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Dear Editor: As members of the Milwaukee County Commission on Aging, we recently read with great interest and even greater concern the article and editorial in the Milwaukee Journal Sentinel about plans to turn over Family Care and IRIS to national for-profit insurance companies. Family Care was initiated by Gov. Tommy Thompson after several years of research and planning and has been implemented over the last 16 years through home-grown Wisconsin managed care organizations (MCOs). From the original five pilot counties in 2000 to the present 64 counties, Family Care/IRIS has eliminated waiting lists, provided quality care to 55,000 frail elders and people with disabilities, and slowed the growth of Medicaid spending on long-term care from 53 percent of the total budget to 43 percent. Ironically, the same claims that Department of Health Services now makes regarding the new plan.

While expansion of Family Care has been slow but sure, there were growing pains in implementing such an ambitious and innovative program. We can assure the members of the Legislature's Joint Finance Committee that the growing pains will be even more severe if they approve going forward without adequate information about how people will be better off and where the savings will come from. And the faster they attempt to implement it, the worse the pain will be, especially to the 55,000 frail elders and people with disabilities.

The article quoted Sen. Alberta Darling as saying, “We’re working hard to get all the information so we can make a decision.” We urge that among all the information they get answers to these questions:

1. Can DHS name one other state where the transition from Medicaid managed care to national for-profit insurance companies has gone smoothly? We know of many other states where it has not gone smoothly.

2. How can DHS all of a sudden come up with $300 million in savings over the next six years from acute and primary health care when less than 20 percent of Family Care/IRIS enrollees are not on Medicare with Medicare as the primary payer? Also, the article quotes the Legislative Fiscal Bureau saying, “Because the Department of Health Services has indicated that the primary and acute savings have already been realized … it is unclear what additional savings would be realized or other benefits gained from the integration of these services.” This statement is consistent with other DHS reports that coordination of health care by MCOs was already saving Medicaid dollars.

3. Wouldn’t the projected savings be the same if the existing Family Care program was expanded statewide? If not, why not?

4. The DHS Concept Paper states that acute and primary care “will not and cannot” be managed but will be coordinated. MCOs have been coordinating acute and primary care for the last 16 years. If the proposed new program is going to be the same, it seems logical to assume that the savings would be the same. The only difference is statewide expansion, which we could much more easily accomplish with the existing Family Care/IRIS program. Will any of the savings come from service cuts or inadequate rates?

5. What will happen if the existing MCOs, with years of experience, cannot survive the new environment and one or more of the for-profit insurance companies want higher rates? What options will the state have other than increasing rates? (This has happened in Florida and other states, and despite providing higher rates in Florida, the state recently passed a law creating waiting lists.)

In summary, the Milwaukee County Commission on Aging couldn’t agree more with the Milwaukee Journal Sentinel editorial that a rush to judgment will be a formula for disaster. We urge legislators to take their time, get evidence that people will get better services and the state will get savings, and, as most consumers said when they held public hearings around the state, if they find that it isn’t broken, then don’t fix it.

Viola “Vi” Hawkins

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Chair, Milwaukee County Commission on Aging

Bob Haase

Chair, Milwaukee County Commission on Aging Advocacy Committee

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