INdiana Systemic Thinking

February 16, 2008

Disability Centers FINALLY Get Funding

Following up on my posts from here and here, the Indiana Family and Social Services Administration has finally decided to give up the 2.5 million last years legislature appropriated to disability agencies.  However, FSSA still bullied the agencies into “agreeing” to some form of “reporting”, which isn’t being explained well.

According to the Fort Wayne News-Sentinel;

FSSA Secretary Mitch Roob said state funding to the centers, once as little as $40,000, has grown to the point where the administration and the Legislature needed assurances that taxpayers were getting their money’s worth.

Hmmmm, I guess we really need to thank Sec. Roob for appointing himself disability appropriations god.  I mean, of course the legislature didn’t think they were getting their money’s worth when they passed the measure, nor did the Governor when he signed the legislation.  Hey, I an idea, lets save a bunch of money and get rid of both the legislature and Governor and let Sec. Roob make all the decisions.  Oh wait, he already is!

February 8, 2008

State Gets 21k Applications for HIP, But…

Yesterday we got news the state received 21,000 applications for the Hoosier Insurance program.  However, and what really matters is, only a fraction of those have been approved.  According to the Fort Wayne News Sentinel:

While the state took 21,101 applications between mid-December and Wednesday, it has processed only 6,198, Roob said. FSSA is meeting the CMS requirement that applications get processed within 45 days, he said.

Of those processed, FSSA has rejected about a fifth for a variety of reasons, including exceeding income limits or eligibility for employer-sponsored plans, Roob said.

Another 3,392 applications, or more than half of those processed, remain pending approval, and Roob said he expects many of those came from applicants with children, since the state requires more paperwork from them.

Only 295 of the applicants have received full approval, and 1,299 others have conditional approval.

FSSA has hired 46 additional people to staff the health plan, , Roob said. The agency expected to enroll only 50,000 people this year.

At this rate, only about 1,800 will be enrolled by the end of the year.  Hope they get those additional people hired soon as there is certainly demand.

January 24, 2008

Wellpoint Cherry Picking

In a follow up to my post from yesterday regarding and increase in profits (by 7%) by Wellpoint, Anthem’s parent company, comes this news from the Indianapolis Star.  Apparently increasing profit by 7% isnt good enough and executives with the company continue to want more, more, and more…

However, the company also reported that during the quarter, it paid out 82.9 percent of each premium dollar for care — a measure called the “medical loss ratio” in industry jargon — up from 81 percent a year ago.

The increased medical spending came from WellPoint’s commercial business and higher-than-expected medical claims in the company’s Medicaid contracts in Ohio and Connecticut. WellPoint said it is terminating its contract with the Ohio Medicaid program because it was unable to reach an agreement with the state that would allow the company to participate in a “financially responsible manner.”

Just as a reminder, Anthem was one of the companies chosen by the Indiana Department of Family and Social Services Administration to administer Indiana’s Medicaid Program.

January 22, 2008

FSSA to Pay For Substance Abuse Program

Finally, someone, somewhere, is looking at treating Substance Abusers.  In an area where money is usually non existent, comes this from the Indianapolis Star about a pilot program in Vigo County.

The Indiana Family and Social Services Administration has been awarded $14.49 million over three years for the Access to Recovery program.

That includes more than $1.44 million annually targeted to people recovering from meth addictions, which will be the focus of the Vigo County program. He said 30 percent of the program’s money must be spent on meth users.

Addiction treatment providers, include faith-based agencies, will apply to participate in the program, Scott said. The agencies are reimbursed for services from state vouchers. Services include care coordination, clinical treatment and recovery support.

January 21, 2008

Anthem CEO Interviewed: Wants MORE Business

From the Indianapolis Star this morning comes an interview with the new CEO of Anthem.  Really nothing new (about Anthem) in the article and the reporter asked a lot of softball questions.  What was new, at least to the Blogmeister, is Anthem’s new buddy-buddy relationship with M-Plan who has apparently decided they cannot compete with Anthem and is giving them a large portion of their business. 

