We have closely followed the Governor's proposed changes to Wisconsin's long-term care programs for people with disabilities and older adults. Many advocates for people with disabilities and older adults expressed significant concerns regarding these changes because they were concerned that the Governor's proposal would undermine several existing programs that have successfully empowered people to access long-term care in their homes so that they could remain active members of their communities and avoid receiving long-term care in nursing homes.
Last week, the Joint Finance Committee (JFC) passed a sweeping omnibus motion along party lines that made significant changes to the Governor's proposal. Many of these changes were in direct response to concerns raised by advocates. However, many advocates remain concerned that, if enacted, the changes approved by the JFC will undermine many of the successful aspects of Wisconsin's long-term care system. Below is a summary of some of the most important aspects of the JFC omnibus motion.
Family Care
The JFC approved the Governor's proposal to expand the Family Care program statewide, which means that the eight counties that currently do not participate in the Family Care program will do so by start of 2017. The JFC motion would preserve the regional model of the program, but opens the program up to be administered by private, for-profit insurance companies. Currently the program is administered by nonprofit Managed Care Organizations (MCO's). The JFC motion gives the Department of Health Services (DHS) the authority to request a waiver from the federal government in order to get permission to implement any changes to the program. Before crafting the proposed waiver, DHS must consult with "stakeholders," but the JFC motion does not specify which stakeholders and in what manner they would be consulted.
IRIS
The Governor's proposal would have eliminated the Include, Respect, I Self-Direct (IRIS) program, which is a self-directed, community-based program for adults with disabilities and elderly adults who have long-term care needs. Participants are able to choose and direct the services that they need to participate in their communities, instead of being forced to look to nursing homes and other institutions for long-term care solutions. While the JFC motion does still provide a self-directed care option, it does so by folding the existing IRIS program into a managed care model, thus eliminating IRIS as a separate program. Advocates remain very concerned that self-directed care under a managed care model will be a very different reality for program participants than self-directed care under the current IRIS model. For an example of such concerns, here is a rundown of how self-directed care would be different under the IRIS program versus the Family Care program.
Aging and Disability Resource Centers
The Governor's Proposal would have dramatically changed the governance structure of Aging and Disability Resource Centers (ADRC's), which help people with disabilities and older adults navigate different benefit systems. The Governor's plan would have allowed the privatization of ADRC functions by providing DHS with the authority to eliminate county-run ADRCs and contracting out many of their functions to private, for-profit entities. Advocates were concerned that a privatized ADRC system would be less accessible and be potentially riddled with financial conflicts of interest.
The JFC motion deleted the Governor’s recommendations, but will require DHS to conduct a number of studies regarding the services provided by ADRC's and their governance structures.
Conclusion
Because many of the changes to Wisconsin's long-term care system will require a waiver from the federal government, it is difficult to fully assess the JFC's actions. While many in the advocacy community continue to have significant concerns regarding these changes, much will depend on the DHS's engagement with stakeholders as the Department crafts the waiver request. The final details of the waiver request will likely hinge on which stakeholders are consulted and how much, if any, of their feedback is included in the final product. We will continue to provide updates on any potential changes to the JFC's long-term care provisions once the budget heads to the full Assembly and Senate for further debate.
Last week, the Joint Finance Committee (JFC) passed a sweeping omnibus motion along party lines that made significant changes to the Governor's proposal. Many of these changes were in direct response to concerns raised by advocates. However, many advocates remain concerned that, if enacted, the changes approved by the JFC will undermine many of the successful aspects of Wisconsin's long-term care system. Below is a summary of some of the most important aspects of the JFC omnibus motion.
Family Care
The JFC approved the Governor's proposal to expand the Family Care program statewide, which means that the eight counties that currently do not participate in the Family Care program will do so by start of 2017. The JFC motion would preserve the regional model of the program, but opens the program up to be administered by private, for-profit insurance companies. Currently the program is administered by nonprofit Managed Care Organizations (MCO's). The JFC motion gives the Department of Health Services (DHS) the authority to request a waiver from the federal government in order to get permission to implement any changes to the program. Before crafting the proposed waiver, DHS must consult with "stakeholders," but the JFC motion does not specify which stakeholders and in what manner they would be consulted.
IRIS
The Governor's proposal would have eliminated the Include, Respect, I Self-Direct (IRIS) program, which is a self-directed, community-based program for adults with disabilities and elderly adults who have long-term care needs. Participants are able to choose and direct the services that they need to participate in their communities, instead of being forced to look to nursing homes and other institutions for long-term care solutions. While the JFC motion does still provide a self-directed care option, it does so by folding the existing IRIS program into a managed care model, thus eliminating IRIS as a separate program. Advocates remain very concerned that self-directed care under a managed care model will be a very different reality for program participants than self-directed care under the current IRIS model. For an example of such concerns, here is a rundown of how self-directed care would be different under the IRIS program versus the Family Care program.
Aging and Disability Resource Centers
The Governor's Proposal would have dramatically changed the governance structure of Aging and Disability Resource Centers (ADRC's), which help people with disabilities and older adults navigate different benefit systems. The Governor's plan would have allowed the privatization of ADRC functions by providing DHS with the authority to eliminate county-run ADRCs and contracting out many of their functions to private, for-profit entities. Advocates were concerned that a privatized ADRC system would be less accessible and be potentially riddled with financial conflicts of interest.
The JFC motion deleted the Governor’s recommendations, but will require DHS to conduct a number of studies regarding the services provided by ADRC's and their governance structures.
Conclusion
Because many of the changes to Wisconsin's long-term care system will require a waiver from the federal government, it is difficult to fully assess the JFC's actions. While many in the advocacy community continue to have significant concerns regarding these changes, much will depend on the DHS's engagement with stakeholders as the Department crafts the waiver request. The final details of the waiver request will likely hinge on which stakeholders are consulted and how much, if any, of their feedback is included in the final product. We will continue to provide updates on any potential changes to the JFC's long-term care provisions once the budget heads to the full Assembly and Senate for further debate.
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