-payments with the federal increase?
1. There are a variety of strategies that are being explored. IDHS continues to seek input from its community partners and work with its federal partners to develop a plan with the federal increase in Child Care funds.
The January edition of the IDHS newsletter - Message from the Secretary references Public Law No. 116-260 and Child care. Specifically it states to continue child care assistance to essential workers without regard to income. The CCR&R does not seem to be familiar with this. Has this been implemented?
1. IDHS ended the allowance for providing child care assistance to essential workers without regard to income. IDHS will continue to adjust child care policy in response to changes needed during the pandemic.
We see that the Early Intervention funding level is above the expected spend for this year, but is cut below last year's appropriation. Caseloads are down due to COVID but we expect to see that to rebound in the next fiscal year. Do you have plans to respond if we do see referrals and enrollment rebound?
1. The FY22 proposed budget for Early Intervention supports an increase or rebound in caseload growth beginning in the latter part of FY21 and throughout FY22.
Re: Moving telehealth from emergency to permanent in Medicaid. Does that mean telehealth therapy services provided to children with developmental disabilities or delays will be reimbursed on a permanent basis?
1. IDHS/EI plans to continue with the telehealth therapy services on a permanent basis, if approved under the Medicaid State Plan amendment.
Can you tell us how the budget will impact caseworker staffing levels at IDHS Family and Community Resource Centers - including caseworkers who may be working remotely?
1. The FY22 proposed budget fully funds current staffing levels, as well as budgeted vacancies available in FY21. The budgeted staffing at FCRCs is level between FY21 and FY22.
Will there be a significant cut to programs in Family and Community Services grant?
1. No, there are some FY21 named grant appropriations within Family and Community Services which are discontinued in the proposed FY22 budget. The traditional Family and Community Services grant programs are proposed at levels to fund estimated need.
Will the budget support programming for employment and training programs for youth in underserved communities?
1. The FY22 Youth Employment proposed level is $19.0M. To maximize the impact of the youth employment program, IDHS not only focused on funding counties hardest hit by COVID but also focused on serving at risk youth in the top 4 (of12) counties with the highest percent poverty population. Programs are funded in each of those four counties.
  
  County % of persons in poverty
  
  Champaign County 19.2%
  
  Peoria County 16.6%
  
  Winnebago County 16.1%
  
  St. Clair 14.8%
  
  The FY22 Afterschool Youth Programs (Teen REACH) proposed level is $14.5M. The Department will be competitively bidding the afterschool program for FY22. The program will fund community-based public or private not-for-profit agencies to provide Teen REACH (TR) services to at-risk youth in high-need communities with a focus on older school-age youth. In FY21, 58 agencies are funded to provide TR programming in 146 community sites in 25 Counties and will serve approximately 14,000 youth. The program provides youth with safe environments, caring adults, guides them toward educational success, marketable skills, STEM education and opportunities to serve their communities.

County	% of persons in poverty
Champaign County	19.2%
Peoria County	16.6%
Winnebago County	16.1%
St. Clair	14.8%

Division of Mental Health

How much of the taxes from Marijuana businesses is going to mental health services?
1. IDHS receives 20% of the remaining allocations of the Cannabis Regulation Fund, once direct and indirect costs associated with the implementation, administration, and enforcement of the Cannabis Regulation and Tax Act are removed. These funds are to be used to address substance use prevention and mental health concerns, including treatment, education, and prevention to address the negative impacts of substance use disorder and mental health issues. In FY21, IDHS estimates $25M will be made available for these purposes.
  IDHS also receives 2% of the remaining allocations of the Cannabis Regulation Fund to develop and administer a public education campaign, educating youth and adults on the risks of alcohol, tobacco, illegal drug use, and cannabis. In addition, funds are to be used for data collection and analysis on the public health impact on legalizing the recreational use of cannabis. In FY21, IDHS estimates $3M will be made available for these purposes.
Are cuts to traditional behavioral health capacity grants anticipated? (i.e., crisis, group homes, etc.)
1. The FY22 proposed budget does not included any reduction to traditional behavioral health capacity grants, such as crisis and group homes. There are a number of FY21 named grant appropriations that are discontinued in the proposed budget.
Please provide as much detail related to Homeless Supportive Housing Budget (Bureau of Homeless Services & Division of Mental Health)
1. IDHS/DMH currently funds supportive housing for individuals with a serious mental illness (SMI) and will continue this funding in FY22. The FY22 proposed funding for MH Supportive Housing is $22.4M.
  The IDHS/FCS FY22 GRF request for supportive housing is flat as compared to FY21 at $16.2M.
What is the allocation for mental health services? This is especially critical as seek to support those who are struggling because of the pandemic.
1. The FY22 proposed budget includes $714.5M in all funds for the Division of Mental Health.
How does this budget address the increased costs for the minimum wage for mental health and substance use providers?
1. The FY22 proposed budget includes $2.9M for a 2% COLA, effective 1/1/22, for MH community-based grant programs and $2.2M for the same increase for SUPR community-based grant programs.
Are you able to create some type of home service program for those with mental health issues? PWD waiver are for those with physical disabilities.
1. The FY22 proposed budget does not include funds to support a Home and Community based waiver for individuals with mental health issues.