Say what you want about the government running a single payor health system, but it appears Anthem is well on their way to providing a private single payor health system, at least in Indiana.  As you read the quote from the story below, keep in mind WellPoint, Anthem’s parent company, according to CNN, made almost 57 billion dollars in 2006 (2007 isn’t available yet).

Anthem Blue Cross and Blue Shield of Indiana is big and it’s getting bigger.

The healthinsurer, part of Indianapolis-based industry giant WellPoint, provides health benefits for roughly 2.5 million Hoosiers. Anthem controls about 60 percent of the commercial health insurance market statewide, according to an analysis by the American Medical Association.

Robert Hillman took the helm of that insurance behemoth when he was named president of Anthem Blue Cross and Blue Shield in Indiana last October.

These are busy times at Anthem. The insurer has been working — under an endorsement agreement with M-Plan, a 125,000-member Indianapolis health maintenance organization that is shutting down — to gain new members. Anthem also is helping to run Indiana’s Healthy Indiana Plan, which provides coverage for low-income Hoosiers.

But Anthem also is involved in high-profile disputes with two physician practices over reimbursement rates and frequently is criticized for selling coverage that many say is simply unaffordable.

Hillman talked with The Star last week after his first few months leading Anthem in Indiana. This is an edited transcript of that conversation:

Question: What are your biggest priorities?

Answer: The primary goal is to make sure we fulfill our mission, which is to improve the lives of the people we serve and the health of our community. We’re looking at making sure that we continue to deliver products that provide value to our customers and that we’re participating in programs that are really improving the health and wellness not only of our members but also the community at large.

Q: Given Anthem’s large market share, where do you see the biggest potential for growth?
A: We still think the consumer- directed market is a big market opportunity for us. The other, obviously, is the uninsured market, particularly in the two- to 50- employee market, where you have really an alarming number of employers who are electing not to participate in the private health- care market and are dropping their health-care coverage.

It’s an opportunity to develop products that bring those folks back into the private payer market.

Q: How much business did Anthem capture from M-Plan shutting down its HMO business? Has the transition been smooth?

A: Well over 50 percent (accounting for 75,000 to 80,000 new Anthem members) of that business transitioned over from M-Plan.

The transition went really smoothly because the partnership with M-Plan, once they decided to exit the business, the cooperation on their part in working not only with our sales team but also our operations team, you couldn’t have asked for a better number.

Q: Indiana has roughly 750,000 people who are uninsured. As the state’s largest commercial health insurer, does Anthem share in the blame for the large number of people who find health coverage unaffordable and unattainable?

A: I don’t think there’s any single payer that’s to blame. We’re all operating in the system that we’re operating in, which is the private payer system, which is an employer-based system. No employer is required to offer health insurance, nor is any (insurer) required to offer health insurance.

What I do think we have an obligation to do, and it’s a challenge, is to try to develop products that are affordable and that provide value to employers and their employees so they want to participate in the private-payer system.

We have an obligation to cooperate whenever we can and however we can with government, like we have cooperated with Gov. Daniels and his Healthy Indiana program.

10% Laid Off At Dunn MHC

Calling it a “temporary reduction in force”, Dunn Mental Health Center is saying goodbye to 29 employees, according to the Indianapolis Star.  This accounts for almost 10% of their workforce.  Not wanting to sound partisean, here is the whole story from the Star.  Remember, she said it, I didnt.

Twenty-nine employees of Dunn Center Mental Health in Richmond have been laid off, said CEO Kay Whittington on Sunday.Whittington called the “temporary reduction in force” a result of Gov. Mitch Daniels’ proposed cuts in Medicaid and a bill that could limit how much Medicaid communal health centers may offer.
Dunn Center is comprised of a staff of more than 300.”We have had a temporary reduction in staff across (the) seven counties that we provide services to,” Whittington said.The Dunn Center is a Medicaid provider, and the state government has “dramatically reduced what (the center) can do for Medicaid rehabilitation options,” Whittington said.Gov. Mitch Daniels said in early January a new budget forecast that shows state revenue falling below predictions could lead to some cuts “in some of the entitlement programs like Medicaid.””It all relates to that,” Whittington said.Five of the 29 positions laid off are part-time and the rest are full-time, and Whittington said many of the employees were offered a transfer into other positions.

