Emergency Meeting of the Illinois Interagency Council on Early Intervention - March 3, 2015

Audience

Open to the general public.

Date

Tuesday, March 3, 2015

Time

9:00 am to 11:00 am

Locations

This Emergency council meeting will be held via video conference at the following locations:

Agenda

Proposed Changes to EI Eligibility

Meeting Report

Present:

• Karen Berman, IL Early Learning Council Designee
• Bob Cammarata, ICG Health Care Services
• Brenda Devito, Manager, Child and Family Connections #6
• Julie Doetsch, IL Dept. of Healthcare and Family Services
• Ann Freiburg, Division of Family and Community Services, Bureau of Early Intervention
• Margaret Harkness, IL Council on Developmental Disabilities
• Beatrice Nichols, IICEI Chairperson, Head Start
• Deanna Pratscher, parent, Thornton
• Pam Reising-Rechner, IL State Board of Education
• Linda Saterfield, IL Dept. of Human Services, Division of Family and Community Services
• Angel Williams, IL Dept. of Children and Family Services
• Amy Zimmerman, Chicago Medical Legal Partnership for Children

Not Present:

• J. Diane Adams-Alsberry, CALM, Inc.
• Gerri Clark, Division of Specialized Care for Children (DSCC)
• Sheila McCurley, IL Department of Public Health
• Mary Petersen, Department of Insurance
• Kathy Schrock, Easter Seals DuPage and Fox Valley
• Connie Sims, DHS, Division of Developmental Disabilities
• Therese Wehman, Elmhurst College
• Constance Williams, PhD, DHS/Division of Mental Health

Call to Order

The Illinois Interagency Council on Early Intervention (IICEI) convened at 9:02 a.m.

Introduction of Council Members

Council members introduced themselves.

Governor's Proposed Budget

Council Chairperson Beatrice Nichols announced that the emergency meeting was called due to changes proposed in the Governor's State Budget Address. The Council requested a meeting to discuss information. Council members sent questions last week and would like to begin by discussing responses to those questions. Ms. Nichols requested that Amy Zimmerman talk about the questions sent. Linda Saterfield, Associate Director for the Office of Early Childhood, began the discussion by providing some context for the budgeting process. In the past, DHS has been provided with a variety of scenarios entering the budget process, examples include a flat budget (same level of funding as prior fiscal year), maintenance (which could include caseload growth/potential rate increases), and multiple cut scenarios (with decreases ranging from 5-20%). DHS has historically been asked to give ideas about what the program would look like within each scenario. Once a scenario has been put on paper, it lives forever. In this budget year, DHS program staff were not involved in the budgeting process. To date, program staff have not been given line item or background information. DHS program staff are operating from the same information as those who attended after budget briefing. EI got a $23 million cut. The Division of Family and Community Services got many cuts, across a variety of programs. Some programs were eliminated entirely in proposed budget. Ms. Saterfield doesn't anticipate that the General Assembly is in agreement with the entire budget as proposed, but DHS must support the Governor's budget and let the entire process play out. They have been told to expect the legislative session to go into the summer.

All requested EI scenarios were developed in prior fiscal years, but the current administration did not request this information. GRF funding was $83.7 million in FY14; $75.7 million for FY15; a supplemental request was submitted this fiscal year for $12 million; revising program needs to $87.7 million; projected FY16 funding is $64.7 million, if $23 million reduction is based on both original appropriation and supplemental request. The 502 EI Revolving Fund level is $160 million, but is comprised of all the various funding streams for EI. An increase to $180 million in the 502 EI Revolving Fund was not based on actual anticipated additional revenue; it is just an increase in spending authority. Actual spending is tied to actual revenue. Council members asked if other programs were proportionately impacted. Ms. Saterfield could not answer as no published breakdown (by division/by program) of GRF funds for next fiscal year is available yet. DHS is using supplemental figures to calculate next year's budget, but they don't know for sure what the actual budget will be.

Many are assuming that the $23 million figure is based on historical information provided, but program staff have not been able to determine which specific pieces were used given that no single proposal coincides with this amount. Ms. Saterfield's assumption is that DHS was given a lump sum and tried to spread cuts across the agency. Some programs cannot be eliminated because they are entitlements. Karen Berman asked how it was determined that this level of eligibility change would adequately address $23 million cut. Ms. Berman also asked if we could determine what portion of average cost per child is covered by GRF? Ms. Freiburg said that she didn't have that information currently, but a previous estimate indicated that the average IFSP cost was approximately $500 per month/child. Ms. Freiburg isn't certain, but thinks approximately $250.00 a month is covered by GRF. Approximate GRF spent per child per year is $3,000. Ms. Berman requested a good figure to use with helping legislators understand. Ms. Freiburg will provide this information once she returns to office. Ms. Berman reiterated that the Council wants to support EI in the context of entire early childhood system and really thinking about how this program impacts other pieces of the early childhood system. Ms. Saterfield hopes focus will continue to highlight impact of eligibility change since budget numbers are more difficult to explain at this time. When asked about the average costs figure, Ms. Freiburg explained that the best information she has will be averaged across all children because GRF amounts will vary across individual children due to a variety of factors including Medicaid and private insurance status.

