Or, Thompson and Walker approach long term care redesign in entirely different ways – A tale of then vs now.
Governor Walker’s proposed Wisconsin budget for the 2015-2017 biennium contains a major overhaul of the Family Care System. This proposal blindsided the vast majority of organizations who work with seniors and disabled individuals. It came as a complete surprise because Walker had not consulted with any stakeholders prior to proposing this overhaul. This is nothing new for Walker, who is not exactly known for having a cooperative approach on reforming laws and services for the less-than-wealthy. Walker prefers the ramrod approach. But it is new for those of us in the elder and disability community, because here in our world we have a history of coming to the table to discuss these things. This approach was put in place by a prior Republican governor, Tommy Thompson.
Before I get in to the historical background, let me briefly explain Family Care. It is Wisconsin’s community long term care program for elderly and disabled individuals. Family Care is a program that is operated through the federal Medicaid Waiver program. This means the program gets Medicaid funding and follows many of Medicaid’s rules. Family Care provides services to people who, because of their medical conditions, need help and support to stay in their homes or in a community setting such as assisted living, a group home or a supervised apartment. Many of my elderly clients who live in assisted living facilities are able to qualify for this program. Others are able to pay for services coming into their home to help with things like medication management, bathing and transportation.
Programs like Family Care are mandatory as a result of cases like the Olmstead decision in the United States Supreme Court, that found a state violated disability discrimination rules when it had long waiting lists for community care that forced people to receive care in an institution when a less restrictive setting would be appropriate.
Which brings me to the history of Family Care. Years ago, Wisconsin’s program to provide community-based long term care services was called the “Community Options Program” (and the Community Options Waiver Program). Although it was a good program for those who could get it, there were extremely long waiting lists and delays, so much so that the state and counties were being sued for discrimination and violations of federal laws. I was one of the attorneys representing elderly individuals on such a case. Governor Thompson, as well as the aging and disability community and the county governments, recognized the need for change. So in 1995, Governor Thompson convened a committee on Long Term Care Redesign to study the possibility for reworking the system to eliminate waiting lists. A history of this effort can be found here. The Redesign Committee worked for several years, formed subcommittees focused on certain issues, and held many stakeholder meetings. Family Care was born as a result. It was in Governor Thompson’s 1999-2001 budget proposal, the product of several years of study and the development of consensus among stakeholders.
But when you are Scott Walker, who needs consensus?
Walker’s redesign proposal would eliminate some important aspects of the program. First, it would eliminate the IRIS ( I Respect, I Self-direct) program, which allows participants to self-manage their own budget for their care, providing the widest latitude to create an individual program within a budget. Second, it would replace the Managed Care Organizations that operate in various districts to run the program. It would restrict participation in Family Care only to those MCOS that can operate on a statewide basis. This is NONE of the current MCOs. To operate statewide, an MCO would have to have significant capital, the kind that only large insurance programs have.Third, it transfers oversight of the MCOs to the Office of the Commissioner of Insurance instead of the Division of Health Services. Fourth, it provides a means to eliminate the current Aging and Disability Resource Centers that provide help on a local basis to seniors and disabled individuals, by allowing this service to be contracted out. There are numerous other changes proposed that are too many to go into here.
You might ask, why the changes? Well, when you are Scott Walker, why not? He must have a good reason. Like, providing big business for out of state insurance companies and putting Wisconsin MCOs out of business. Reducing the size of government by eliminating the ADRCs. Or something like that. But definitely not improving services for elderly and disabled people. That is nowhere in this equation, or else he would have had them at the table in making the decision.
Since its implementation, Family Care has eliminated waiting lists, reduced long term care costs, and increased the delivery of care and services. Is it perfect? No. Part of my job is to complain about the things that go wrong in that system. But it is effective. And changing it is something that should be done with careful consideration, not an iron Walker fist.
The reaction of most seniors at this radical change is about the same as the woman in the picture I’ve included in this post. If you feel the same, now is the time to contact your state legislators and tell them to put a stop to this. You can find your legislators by putting your address into the box on this page. You might also want to attend one of the four public hearings on the proposed budget. The dates and locations of all four public hearings are provided below:
March 18, Brillion High School, 10 a.m. – 5 p.m.
March 20, Alverno College, Milwaukee, 10 – 5.
March 23, U.W. Barron County, Rice Lake 10 – 5.
March 26, Reedsburg High School 9:30 – 4:00.
It might be the only chance that consumers get to be part of the discussion. It seems certain we won’t get an invitation from Governor Walker.