I know a lot about how Value Options does business because the State of Illinois Department of Mental Health began contracting with Value Options in 2007 to manage the Individual Care Grant program. The Individual Care Grant, or ICG, is a program, became law in Illinois in the 1970’s, and was revised to this current code in 1999. It’s regulations are listed under Administrative Code 59, part 135. It’s purpose, as written into the code, is:
This Part is intended to define the terms under which children are eligible to receive funds for residential placement due to their mental illness, including alternative in-home/community services in lieu of residential placement, when clinically appropriate. Funds are provided to assist parents/guardians in obtaining such services at the appropriate level of care. Among the Part requirements are two primary mandates to be satisfied so that the grant can be approved for renewal on an annual basis.
The emphasis is mine. Those are two important points.
The requirements that must be met to qualify for an ICG are stringent:
a) Parent/guardian must be a resident of the State of Illinois.b) The child must have a severe mental illness. A severe mental illness is defined as a mental or emotional disorder which substantially impairs thought, perception of reality, emotional process, judgment, behavior, or ability to cope with the ordinary demands of several life domains. Symptoms must include severely impaired reality testing and may include hallucinations, delusions, avoidance or withdrawal from human contact, marked effective instability, apathy, bizarre behavior, deficient or unusual forms of communication, agitation and/or danger to self or others. The course of the illness should indicate that the symptoms do not represent an acute episode from which rapid and substantial remission is likely.c) There has been an appropriate trial of inpatient, outpatient and/or community-based treatment efforts, and subsequently residential services are required.d) The child must not be under the guardianship of a State agency, or in the legal custody of a State agency.e) The child must be enrolled in an approved educational program at the elementary/high school level.f) A completed application package in accordance with Section 135.40 of this Part must be submitted before the child attains the age of 17 years and six months.
And Tim is as typical a child approved for an ICG as any other child who applies. I don’t have exact numbers, but there are roughly 265 children in the State of Illinois that have an ICG in place. Roughly half are in residential treatment and half are in community-based treatment. 265 may sound like a lot, but of the 3.2 million children in Illinois, that’s just 0.00008% of them. That’s just the most severely ill. But that’s not all of them.
From 1995 to 2006, before Value Options took over the management of the application review and approval process, as well as the annual renewal process for ICGs awarded, there were an average of 205 applications for ICGs every year, with an average 38.5% approval rate.
Since Value Options took over the process, there have been an average of 273 applications annually, with an average approval rate of 18%. Let’s see that graphically:
I hate these guys.. I waa constantly fighting with them over medication and prior authorizations I was very happy when new Mexico decided to stop using them. Ugh. It is inconceivably hard to explain how difficult navigation of the system as it is for yourself or a loved one it's battling a life long illness in which the sometimes easiest answer is exhausted tetreat from trying with disasterous results…. it shouldn't. Be this hard..