Ms. Zimmerman asked Ms. Freiburg to review the data sheet provided to the Council and Chicago audience members. The first table shows level of delay for all children exiting in FY'14. Council members asked questions about the data and Ms. Freiburg provided explanations. Ms. Zimmerman clarified that figures used should be pulled from the E01 line. Ms. Freiburg said that is probably the most straightforward calculation we currently have for estimating how many children this change in eligibility might impact. No answer is yet available about whether 50% delay would be required at annual redetermination of eligibility. Ms. Zimmerman asked about the possibility of getting this same delay level information broken down by CFC. Ms. Freiburg can send this information to them later. CFCs would like copies of this information, too. Given the tables provided, it looks like eligibility change would eliminate service to approximately half of the children currently eligible.

Are there other strategies being put forward as alternatives to eligibility change? Does DHS have the opportunity to make a case for alternatives? DHS has not been provided an opportunity to provide alternatives yet and do not know if they will get an opportunity. Ms. Zimmerman asked about historical scenarios. Ms. Freiburg only remembered the scenario proposed when we had a flat 10% cut- these changes were primarily addressed through changes to CFC support staff. Ms. Zimmerman reviewed the potential benefits of screening being conducted prior to proceeding to full evaluation as past data has shown that approximately 50% of referrals do not result in IFSPs. Children close from intake, though, for a variety of reasons. Can Council members get the number of children closed from intake due to EI ineligible? Ms. Freiburg can provide this information. What is the average cost of evaluations per child? Ms. Freiburg said their figures could only provide a gross estimate because sometimes additional evaluations are conducted after the IFSP is developed. Ms. Freiburg will look at this and provide the information she has available. What about the costs associated with annual evaluations? She will try to provide this information as well.

Ms. Berman asked if others felt the message should focus on opposing the cut in EI versus proposing alternatives so as not to water down the issue. If the cut proceeds, then alternate strategies for program savings could be offered. Ms. Saterfield said that she cannot provide strategy for advocacy but would understand if advocates wanted to oppose program cuts. Simultaneous efforts of reviewing program efficiencies may be beneficial as well. Ms. Berman clarified that what is most certain is the $23 million cut. DHS will be charged with figuring out how to live within proposed budget. She asked, though, if DHS will be directed to do this via an eligibility change or will they have discretion? Ms. Saterfield is not sure how these decisions will be made under this administration. If the budget says this is how it will be done, DHS may be directed to implement the change in this way. DHS has already been directed to provide the steps necessary for making these changes a reality and will present this information in the coming weeks. Ms. Zimmerman asked for clarification about the rulemaking process. Ms. Saterfield is unclear if this would be a regular or emergency rulemaking process. It is unclear if changes would be effective July 1 or impact the remainder of this fiscal year but nothing indicating a change for this year has been requested so far.

Are there any other options being discussed to increase EI funding? Only information Ms. Freiburg has about President's budget is that there would be $50 million dollars split between Part C/619 across 50 states. Ms. Berman pointed out how changing the numbers served impacts other funding streams as well, e.g. Medicaid and Part C. Ms. Freiburg has not received anything about any changes in Federal funding.

Margaret Harkness asked if the argument that our program could sustain cuts due to similar services now being available through ACA had been put forward. Ms. Freiburg said that she has not heard this proposal and that it would not likely work out that way since ACA is a medical, not a developmental program. Ms. Berman added that what families could access through ACA is not the same as early intervention.

Ms. Nichols requested that professional association members share information about their ongoing advocacy efforts. Benny Delgado, President of IDTA, shared efforts to date. An advocacy coalition between IDTA, IOTA, IPTA, and ISHA has been formed. They are also working on getting IAIMH and IASW to help with sharing of consistent and accurate information. The coalition is meeting regularly to share resources and coordinate efforts. They have plans to share information with both providers and families. Ms. Zimmerman asked about dates of DHS budget hearings. Ms. Saterfield has not been provided this information. Ms. Berman said that they have received information about meetings tentatively scheduled for Chicago on March 16th and April 1st. Any messages that could impact the budget should be provided prior to these dates. Ms. Zimmerman talked about a Facebook page that the coalition has established for sharing of information. Ounce also creating a landing page with resources and a "find your legislator" function. The recently created Facebook page is targeted to support parents/families of children participating in early intervention. Ms. Zimmerman can try to share letters that they receive from families with Ann, if desired. Ounce of Prevention is working on a legislative fact sheet and accompanying signatures for support. Template for family letters has already been drafted. Ms. Zimmerman and Ms. Berman have asked to be copied on letters sent to legislators and the Governor. CFCs are not prohibited from supporting advocacy efforts. Ms. Zimmerman also shared that a document that has been developed describing various ages and what varying percentages of delay would mean for children.

