( – promoted by Clark)

If approved by the State Legislature, over the next three years, the Axman will come for 484 case managers from the Missouri Department of Mental Health.  So states the St. Louis Post Dispatch.  These case managers work with the developmentally disabled populations and serve clients with disabilities such as mental retardation, cerebral palsy, head injury, autism, epilepsy and learning disabilities of some types. 

Never an easy job, ( workers currently handle caseloads of some seventy individuals) the state now figures it is too expensive to afford health and retirement plans for these state employees.  According to Keith Schaeffer, Director of the Department of Mental Health, “outside groups can hire workers more economically than the state.”  Of course, Mr. Schaeffer does not elaborate on  the professional backgrounds and/or licensures, if any, that these “outside groups” will need to possess.

Needless to say, parents and family of the disabled clientele are disturbed at this callous “outsourcing” of their loved ones care to entities as yet unidentified. County mental health boards that are currently targeted for taking over were initially set up to provide or award contracts to providers of services such as group homes, transportation, workshops and various therapies. These boards are not enthusiastic about the proposed arrangement citing such reasons as fear that approved state funds may not cover sufficient services.  They also cite the fact that boards were really set up to oversee services rather than provide them. 

It is no wonder that parents and families are upset.  They know the difficulties of caring for individuals with disabilities.  They know how difficult it is to find the services their children/loved ones need. They know how often  the disabled get lost in the system.  They know that the bumping of care from subcontractor to subcontractor is a recipe for abuse and lack of accountability. They know that untrained or poorly trained workers are more frequently unable to cope with the stress of providing care for difficult clients.  We read enough about abuse of the developmentally disabled and other vulnerable members of society. 

Although unstated in the SLPD article, services provided by these case managers have traditionally been covered by Medicaid.  The overall trimming of funding for public health programs invariably effects vulnerable populations in negative ways.  The subcontracting of care for the developmentally disabled from individual case management to bulk services is a prime example of abrogation of principle and duty for the sake of cutting corners in health care. 

Kudos to State Rep, Margaret Donnelly (D) Richmond Heights who says that:

…the state, not outside groups, has the duty of looking after the care of our developmentally disabled.  The real issue is that those clients are our responsibility.