FY 2022 Budget Briefing Q and A

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.

IDPH is working to establish a state-wide call center in the very near future.

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.

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.

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.

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 25^th.

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.

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.

COVID testing is available to all residents and to those with disabilities.

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.

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.

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.

The goal of this program is to raise awareness and promote early detection and treatment of disease among men and boys.

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.

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.

Total increase to the DCFS budget was $114 million which is 7.9%.

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.

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.

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.

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.

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.

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.

These rate changes will occur January 1, 2022. Aging will work with HFS to submit the rate change for Federal approval.

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.

Yes, the Illinois Assistive Technology Program is providing technical assistance to those who receive devices, along with a step by guide "how-to" guide.

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.

No

The rate increase is for Community Care Program in-home care rates which are paid to providers that employ the in-home care workers.

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.

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.

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.

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.

This line was increased in anticipation of a one-time revenue from Medicaid back claiming. This appropriation is used to support facility operational costs.

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.

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.

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.

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.

Dental, epilepsy services, Autism Program of Illinois, and other DD grants are proposed at the same level as FY21 estimated spending.

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.

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.

The overall proposed investment in the Division of Development Disabilities is over $2.0 billion.

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.

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.

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.

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.

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.

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.

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.

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.

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.

The GRF FY22 requested funding level is $20.5M.

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.

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.

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.

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.

IDHS/EI plans to continue with the telehealth therapy services on a permanent basis, if approved under the Medicaid State Plan amendment.

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.

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.

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.

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.

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.

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.

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.

The FY22 proposed budget includes $714.5M in all funds for the Division of Mental Health.

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.

The FY22 proposed budget does not include funds to support a Home and Community based waiver for individuals with mental health issues.

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.

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.

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

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.

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.

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.

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.

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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.

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.

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.

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.

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 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.

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.

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.

HFS’ Fiscal Year 2022 proposed budget assumes the COVID enhanced federal match will continue through December 2021.

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.