Working for Illinois Caucus

SPRINGFIELD – An Illinois advocacy group is pushing legislation it says would bring $50 million in new money to state mental health services over the next four years.

According to the Illinois Coalition for Better Mental Health Care, more than 2.5 million Illinoisans have a mental health condition.

But the state ranks only 38th in the nation for mental health investment, while 82 of its 102 counties are designated as mental health professional shortage areas by the federal government.

Two lawmakers, Rep. Deb Conroy (D-Villa Park) and Sen. Heather Steans (D-Chicago), are sponsoring legislation – House Bill 2486 and Senate Bill 1673 – that would ramp up state mental health funding and change the funding structure to incentivize good results over flat service fees.

“Thousands of Illinois families … are victims of our mental health crisis,” Conroy, who heads the House Mental Health Committee, said Monday in a news release. “By creating a multiyear solution to reinvest and restructure our mental health programs with targeted, federally matched dollars, we can provide renewed hope to the millions affected.”

Most of the services targeted by the bills are Medicaid services, for which the federal government matches funding.

“The phase-in of rates that would enable growth of [mental health services] would happen slowly over a four-year period,” said Heather O’Donnell, who drafted the legislation and is vice president at Chicago-based mental health group Thresholds.

In year one, Illinois would provide $3.4 million of new funding, to be matched by the federal government. In year two, $5.7 million; in year three, $10.7 million; and in year four, $13 million.

After four years, O’Donnell said, the state would pay no more than $13 million in additional mental health funding in any given year, while the total new funding for state mental health services would reach more than $50 million with federal matching.

The state would also have to cover startup costs in years three and four, and bring additional funding to components of the bill that are not matched with federal funds.

So, although this federal matching would provide a much-needed funding boost, it is not clear where the new state money would come from.

“Preferably it would be new revenue,” O’Donnell said. “Some of it could come from the legalization of cannabis, but we are not specifying revenue sources [in the bills].”

Conroy agreed, saying “we’re all hoping for new revenue,” particularly from internet gambling and legalized marijuana.

“I know there is a commitment that some of the revenue from cannabis will go to mental health and addiction services, so that’s on the table,” Conroy said without discussing specifics. “And I do believe the commitment [to mental health and addiction] is there from the governor. He’s made it clear that’s a priority for him.”

Without specific funding plans, the bills more or less just lay groundwork for the new funding and changed payment methods.

Those changed payment methods deal with how mental health providers get money for the services they provide.

Currently, nearly all Medicaid contracts with mental health providers in Illinois are fee-for-service – the providers provide the service, and get reimbursed a specified fee.

The bills claim that this structure “allows for no innovation” in providing better services, because there is no reward for better outcomes and efficiency.

If passed, the bills would create a working group of providers, managed care organizations and state health workers, to figure out a set of metrics to “bring the regulatory structure in line with modern health care,” O’Donnell said.

These metrics would drive a new “pay-for-performance” structure, which providers could opt into each year, or opt out of after two years if they don’t like it.

Both bills await further assignments to committee.