Chapter Update

Tuesday, November 26

Comments on The Path to Transformation Concept Paper for an 1115 Waiver for Illinois Medicaid

Joel L. Rubin, MSW, ACSW, CAE
NASW Illinois Chapter Executive Director

On behalf of the 7,000 members of the National Association of Social Workers (NASW) Illinois Chapter, I am submitting comments regarding the state’s Path to Transformation Concept Paper for an 1115 Waiver for Illinois Medicaid. 

The Medicaid reform proposal in Illinois closely aligns with the values of the social work profession. Throughout our history, the social work profession has been committed to addressing the underlying causes of poor health outcomes, and we appreciate the proposal’s explicit recognition of the growing health disparities in our society and the impact of the social determinants of health on rates of illness. 

Social workers have been strong supporters of health delivery system approaches that address the holistic needs of patients and families including home and community-based services, the patient-centered medical home, and the integrated care model. Social workers serve the health care system in many capacities including care coordination for individuals with chronic illness, behavioral health, and substance use disorder treatment. The Affordable Care Act explicitly recognizes the role of social workers as both mental health professionals and care team members within the medical home.

Social workers will play a key role in the new Illinois Medicaid program. With expertise in systems, social workers not only collaborate with other disciplines and organizations but also help clients navigate service delivery systems. As resource experts, social workers help individuals and families access the services and supports to maximize their own functioning, independence, and well-being. Social workers also bring psychosocial expertise in individual, family, and community dynamics to care coordination. Their person-in-environment perspective uniquely equips them to assess both the psychological and social aspects of each client’s situation; it also helps social workers to partner with clients in developing and implementing a plan of care that is culturally and linguistically appropriate as well as patient- and family-centered. This expertise is especially critical given the complex psychosocial issues underlying treatment non-adherence, lifestyle-related medical conditions, and caregiving gaps that pose significant barriers to coordinated care and cannot be solved with medical interventions alone. 

The following are more specific comments on the Concept paper. 

Re: Behavioral Health Expansion and Integration 

We strongly recommend establishing a rules process for PA 95-518, the social work Medicaid reimbursement law, which will enable behavioral health services to be more readily available on a community level. Public Act 95-518 authorizes (but does not mandate) reimbursement to licensed clinical social workers (LCSWs) for Medicaid-eligible services in all settings, but to date the Department of Healthcare and Family Services (HFS) has chosen not to implement the Act. The NASW Illinois Chapter has met with HFS Director Julie Hamos regarding this issue as well. 

Re: Loan Repayment 

The NASW Illinois Chapter requests that social work be included in the list of health care professions eligible for the state loan repayment program. Alleviating some of the financial burden associated with obtaining a master’s level social work degree (necessary for most positions in health care settings) will foster a stable and competent social work workforce. Loan repayment will also incentivize social workers to practice in medically underserved areas. 

During the past few years, media attention has increasingly focused on the growing burden facing college graduates as a result of debt accumulated from student loans and other educational costs. While the amount of educational debt is not confined to a particular segment of the student population, the implications are vastly different for those who choose careers like social work where salaries tend to be lower. Social workers have been identified as one group of professionals especially burdened by educational debt. The average loan debt for students graduating MSW programs in the state of Illinois is well over $30,000. Combine that with median average social work salaries of $42,000, and much lower for certain practice areas, inclusion in the list of health care professions eligible for the state loan repayment program is imperative. 

Our state’s demographics demonstrate an increasing demand for social workers, but educational debt is pushing people away from a challenging yet rewarding field. A choice to pursue a career in social work should not be a decision to live in the red. 

Re: Workforce Training (section 4C, p. 13)

We request that social work be included in the list of health care professions eligible to receive workforce training grants. With social work playing a critical role in the implementation of state Medicaid reform, we need to build and sustain our workforce capacity. Funding for training and continuing education, particularly in the areas of gerontology and chronic care management, will help us in this effort. 

According to the U.S. Substance Abuse and Mental Health Services Administration, social workers are the largest mental health providers in the country with clinically trained professionals working with those with emotional disturbances or serious mental illness. There are more clinically trained social workers than clinically trained members of psychology, psychiatry, and psychiatric nursing combined. Social workers are often the only providers of mental health services in rural areas. 

The social work profession wants to participate in achieving the vision of Medicaid reform in Illinois. Please consider our chapter as a resource as you move forward on this timely and important project. 

Posted on 11/26/13 at 02:30 PM

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