Some advocates for the disabled and elderly have long pushed Dane County to adopt Family Care, saying more people would get home care, transportation, job assistance and other supportive services through the state Medicaid program.
But now that Gov. Scott Walker’s proposed budget requires Dane County and seven other counties to join Family Care, the advocates are backing off their plea.
Instead, they’re attacking Walker’s plan to replace Family Care’s regional structure with a statewide insurance model that would include medical care. The changes could reduce services and eliminate choices, they say.
“Family Care as it exists now will vanish,” said Barbara Katz, of Madison, whose 23-year-old son, Ben Fleischman, is developmentally disabled and receives supportive services. “I don’t want Family Care as envisioned in Walker’s budget to come to Dane County.”
Tom Frazier, former executive director of the Wisconsin Coalition of Aging Groups, said the proposed changes “would take away choice of where to get health care.”
Kitty Rhoades, secretary of the state Department of Health Services, said the Family Care changes would slow spending growth and a related proposal requiring independent assessments of personal care would reduce fraud and abuse.
“The governor’s Family Care reforms end the state’s fragmented delivery of health and long-term care, while establishing the focus on the overall health and well-being of our members,” Rhoades said in prepared testimony to the Legislature’s Joint Finance Committee.
The Family Care proposal would save $6 million in state money and $8.4 million in federal money over two years because of contributions from counties joining the program, according to the nonpartisan Legislative Fiscal Bureau. There is no estimate of savings from the structural changes.
Independent assessments of personal care would save $7.6 million in state money and $12 million in federal money over two years, a significant portion of it in Dane County.
Dane County’s approach
Family Care started in 2000 as a managed care alternative to traditional Medicaid programs that offer long-term care services to the frail elderly and people with physical and developmental disabilities. The supportive services are designed to keep people out of nursing homes.
Sixty-four of Wisconsin’s 72 counties have Family Care or are implementing it, leaving Adams, Dane, Florence, Forest, Oneida, Rock, Taylor and Vilas counties without it. Under the proposed budget, the counties would have to join by 2017.
Dane County has provided richer services by continuing the traditional programs and contributing county money — roughly $17.6 million a year — that brings in federal matching funds, said Lynn Green, director of the county’s Department of Human Services.
The richer services include more home care, transportation and job assistance, along with housing many people in duplexes instead of larger facilities, Green said. In addition, many people get personal care, or help with eating, bathing and dressing, she said.
But some advocates say Dane County’s approach has left a perpetual waiting list that would vanish under Family Care, an entitlement program.
The waiting list currently has 585 people, but not all would be impacted by Family Care, Green said. Advocates say additional people are waiting for services but aren’t on the list because they’re receiving at least one service.
The county was preparing for the likelihood of a required switch to Family Care within five years, but the budget proposal to do so by 2017 is “rather abrupt” and “overly ambitious,” Green said.
About 2,000 county residents receive long-term care services, nearly two-thirds of them adults with developmental disabilities. Green said about 30 county jobs will be eliminated when the county adopts Family Care, a move that could also affect local agencies that provide many of the services.
Under Family Care, Dane County would pay $17.6 million to the state the first year, an amount that would gradually drop to $3.9 million a year. County officials are concerned that the switch to Family Care would diminish services for the disabled and elderly, but it would free up county money for other needs such as adult mental health care, Green said.
Statewide, more than 41,000 people are in Family Care and another 11,000 use an alternative program called IRIS, which stands for Include, Respect, I Self-Direct.
The fiscal bureau said that under Walker’s proposals, some subject to federal approval, the state would be able to:
• Require all counties to adopt Family Care.
• Select certified insurance companies to run Family Care statewide, replacing eight managed care organizations operating in regions.
• End a competitive bidding process for contracts and a required review of Family Care expansion by the Legislature’s Joint Finance Committee.
• Include acute and primary care with supportive services, instead of offering the medical care as a separate Medicaid benefit.
• Eliminate IRIS, which lets people choose their services instead of working with a managed care organization. People could still self-direct within Family Care.
• Contract with a private provider to replace some or all benefits assistance provided by 41 county-run Aging and Disability Resource Centers. ADRC governing boards and regional long-term care advisory committees would go away.
Require an entity that doesn’t provide personal care to assess how much personal care recipients need, instead of allowing providers to do so.
The reforms will “strengthen the service delivery system and ensure that members continue to have choice and input in the delivery of their total care,” Rhoades said. “Additionally, these reforms will make the program more financially secure into the future and keep members in their own home.”
Madison-based Care Wisconsin, one of the managed care organizations that operate Family Care today, might be able to meet the new requirements to become a statewide provider, said Karen Musser, president and CEO.
“We have many of the elements that are in there,” Musser said.
Care Wisconsin, which has more than 400 employees, soon will operate Family Care for about 5,000 people in 26 counties and could ramp up to do more, Musser said. In some counties, including Dane, the agency runs a self-directed alternative that includes medical care, she said.
Katz, co-director of the disabilities group Family Voices of Wisconsin, said the new structure could jeopardize supportive services by combining them with medical care in contracts run by insurance companies.
“It’s a dismantling of a very successful system,” said Katz, whose son receives transportation and employment assistance for three part-time jobs and work as an artist.
“My fear is that he would no longer receive the vocational supports he needs to be a contributing taxpayer and have a fulfilling vocational life,” Katz said.
Helen Hartman’s 26-year-old daughter, Hannah Kitzman, has Down syndrome. Hartman, of Madison, said she is pleased with the residential and vocational services Kitzman receives. “I don’t understand what possible reason there would be to change the system we currently have,” she said.
Frazier, the advocate for the elderly, said statewide insurance companies likely would restrict people’s choices of doctors and other providers.
Lisa Pugh of Disability Rights Wisconsin and Jim Hoegemeier of the Arc-Wisconsin Disability Association said they were caught off guard by the proposed changes. “There was no stakeholder input,” Pugh said.