Whittington said she knows of other communal health centers in the state that have laid off workers.

“We’re all faced with the same thing,” she said. “You can’t wait for the ship to sink.”

Whittington will be available for further details about the situation today, she said.

“We wanted to make sure our staff had the weekend to think about (transferring).”

January 20, 2008

Drug Test Welfare Recipients?

The Evansville Courrier Press has a good story about a Kentucky lawmaker who wants to start drug testing people who rely on various welfare programs.  The argument for this seems to be that many people in the private sector have to undergo drug tests for their money, so why shouldn’t welfare recipients.  The argument against it is what do you do with the children of parents who test positive?  In addition, there is this bit of history:

Michigan briefly required drug tests for welfare recipients in 1999, but was ordered by a federal judge to stop just weeks into the program when the American Civil Liberties Union filed suit. After a federal appeals court in Cincinnati ruled the law unconstitutional in 2003, Michigan officials reached an out-of-court settlement with the ACLU, agreeing to stop the drug-testing program.

So, this legislation probably won’t go anywhere in Kentucky, but if it does, it may come our way soon.

Bills and Resolutions Updated

Here are the current bills and resolutions filed in the statehouse this week.  The master list has been updated and is here.  This should be the all the filings for this legislative cycle, if the state web site is up to date (and thats a big if). 

House:

