Late yesterday, Judge Joan Humphrey Lefkow ruled that the State of Illinois' Family Case Management grant program is part of the Medicaid program and ordered that the State immediately begin making payments to service providers. The Illinois Public Health Association, in partnership with the Sargent Shriver National Center on Poverty Law, has successfully argued that the Family Case Management program is part of Illinois' Medicaid program because of the State of Illinois' long-standing practice of claiming matching funds through the Medicaid program for Family Case Management services. As a result of this ruling, nearly $30 million will be released to Family Case Management program grantees statewide, none of whom have been paid since the fiscal year began July 1. A copy of Judge Lefkow’s order may be found here.
"We regret that this course of action became necessary," said Tom Hughes, Executive Director of the Illinois Public Health Association. "But it's our role as public health advocates to fight for the resources and services that will improve the health of all Illinoisans. As a result of today's ruling, Illinois' Maternal and Child Health system will be able to keep its commitment to expectant women and parents of newborns. This is also a life-line to local health departments and community-based program grantees across the state. Several local health departments have discontinued their Family Case Management programs and many others had scaled services back. We call on the Governor and the leaders of the General Assembly to pass a responsible budget now so that the process of rebuilding can begin," he added.
The Family Case Management program is the core of the state's effort to reduce infant mortality. The program helps to link families with a pregnant women or infant to the health and human services they need for a healthy pregnancy and first year of life. Services are provided by local health departments in most of the state, while community-based human service agencies provide services elsewhere, especially in Cook County.
Much of the program's effort is focused on helping families get to and keep going to health care providers for prenatal and well-child care. Since many of the families served by the program are eligible for Medicaid and since much of the program's effort is geared toward services that are covered by Illinois' Medicaid program, most of the funds are considered as part of the cost of administering the Medicaid program in Illinois. The program dates back to the Thompson Administration's Infant Mortality Reduction Initiative, "Families with a Future." The program has changed in size and scope since its launch in the late 1980's. Its biggest expansion came in the early 1990's when leaders in the Illinois Department of Public Health and, at the time, the Illinois Department of Public Aid met to consider how recent changes in federal Medicaid law could be used to expand the program to more families. The program expanded again in the Edgar Administration as a part of "Healthy Moms, Healthy Kids," that administration's effort to implement Medicaid managed care. It took its present form during the Ryan Administration.
The program saves money. Infants who weigh less than five-and-a-half pounds when they are born face more health and developmental challenges that infants with higher birth weights. Those who weigh less than 3.3 pounds (1,500 grams) are considered to have "very low birth weight." Nearly all of these infants are born prematurely; some are quite ill and spend the first days, weeks, or months of their lives in the hospital in neonatal intensive care units. This care is very expensive. Evaluations over several years showed that infants born to Medicaid-eligible women who participated in Family Case Management and the Special Supplemental Nutrition Program for Women, Infants and Children, better known as "WIC," had rates of low- and very-low birthweight comparable to those of non-Medicaid eligible women. Fewer high-risk births means less is spent on hospital care, saving taxpayer dollars at the state and federal levels.
Illinois' infant mortality rate, the rate at which infants die before reaching one year of age, has steadily decreased through the efforts of Family Case Management, WIC, and similar Maternal and Child Health programs. In 1980, the baseline year for planning the Families with a Future initiative, Illinois' infant mortality rate was 14.7 infant deaths for every 1,000 live births. Some of the community areas in Chicago that were targeted for intervention had infant mortality rates worse than some third-world countries; these communities were within a few miles of some of the finest hospital maternity services in the country. Recognizing that the problem had as much to do with families' need for support and assistance in obtaining care as it did with limits in services, "case management" or a planned approach to assisting women and families obtain services, was always a central part of the program.
Illinois' infant mortality rate was 6.0 infant deaths for every 1,000 live births in 2013 (the most recent data available), less than half of what it was in 1980. However, one thing about Illinois' infant mortality problem that has worsened over time is the gap in mortality rates between black and white infants. There were 2.25 black infant deaths for every white infant death in 1980 and there were 2.9 black infant deaths for every white infant death in 2013. "We are seeing the persistent effects of poverty and racism reflected in these data," Hughes remarked. Tight budgets have caused state spending for this program to shrink over the last 15 years, while costs have steadily increased for service providers. The State of Illinois' appropriation for these services was nearly $46 million in 2001 and had fallen to $36.8 million for SFY’15. "This is no time to give up, to walk away from supporting the very most vulnerable among us," Hughes said.