Division of Substance Abuse Prevention & Recovery

As you know, public health data shows that the principal route through which opioid use disorder is initiated is by way of legally prescribed oral opioids. (80% of heroin users started with oral opioids). Will State of Illinois officials consider shifting resources toward fact based prevention strategies that have been shown to reduce the incidence of opioid addiction and misuse? Specifically, would the State consider using a grant or opioid settlement funds for a demonstration project involving a health technology that allows prescribers to know whether a patient is at high risk of addiction prior to prescribing an opioid?
1. IDHS/SUPR will continue working with the Prescription Monitoring Program. In addition, SUPR will explore both evidenced-based as well as evidenced-informed practices, inclusive of technological solutions to prevent the abuse of prescription opioids.
How will the department handle funding from the Marijuana tax revenue?
1. The overarching strategies are to support people and programs, invest in existing and seed new projects, disrupt the status quo, impact the short- and long-term, and leverage the expertise of SUPR and DMH.
  IDHS will continue to invest in Healing Illinois which is a racial healing initiative in partnership with The Chicago Community Trust. This initiative is designed to distribute grants to organizations across the state to activate the work of racial healing.
  
  DMH will continue to invest in the intervention strategy that begins with social marketing in public settings and the development of a smart phone app for Suicide Prevention. The initiative will include advertisements on buses and utilizing bus wraps, billboards, TV, and radio ads.
  
  DMH will also continue to invest in the expansion of the infrastructure for the Lifeline to ensure that at least 70% of the Illinois calls going into the National Suicide Hotline are answered by call centers in Illinois.
  
  SUPR will be increasing its investment in the amount of and accessibility of Naloxone for all Drug Overdose Prevention Program enrolled entities to distribute to Illinois non-traditional first responders including people who are at risk of an overdose.
Can you share more about plans for a pilot overdose prevention site? How can advocacy and community groups support such efforts?
1. IDHS/SUPR is currently working on a Notice of Funding Opportunity. Interested parties can find Notice of Funding Opportunities at https://www.dhs.state.il.us/page.aspx?item=120314

Division of Rehabilitation Services

With so many Illinoisians having lost jobs, retraining of individuals with disabilities who fall into that category will be important. How is the Division of Rehabilitation Services budget impacted in fiscal year 2022 so we can continue and enhance training and rehabilitation services to individuals with disabilities?
1. The FY22 budget proposed for the Division of Rehabilitation Services reflects sufficient appropriation authority to expend available Vocation Rehabilitation funds. The Division is ready to train people with disabilities to achieve employment, education, and independent living. In addition, we have increased flexibilities for community providers to prevent the spread of COVID-19.