  • HB 1218 — Eminent domain issues.
  • HB 1219 — Unemployment insurance.
  • HB 1220 — Transportation tax area.
  • HB 1221 — Operating a vehicle recklessly.
  • HB 1222 — Death taxes.
  • HB 1223 — Sales tax exemption for road material recycling equipment.
  • HB 1224 — Transfer fees.
  • HB 1225 — Illegal alien matters.
  • HB 1226 — State licensure of towing services.
  • HB 1227 — Shoreline development commission.
  • HB 1228 — Sheriff’s compensation.
  • HB 1229 — Fresh start income tax credit.
  • HB 1230 — Redistricting commission.
  • HB 1231 — Mechanic’s liens.
  • HB 1232 — Criminal history checks.
  • HB 1233 — Grandparent visitation.
  • HB 1234 — School attendance records and enforcement.
  • HB 1235 — Deduction for postsecondary tuition.
  • HB 1236 — Local spending caps.
  • HB 1237 — Extra heavy duty highway route.
  • HB 1238 — Year to year tenancy on land used for agriculture.
  • HB 1239 — School improvement progress and awards.
  • HB 1240 — Restrictions on public benefits to illegal aliens.
  • HB 1241 — Lottery advertising.
  • HB 1242 — Business tax matters
  • HB 1243 — Retractable tire studs.
  • HB 1244 — Common school fund; certification fee.
  • HB 1245 — Transit districts.
  • HB 1246 — Student graduation plan and online learning.
  • HB 1247 — Taxes on motor fuel; mass transit funding.
  • HB 1248 — Law enforcement continuing education program court fee.
  • HB 1249 — Tuition exemption for Purple Heart recipients.
  • HB 1250 — State park development and funding for the NAIAC.
  • HB 1251 — Various property tax matters.
  • HB 1252 — Property tax relief.
  • HB 1253 — Manual on uniform traffic control devices.
  • HB 1254 — Animal cruelty.
  • HB 1255 — Valuable metal dealers.
  • HB 1256 — Distributed generation facilities.
  • HB 1257 — Judges’ pensions.
  • HB 1258 — Methadone clinic drug testing and minors.
  • HB 1259 — Child safety and CHINS.
  • HB 1260 — Encoded ammunition.
  • HB 1261 — Study commissions.
  • HB 1262 — Police enforcement of federal immigration laws.
  • HB 1263 — Lake County innkeeper’s tax.
  • HB 1264 — Limitation on school starting date.
  • HB 1265 — Land surveyor registration.
  • HB 1266 — Eligibility criteria for Medicaid waiver.
  • HB 1267 — LIFE Scholarships.
  • HB 1268 — Regulation of cigarette retail sales.
  • HB 1269 — Employee classification.
  • HB 1270 — Greendale local taxes.
  • HB 1271 — Inmate credit time.
  • HB 1272 — City legislative bodies.
  • HB 1273 — Compensation for emergency or disaster training.
  • HB 1274 — Illegal alien matters.
  • HB 1275 — Local government copying fees.
  • HB 1276 — Bail.
  • HB 1277 — State economic development incentives.
  • HB 1278 — Reporting tax violations.
  • HB 1279 — ISTEP for students with disabilities.
  • HB 1280 — Energy efficient buildings.
  • HB 1281 — Property tax exemptions.
  • HB 1283 — Unemployment insurance benefits fees.
  • HB 1284 — Group insurance.
  • HB 1285 — Limit on sex offender as guardian or custodian.
  • HB 1286 — Library services authorities.
  • HB 1287 — Home health agency expenditures.
  • HB 1288 — Certification for behavior analysts.
  • HB 1289 — Electronic waste.
  • HB 1290 — Older youth foster care.
  • HB 1291 — Unauthorized aliens.
  • HB 1292 — Flags on public buildings to be made in USA.
  • HB 1293 — Homestead deduction application.
  • HB 1294 — County option dog tax on kennels.
  • HB 1295 — Fees for spinal cord and brain injury fund.
  • HB 1296 — State funding of child welfare services.
  • HB 1297 — Publication of notices.
  • HB 1298 — Communications and public safety answering points.
  • HB 1299 — Sex offender residency.
  • HB 1300 — Labeling standards for milk.
  • HB 1301 — Expungement of certain felony conviction records.
  • HB 1302 — Custodial interrogation recording.
  • HB 1303 — Contracts for operation of animal shelters.
  • HB 1304 — Diesel fuel inspection program.
  • HB 1305 — Public safety funding.
  • HB 1306 — State spending cap.
  • HB 1307 — State spending cap.
  • HB 1308 — College readiness program.
  • HB 1309 — Repeal of valuation method for certain property.
  • HB 1310 — Faculty member on university boards of trustees.
  • HB 1311 — Medical care for town firefighters.
  • HB 1312 — County drain maintenance funding.
  • HB 1313 — Inmate employment counseling and searches.
  • HB 1314 — Expungement of certain conviction records.
  • HB 1315 — Automated traffic control systems.
  • HB 1316 — Sales tax holiday.
  • HB 1317 — Spinal manipulation.
  • HB 1318 — Funding for spinal cord and brain injury research.
  • HB 1319 — Assessment of forest land for taxation purposes.
  • HB 1320 — BMV fees for law enforcement academies.
  • HB 1321 — Veterans’ jobs tax credit.
  • HB 1322 — Mandatory ethanol level in gasoline.
  • HB 1323 — Dialysis treatment coverage.
  • HB 1324 — Disclosure of event data recorders.
  • HB 1325 — Contractor performance bonds.
  • HB 1326 — Commission on Hispanic/Latino affairs.
  • HB 1327 — Property tax deductions.
  • HB 1328 — Testing of special education students.
  • HB 1329 — Sex offenses and children.
  • HB 1330 — Eliminate sales tax on gasoline.
  • HB 1331 — Expense advances to driver employees.
  • HB 1332 — Trustee duties concerning life insurance.
  • HB 1333 — State reimbursement of child services costs.
  • HB 1334 — Annexation.
  • HB 1335 — Child visitation and electronic communication time.
  • HB 1336 — County government reorganization.
  • HB 1337 — Elimination of property taxes.
  • HB 1338 — Property tax elimination.
  • HB 1339 — Drug testing of welfare recipients.
  • HB 1340 — Privatization review committee.
  • HB 1341 — Ports of Indiana.
  • HB 1342 — Electronic health records system.
  • HB 1343 — Health insurance coverage for children under age 24.
  • HB 1344 — 1985 judges pension fund.
  • HB 1345 — Trespass.
  • HB 1346 — Loan broker commission.
  • HB 1347 — Excise tax on recreational vehicles and campers.
  • HB 1348 — Review of total debt and lease burden on taxpayer.
  • HB 1349 — State spending cap.
  • HB 1350 — Police enforcement of federal immigration laws.
  • HB 1351 — Game preserve licenses.
  • HB 1352 — Appraisals and assessment reviews.
  • HB 1353 — Property tax benefits for seniors.
  • HB 1354 — Disaster relief fund.
  • HB 1355 — Donations by local units to community foundations.
  • HB 1356 — Donor withdrawal of property from institutions.
  • HB 1357 — Marion superior court magistrates.
  • HB 1358 — Civil rights.
  • HB 1359 — Various financial institutions matters.
  • HB 1360 — Mortgage lending issues.
  • HB 1361 — Nutritional information at food establishments.
  • HB 1362 — Nonprofit and county hospitals.
  • HB 1363 — Solid waste management districts.
  • HB 1364 — Long term care coverage.
  • HB 1365 — High school athlete steroid testing.
  • HB 1366 — High school IEP diplomas for students with a disability.
  • HB 1367 — Reclassification of manufactured homes as real property.
  • HB 1368 — Industrial waste products.
  • HB 1369 — Defenses to controlled substance offenses.
  • HB 1370 — State forests.
  • HB 1371 — Marion County airport authority.
  • HB 1372 — Selection of superintendent of public instruction.
  • HB 1373 — School board elections at general election time.
  • HB 1374 — Public works projects.
  • HB 1375 — Judges pensions.
  • HB 1376 — Drug courts and children in need of services.
  • HB 1377 — Crimes of violence.
  • HB 1378 — Indemnification requirements in state contracts.
  • HB 1379 — Viatical settlements.
  • HB 1380 — Distribution of Lake County Income Tax.
  • HB 1381 — Annexation.
  • HB 1382 — Redistricting commission.
  • HB 1383 — Lobbying by former legislators.
  • HB 1384 — Various economic development matters.
  • HB 1385 — Restrictions on public benefits to illegal aliens.
  • HB 1386 — Validating certain law enforcement actions.
  • HB 1387 — Personal needs allowance.
  • HB 1388 — Vehicle Bill.
  • HB 1389 — Vehicle Bill.
  • HB 1390 — Vehicle Bill.
  • HB 1391 — Vehicle Bill.
  • HB 1392 — Vehicle Bill.
  • HB 1393 — Vehicle Bill.
  • HB 1394 — Vehicle Bill.
  • HB 1395 — Vehicle Bill.
  • HB 1396 — Vehicle Bill.
  • HB 1397 — Vehicle Bill.
  • HB 1398 — Vehicle Bill.
  • HB 1399 — Vehicle Bill.
  • HB 1400 — Vehicle Bill.
  • HB 1401 — Vehicle Bill.
  • HB 1402 — Vehicle Bill.
  • HB 1403 — Vehicle Bill.
  • HB 1404 — Vehicle Bill.
  • HB 1405 — Vehicle Bill.
  • HB 1406 — Vehicle Bill.
  • HB 1407 — Vehicle Bill.
  • HB 1408 — Vehicle Bill.
  • HB 1409 — Vehicle Bill.
  • Sentate:

