Compassion meets efficiency

Chicago Tribune Editorial
May 28, 2003

Even though the state is facing a $5 billion budget deficit, the Democratic-controlled Illinois Senate last week advanced spending bills that would cost the state nearly $400 million more than what Gov. Rod Blagojevich presented in his budget.

That's too often the natural inclination for lawmakers, to seek ways to spend money without bothering with the follow-up question: And how will you pay for that?

But that has to be the question of the week as legislative leaders try to fashion a responsible budget. That has to be the question for every lawmaker who wants something in this budget.

It can be done. Here's a fine example.

Reps. Julie Hamos (D-Evanston) and Sara Feigenholtz (D-Chicago) have been working for years to address the state's dire need for more affordable, supportive housing for the homeless and the mentally ill. If they could find $3.5 million in the state budget, they could access $41 million in federal commitments. That would create 1,100 units of neighborhood housing designed to help these vulnerable individuals.

They didn't just find $3.5 million. They found a way to make far, far more effective use of the money Illinois spends on these services.

Hamos and Feigenholtz recommended that $13 million be taken from a state fund that pays for 28 nursing home facilities that house large numbers of mentally disabled residents.

The state and federal government share the cost for most low-income residents of the state's 800-some nursing homes. But when mentally ill residents occupy more than half the beds in a nursing home, they are called Institutes for the Mentally Diseased and the entire cost of care has to be borne by the state.

That's the case in these 28 nursing homes.

The federal government refuses to pay for mentally ill residents in these settings. But as soon as one of those residents moves into a neighborhood-based setting, the feds will cover half the cost.

Easy answer: Put the state's money in community care rather than the institutions, and leverage millions in federal revenue.

Not so easy, it turns out. The nursing home industry lobby is working furiously to protect its revenues. The operators of these 28 facilities desperately want to keep their clientele, because it is far less expensive to care for mentally ill residents than it is for geriatric residents. The profit margins, according to Hamos, can be huge.

Under that intense lobbying, the $13 million transfer has since been whittled down to $5 million. Even that amount stands in danger of being chipped away more as budget negotiations continue this week.

So here is a prime example of where an opportunity to make far more efficient use of state money may be lost because of special interest lobbying. A prime example of what Gov. Blagojevich is fond of calling "business as usual."

Illinois and other states are under obligation, because of a 1999 Supreme Court ruling known as the Olmstead Act, to give mentally and developmentally disabled residents a full range of choices about where to live and, to the extent possible, place them in settings integrated into communities.

Hamos and Feigenholtz have devised a clever way to work toward that goal while increasing the number of homes that give mentally ill and homeless residents a chance to live independently and productively. Efficient, compassionate government. So why is this still under debate?