Amidst record tax hike, county cuts program for poor moms, babies
Monday, July 14, 2008
by Rob Olmstead
Despite raising taxes $426 million annually earlier this year, Cook County leaders have decided to stop funding at least $1.8 million a year for a program designed to keep poor pregnant women and their babies healthy.
The move also will likely mean the layoff of 80 county employees.
County public health officials say the state program will continue on without its participation, and poor mothers and babies will receive preventive care.
But it is undisputed that as a result of the county's decision, at least $1.8 million in funding will be lost.
"I think it's concerning any time a program designed to prevent infant mortality - is eliminated," Cook County Commissioner Forrest Claypool said. Claypool said he wasn't passing judgment on the move just yet, but he indicated he would be inquiring further into the matter.
Critics of the administration also questioned the timing of the cuts, which removed the decision from the county board and put it before a brand new hospital board, meeting Friday for just the second time, even though problems with funding for the program were known as far back as March.
"I wish they (county administrators) would have told us," said county Commissioner Mike Quigley, who wondered if the cuts were deliberately delayed to ease their passage by putting them before a new board. "You can get snookered (by the administration) really easily - if you don't have the institutional memory here."
But county health administrators insist the state can provide the same amount of services more efficiently by privatizing the effort and avoiding ever-spiraling county personnel costs.
And they denied there was any delay in order to ramrod the changes through a new and unsuspecting board.
"There was no push to push this off on anyone," said Dr. Stephen Martin, the head of the county's public health department and a member of President Todd H. Stroger's administration.
The program cuts came to light Friday at the board meeting of the newly constituted Cook County Health and Hospitals System board of directors. That board was created as part of the county budget deal in February with the goal of putting county hospitals and clinics back in the black financially by turning them over to an independent board. Previously, the hospitals and clinics had been run by the county board.
While Friday's agenda contained items with as many as five paragraphs to describe innocuous contract purchases, the elimination of the poor mothers' program was referenced in just a single sentence and described as a "motion to receive report." The "report," in fact, was a move to dismantle the program.
Under the program, nurses and other county workers check up on pregnant and new mothers enrolled in Medicare and their children as old as 5. Case managers - both at mothers' homes and in health-care clinics - check in regularly with them to ensure pregnant women are eating right and getting checkups and that babies are receiving vaccinations.
The county is then reimbursed by the state for providing the services, at a contract rate of up to $6 million annually. Any money the county spent in excess of that was then partially matched at a rate of 50 cents on the dollar by the federal government. Martin said the county had been spending $1.8 million more than $6 million, and the federal government was then kicking in $900,000, for a total program cost of $8.7 million.
In March, state administrators told the county the federal match had dried up, Martin told the new board in a memo dated July 7. Martin and county officials then negotiated unsuccessfully with the state to try to get it to kick in more money.
The state made its decision not to contribute any more funds in April, Martin said.
So why didn't county officials then come to the county board, which ran the hospital system at the time?
Martin said they waited in part because the state's fiscal year didn't start until July 1.
Additionally, there was no good alternative to cuts.
"I would simply be asking them (the county board) to take something from somewhere else," he said. "That would not have gone over well either way."
To continue to fund the program, Martin said, "The county would have to steal from other county health programs to pay for a state program."
That reticence to approach the old governing body was atypical, however. Last month, the county board approved a new clinic in the Skokie courthouse. And just a month or two earlier, the board approved a long-term contract with a bill-collection agency it acknowledged the new board might not want.
Tom Green, a spokesman with the Illinois Department of Human Services, confirmed that the county had notified the agency it would not continue to administer the program.
As of yet, however, the state has not found any organization to take over administration of the program, he said.
Martin told the board there will be a transition period of four to five months while the county still provides the service because by union contracts it must provide advance notice to employees it plans to lay off. About 20 nurses are expected to be retained in other positions that were deliberately left unfilled in anticipation of the program shutdown, Martin said. But about 40 health advocates and 40 clerks will likely be laid off, he said.
Asked about the impact on mothers and children by board member David Ansell, Martin did not directly answer at first, but conceded when pressed that it could result in lower birth weights in the target group. And he acknowledged that even if the services are picked up by another agency, they will be based on a social service model, rather than the nurses the county currently uses.
The board approved the shutdown on a voice vote, with just one board member abstaining.