    •  
      • SB 0336 — Stroke prevention task force.
      • SB 0337 — Direct wine sales.
      • SB 0338 — Electronic registration and titling of vehicles.
      • SB 0339 — Various motor vehicle matters.
      • SB 0340 — Prosecuting attorney pensions.
      • SB 0341 — Explanation of proposed constitutional amendments.
      • SB 0342 — Exemption of nonbusiness personal property.
      • SB 0343 — Theft of copper and other valuable metals.
      • SB 0344 — Police officer and firefighter appointments.
      • SB 0345 — Collection of unemployment contributions.
      • SB 0346 — Property tax circuit breaker.
      • SB 0347 — Dangerous communicable diseases.
      • SB 0348 — Child product safety.
      • SB 0349 — Sales tax increment financing feasibility study.
      • SB 0350 — Funding for community mental health centers.
      • SB 0351 — Property tax limitations and procedures.
      • SB 0352 — Various financial institutions matters.
      • SB 0353 — Office of the child advocate.
      • SB 0354 — Parole eligibility.
      • SB 0355 — Cemeteries.
      • SB 0356 — Possession of handguns on public property.
      • SB 0357 — Expungement of criminal offenses.
      • SB 0358 — Voter deception.
      • SB 0359 — Enhanced 911 systems.
      • SB 0360 — E85 fueling station grants.
      • SB 0361 — Treasurer of state.
      • SB 0362 — Interstate enforcement of protective orders.
      • SB 0363 — Uniform emergency health practitioners act.
      • SB 0364 — Child abuse or neglect reports.
      • SB 0365 — Law enforcement training funding.
      • SB 0366 — Standards for tutoring services.
      • SB 0367 — Financial responsibility for carriers of property.
      • SB 0368 — Teacher professional development days.