Ms. Berman reiterated that the primary message should be that EI cannot afford a budget cut, period. Mr. Cammarata feels that there is wisdom in also having discussions about alternatives for saving money if some cut is implemented. Council has asked Bureau for numbers around some other options. Council members could generate some additional alternatives for program savings.

Audience members brought up the following issues:

• Jennifer Barrett-Zitkus asked about maximizing private insurance use and collecting family fees. She also described the impact of providing services in EI versus the cost of services when children enter early childhood or elementary school services. Ms. Zimmerman asked if Pam Reising-Rechner could provide estimates of what it would cost ISBE if more children are not served in EI. ISBE is currently trying to collect this estimate, but it is difficult to obtain given the variations across school districts.
• Angela Pitts, Developmental Therapist, who runs her own agency provided suggestions she had gathered from providers in her area as to options for potential cost-savings: eliminate IFSP development time, decrease time allowed for evaluations/assessments, reduce the number of assessments completed in EI solely for the purpose of determining eligibility for other programs (e.g. SSI), increase the use of evaluations/assessments completed in other systems (e.g. NICU evaluations) instead of repeating evaluations, improve processes around determining which and how many evaluations/assessments are completed for eligibility, and evaluate children who are 30-40% delay sooner than at annual.
• Dr. Tomi Henek asked that a breakdown of EI costs be provided, e.g. provider payments, CFC costs, and administrative contracts.
• Kay Komie, LaRabida Hospital, talked about the EI Task Force (2010) finance committee's recommendations for cost-savings. She advised the group to look at those recommendations. She also asked that CFCs not receive cuts due to their direct support to families. Ms. Berman reminded everyone that these recommendations were provided as part of a comprehensive system improvement plan. Kay also asked about the value of involving families of young children with autism through Autism Speaks or other similar advocacy organizations. She also wants to make sure that Dr. Cutler is being involved in discussions of potential changes.
• Benny Delgado, Developmental Therapy Association, also asked about potential of raising family fees for families in uppermost income brackets.
• Drew Haverstock, IPTA representative and Milestones Therapy, an agency who provides EI services, and is the parent of a child who was involved in EI, eligible based on the delay percent currently being considered for elimination. Statistics show that the group of children we are cutting are those who respond best to intervention and are most likely to not require ongoing educational and social services in the future. Studies have shown that services provided in EI save dollars in other programs. Heckman (2007) study shows these cost-savings to society at large. Ms. Zimmerman has been in touch with Professor Heckman's staff at University of Chicago and they are trying to put something together for advocacy efforts.
• Ms. Zimmerman mentioned that ICAAP is also willing to engage in advocacy efforts on behalf of physicians who work with early intervention. Karen Vander Ploeg-Booth is putting together information.
• Rachel Wood reiterated the importance of families being heard by legislators. It is a more powerful story when families share than when providers, whose motivations might be suspected, provide testimony.
• Ms. Barrett-Zitkus reminded everyone about changes proposed ten years ago and the impact of families mobilizing on the rulemaking process.
• Ms. DeVito reminded people about involving families who have already exited EI as well.
• Susan Kaufman, Clearbrook Center, shared that Governor's desired interest in reducing Medicaid may be part of this proposed cut.

Other

1. Group asked about options for distribution, approval and posting of meeting minutes.
2. Ms. Zimmerman asked that to the degree possible, DHS get clarification about whether or not this would follow the regular or emergency rule making process and share that information with all system stakeholders.
3. Ms. Saterfield provided an update on staff vacancies. They have interviewed for Eileen's former position and hope to have someone available soon. Bureau Chief Position has been posted and candidates being reviewed in the next several weeks. Accountant position interviews scheduled for early March.
4. Ms. Zimmerman made a motion that the Council submits a letter to the Governor and the four legislative leaders outlining the Council's opposition to the proposed cut and eligibility change. It was determined that a quorum was not present so approval of this motion would need to be made when more members could participate.

Adjournment

Motion to adjourn was made by Bea and seconded by Ms. Berman. Meeting adjourned at 11am.

Contact Information

If you have any questions or require special accommodations, please contact:

Jenni Grissom
IDHS - Bureau of Early Intervention
823 East Monroe
Springfield, IL 62701

Phone: 217/524-1596

email: jennifer.grissom@illinois.gov