January 27, 2012
On January 19, 2012, Governor Pat Quinn announced plans to close a State psychiatric hospital in Tinley Park and a State residential facility for the developmentally disabled in Jacksonville. The Tinley Park Mental Health Center is scheduled to cease operations in July 2012, while the Jacksonville Developmental Center is expected to close in October 2012.
As discussed here and here, the two facilities were among seven previously set to close under a budget-driven plan announced by the Governor in September 2011. Those closures were averted after a budget agreement in the fall veto session of the Illinois General Assembly.
However, as part of the negotiations last fall, the Quinn administration in November 2011 issued a longer term agenda for State facilities closures. The agenda calls for the closure of up to four State developmental centers, reducing the number of residents by at least 600, and the closure of at least two State psychiatric hospitals by June 30, 2014.
The closures of the facilities in Jacksonville and Tinley Park would be the first two under the longer term agenda. The agenda is referred to as a “rebalancing plan” because it is intended to move people from institutions to community care settings. This aim supports the U.S. Supreme Court’s landmark 1999 opinion in the Olmstead case, in which the court ruled that the federal Americans with Disabilities Act requires states to provide services in the most integrated setting appropriate to the needs of individuals, consistent with an individual’s wishes and the resources available to the state.
In dealing with centers for the developmentally disabled and psychiatric hospitals, the State faces different policy issues and fiscal challenges. Illinois has eight developmental centers with a total of approximately 2,034 residents. A five-year strategic plan issued by the Illinois Department of Human Services (DHS) in June 2010 stated that Illinois should accelerate its relocation of developmental center residents into less restrictive settings to meet national benchmarks by 2017.
According to the Governor’s January 19, 2012 announcement, the State spends between $150,000 and $210,000 a year for each resident of a developmental center, compared with $45,000 to $84,000 a year for community care. Closing the Jacksonville center is expected to result in $11.7 million in annual savings, after accounting for an additional investment of $16.2 million in community services. Most residents of developmental centers are eligible for Medicaid, which means that the State is reimbursed by the federal government for roughly half of its spending on the facilities. Savings to the State would also be half as much, due to the corresponding loss of federal reimbursements.
The State operates nine psychiatric hospitals, which handled 10,272 admissions in FY2011. The psychiatric hospitals provide acute inpatient care, maximum security treatment for people referred by courts and extended care for individuals who have not responded to medical treatment. The Tinley Park center, which provides acute inpatient psychiatric care, has 75 budgeted beds but handled 1,905 admissions in FY2011. On average a patient stayed at the facility for only 11 days, according to testimony by State officials at a hearing of the legislature’s Commission on Government Forecasting and Accountability (COGFA) in November 2011. (An audio version of the hearing is available here.)
The State is currently working on a strategic plan for mental health services. Public Act 97-0438 requires that a newly created Mental Health Services Strategic Planning Task Force, composed of lawmakers, State officials, healthcare providers and community representatives, develop a comprehensive five-year strategic plan by early 2013.
According to the January 19, 2012 announcement, the State expects to save $8.1 million a year on the closure of the Tinley Park facility, after a $9.8 million investment in community services.
Unlike State developmental centers, expenses for State psychiatric hospitals are not reimbursed by Medicaid. Psychiatric hospitals are Institutions for Mental Diseases (IMDs), which are defined under the federal Social Security Act as institutions that primarily care for the mentally ill. Medicaid does not cover care for patients aged 21 to 64 in IMDs, meaning that total costs are borne by the State and total savings are realized by the State.
The physical condition of the Jacksonville and Tinley Park facilities was a factor in the decision to close them, according to the State. Due to lack of funds, the State has put off needed repairs on the facilities valued at $102.8 million for Jacksonville and $158.4 million for Tinley Park.
The State’s plan to close the facilities has already caused considerable controversy. While the Arc of Illinois, an advocacy group that favors deinstitutionalization, has praised the Governor’s decision, Council 31 of the American Federation of State, County and Municipal Employees, which represents workers at the facilities, has vowed to fight the plan.
Some mental health advocates are reportedly planning to sue the State over the Tinley Park proposal, which they believe includes no plan for serving those with serious mental illnesses in alternative locations. Patients at the Tinley Park facility are too sick to be cared for in community settings, the advocates maintain. Any lawsuit would likely be based on alleged violations of the State’s Community Services Act, which requires that savings from closing a state facility be used for other services for the mentally ill or developmentally disabled.
At the COGFA hearing, Lorrie Rickman-Jones, Director of DHS’ Division of Mental Health, said that national healthcare reform, beginning in 2014, is expected to reduce the need for public psychiatric hospitals by increasing both Medicaid eligibility and private insurance coverage. At Tinley Park, 98% of the patients currently lack insurance of any kind, public or private. Even if they were not treated at an IMD such as the Tinley Park facility, they would still not be covered by Medicaid.