Department of Healthcare & Family Services

As a solution to gaps in care and safety nets, are there any discussions on establishing a per diem rate for crisis stabilization units for non SMHRF and non hospital based units?
1. HFS will be launching the Crisis Intervention Services Pilot described in the 1115 waiver later in calendar year 2021. This pilot will allow short-term crisis intervention services to be provided for individuals who are experiencing a mental health crisis and who can be safely stabilized in a community based setting that is less intensive than a psychiatric hospital. HFS will be providing additional information regarding individuals who are eligible and provider requirements for participation in this pilot as that information becomes available closer to the time that the pilot will be launched.
Does the State anticipate that Medicaid payments will be slowed next FY due to state's financial status?
1. The Governor is proposing a balanced budget so therefore we are not forecasting lengthy delays in FY 22 beyond the current average payment cycles in place now. Managed Care Organizations help with payment cycles by keeping their payments around 30 days during periods when the State experiences uneven cash-flow throughout the year.
Will there be a public process for providers to apply for the HFS equity-centric healthcare transformation pilots announced on November 13, 2020? If so, is there an estimated time-frame for this and where will it be posted?
1. We are so excited to have just gotten approval from the Illinois General Assembly during the lame duck session to move forward on the Healthcare Transformation Proposal. We are in the process right now of creating all the materials for interested parties to review the opportunity, apply now or seek consulting assistance to potentially apply down the road. This is a multi-year effort which is targeting real, community-driven, transformation changes to the health care delivery system in the most distressed communities in Illinois. We have some preliminary information about our initial proposal and the research behind it on our website. From the main page there is a blue box on the right titled Healthcare Transformation. That will be the landing page for the materials we will be publishing in the weeks ahead.
Last year in his 2020 budget address, Governor Pritzker committed to providing general revenue funding for family planning service providers that were harmed by the federal Title X changes. EverThrive IL is writing to ask if HFS has concrete plans to submit a family planning state plan amendment to the Medicaid program to leverage potential federal dollars that could help Illinois fill the remaining Title X funding gap.
1. Same answer as below 1 of 3
Does the fiscal year 2022 budget proposed by Governor Pritzker allow for the enactment and implementation of a Family Planning State Plan Amendment? The fiscal year 2021 budget included allowances for enactment of the FP SPA but submission to CMS was delayed due to COVID and related priorities. The FP SPA is urgent and necessary to address the state's state priorities of reducing disparities in maternal mortality and morbidity. Further, the FP SPA is fiscally prudent given the 90/10 federal match for family planning services and the abundance of research on realized cost savings to Medicaid programs following investments in family planning coverage (including from the previous Illinois Healthy Women Program.) The FP SPA is urgent and needed in addition to any potential expansion and/or changes to the federal Title X program that might be coming with the new federal administration. Title X dollars cover only a small portion of the uninsured population at select sites across the state leaving many of our most low-resource Illinoisans behind.
1. Same answer as below 2 of 3
As a FQHC nurse midwife, I hope the state will see the ROI for preventive services especially focused on contraceptive equity. There is no reason anyone in Illinois should have financial barriers to unbiased education and tools to decide if/when and under what circumstances to parent/be pregnant (includes male vasectomy). Budgeting in a family planning SPA will cover thousands more families which will also help insure continued healthcare coverage that can alleviate coverage concerns related to the maternal health crisis amongst black postpartum women. Research has shown, a dollar used in family planning saves $7 dollars. Also, the often referenced TX dollars available under this current administration will not impact the disparate perinatal outcomes as TX dollars are mired in administrative burdens and the FP SPA is needed to provide increase access to thousands of more people. Plus with a 90/10 FMAP, this is the definition of fiscal prudence.
1. Answer 3 of 3
  While we very much support Family Planning and have done a lot to enhance rates for and access to Family Planning services, we also have several additional priorities at this time. Continued Covid-19 response is among them, as well as numerous programs and changes that address racial and other health disparities, such as the 65+ program, vaccines, health care transformation, emphasis on contracting with minority vendors, reviewing roll out of enhanced care coordination for certain populations (esp. behavioral health), overall emphasis on re-evaluating our programs and policies for Diversity, Equity, and Inclusion impact.
  
  High on the priority list is getting our postpartum coverage waiver through the new federal administration and implemented. That said, we will continue to evaluate the changes from DC under the new administration around Family Planning and evaluate what that might mean for a Family Planning SPA and the timing of such.
What is the process for interested providers to apply to be involved in the HFS 1915c Supported Employment and Housing Waiver pilots? What provider types will be permitted to participate? Will CMHCs be included? Will DASASUPR providers be included?
1. The Department is currently negotiating its recently submitted 1915 I State Plan Amendment with federal CMS. (These are not 1915 c services.) Subject to federal approval, the Department is proposing that Community Mental Health Centers and Behavioral Health Clinics will be eligible to offer these services, which are scheduled to begin on July 1, 2022.
Will the Children Crisis unit ever be able to get full re-imbursement (at the higher rate) for crisis assessments via telehealth? Right now it has to be IN PERSON, which is a cause of much distress for the clinicians as they do no want to (necessarily ) go inside someone's home
1. There are several ways that a crisis assessment may be completed without requiring staff to enter a customer's home. The guidance provided by HFS in April 2020 is referenced below to outline the response options:
  Initial Crisis Intervention via Phone or Video
  
  After receiving a referral from CARES, the SASS/MCR provider will contact the individual in crisis, or the individual who reported the crisis to CARES, via phone or video to provide initial Crisis Intervention to attempt to stabilize the crisis. If the SASS/MCR provider is able to stabilize the individual, a Crisis Screening via the Illinois Medicaid - Crisis Assessment Tool (IM-CAT) will not be required. Staff should bill for their time completing telephonic or videoconference intervention as Crisis Intervention, on-site.
  