    January 14, 2008

    Roob Continues to Balk, Won’t Pay Up

    Back on November 25, 2007 I posted on the Family and Social Services Administration not following legislative directives by withholding payment to  seven centers around the state.  According to the Fort Wayne Journal Gazette, Mitch Roob continues to balk at paying up.  Despite “some movement”, Roob continues to want the centers to contractually agree to goals and objectives and continues the mantra “that a higher level of review [is] attached to the new money”.  Now, this softening is not because Roob felt like being a nice guy.  Apparently, a few legislators are ticked and this has caused Roob to soften somewhat.  However, at least one of the Directors of these centers is talking, and he says Roob is funding the increase, not with money allocated by the legislature, but by funds already available to FSSA.  Those funds, the Blogmeister would guess, probably require the accountability Roob wants from the centers.   Legislators have told the Centers not to sign the contract because if the money the legislature allocated to them is not used, it will revert back to the general fund and will take additional legislation to allocate more.  Therefore, it will not be available in the future.  So, if the centers sign they will get their money, from other sources, this year, but there is no guarantee of future funding. 

    The big question here is:  Why won’t Roob fund the centers with the money allocated by the legislature?  My guess is he has access to some big federal dollars he has to use, which require the accountability.  He may not be able to come up with a single program, but by combining a bunch of programs he can get the money.  He can then look like a great guy because he saved the state a bunch of cash.  However, it doesn’t appear, if my guess is correct, that the pile of scratch he can get his hands on is a sure thing in the years to come.  Anyone have any better ideas?

    January 11, 2008

    Charity Bailey’s Records Released: Police @ Phoenix

    Last week Charity Bailey’s records were released from the Marion County Juvenile court.  According to the Indianapolis Star:

    The 20-year-old Indianapolis woman now sits in a jail cell, accused along with her live-in boyfriend of killing her 3-year-old daughter, TaJanay, in November.
    Bailey’s alleged role in TaJanay’s death is the latest twist in a troubled life detailed in an unusual release of juvenile delinquency records Friday.
    Those records reveal a childhood fraught with drugs, sexual abuse and family discord — and a long list of interventions that failed to turn around her life.

    The article is really long and almost…almost…makes one feel sorry for her.  It’s a good example of what we in the therapy world call transgenerational issues.  Simply put, the term means issues that travel from on generation to the next.  It’s not an excuse for behavior, because every adult can change their circumstances, but an explanation for how these things happen.

    On a related note, the Indy Star has another story about the police and prosecutor opening offices in the Phoenix apartment complex where Tajanay died.
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