  Crisis Screening
  
  If the initial Crisis Intervention via phone or video does not result in a stabilization of the crisis, a Crisis Screening will be conducted.
  
  If the SASS/MCR staff are unable to have direct access to the individual (e.g., the individual is at a location that the staff is not allowed to access, the family does not want in-person contact by MCR staff), or the SASS/MCR provider assesses the situation as clinically unsafe for clients and themselves, the staff may, under these circumstances, conduct the Crisis Screening via telephone or video. Staff should bill for their time completing the telephonic or videoconference screening as Crisis Intervention, on-site.
  
  If the individual is accessible, is requesting an in-person screening and an in-person screening can be completed with reasonable safety precautions (e.g., use of PPE, CDC recommended social distancing, use of alternative safe locations, etc.) the SASS/MCR provider will complete, or will arrange for a partner provider to complete, a face-to-face crisis screening at the location of the crisis, or an alternative safe setting away from the home to ensure the safety of the individual and staff. Staff should bill for completing the in-person Crisis Screening as Mobile Crisis Response, off-site.
  
  If the SASS/MCR provider reaches the location of the crisis and is only able to interact with the individual in crisis via phone or video, as a reasonable safety accommodation, that is allowable as part of the Mobile Crisis Response, off-site service event.
Can you say more about what the Director meant by transitioning telehealth expansion from emergency to permanent under the Medicaid program?
1. We filed both emergency (emergency rules expire after 150 days) and proposed rules. The proposed rules were adopted (89 Ill. Adm. Code 140.413(e) - Telehealth Requirements During a Public Health Emergency and are in effect for the duration of a public health emergency. HFS is looking at the possibility of changing our telehealth policies post PHE.
May we know why HFS gives contracts to for profit business and not to non profit community service organizations who have deep understanding of people in need in the community?
1. HFS contracts with a variety of vendors for programmatic and operational needs large and small. Along with our managed care and other provider partners, HFS does collaborate with and value community-based organizations with a deep understanding of the needs of the people they serve. The needs of our customers and the business needs of the Department cannot be met exclusively by non-profit organizations across the state.
HFS/DHS - As a solution to gaps in care and safety nets, are there any discussions on establishing a per diem rate for crisis stabilization units for non SMHRF and non hospital based units?
1. HFS will be launching the Crisis Intervention Services Pilot described in the 1115 waiver later in calendar year 2021. This pilot will allow short-term crisis intervention services to be provided for individuals who are experiencing a mental health crisis and who can be safely stabilized in a community-based setting that is less intensive than a psychiatric hospital. HFS will be providing additional information regarding individuals who are eligible and provider requirements for participation in this pilot as that information becomes available closer to the time that the pilot will be launched.
How families in the community could help increase HFS budget?
1. HFS is here to serve families in the community through our medical assistance program and our child support services. For more information about our services and how to access them, please go to our website at www.hfs.illinois.gov.
Director Eagleson, how do you comply with federally required monitoring of the $800 million in COVID grant funds?
1. HFS has contracted with Ernst & Young, a leading accounting and consulting firm, to provide assistance with program implementation and federal compliance guidance. In accordance with federal monitoring requirements in 2 CFR 200.332 for pass-through entities, HFS will review final reports from HFS CARES payment subrecipients as a closeout monitoring activity. Subrecipients are required to submit final reports and supporting documentation by March 29, 2021. HFS will analyze the expenditures reported against the HFS CARES Program requirements and the subrecipient's previously submitted budgets and/or applications, identifying expenditures which may not be allowable. HFS will follow-up with subrecipients to resolve any issues or findings identified, which per the subaward agreement may include the recoupment of misspent funds.
Does the HFS budget assumption of the enhanced FMAP include the assumption that the enhanced match will only go until CY 21 ends or for the entire FY 22?
1. HFS' Fiscal Year 2022 proposed budget assumes the COVID enhanced federal match will continue through December 2021.
Will the state pursue federal funding for Money Follows the Person?
1. HFS has no immediate plans to apply for the federal Money Follows the Person program but will be forming a subcommittee of the MAC during the next quarter to focus on issues around community integration and removing barriers to home and community-based services expansion.