Walker Budget Would Restructure Long-Term Care Programs

Mar 4, 2015

Family Care provides long-term care for about 50,000 low-income older adults and people with disabilities so they can remain in their homes.
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Gov. Walker’s proposed budget would change the way thousands of Wisconsin families get care for an elderly loved one, or a member with disabilities.

Walker wants to overhaul the state’s Family Care program and eliminate a related program called IRIS, which allows families to choose their own long-term care providers.

The Legislature’s budget committee listened to the Department of Health Services comment on the proposed changes Tuesday.

Family Care provides long-term care for about 50,000 low-income older adults and people with disabilities so they can remain in their homes. Gov. Walker’s budget would require Family Care to also coordinate the health care services of participants. Right now, they go through Medicaid.

Walker’s plan would also change who administers Family Care. Instead of four regional Managed Care Organizations, statewide insurance groups would take over.

Stephanie Smiley, a spokesperson for the state Department of Health Services, says the changes would ensure participants get comprehensive care, regardless of where they live.

“The long-term care reforms outlined in the budget, they’re focused on the overall health of an individual by establishing a more coordinated care model that covers long-term care, it covers behavioral health and it covers the primary care needs of the individual,” Smiley says.

The governor’s budget would end IRIS, the state program that gives families a monthly budget to manage the long-term care of loves ones with disabilities or older adults. About 11,000 people use the program to live independently, rather than in nursing or group homes.

Smiley says IRIS would end in name only. She says Family Care would offer a similar option, allowing families to choose providers, but in coordination with the program’s managers.

“What the governor’s reforms do, is it actually does preserve the ability for members to self-direct their care,” Smiley says.

Smiley says there won’t be details of the new self-direct option until lawmakers pass the budget, and the state applies for a federal waiver to create the program.

Marion Holmberg says she’s terrified about the prospect of not being able to directly manage her daughter’s care, an 18-year-old who has developmental disabilities.

Holmberg says through IRIS, she’s arranged for people to take her daughter shopping and mini-golfing – things teenagers typically do without their parents – and even attend a summer camp.

“And what it’s done is…she’s an individual who needs a lot of support from me. It has given her more independence as she’s getting used to other people being with her. And she has been able to have a variety of experiences with it,” Holmberg says.

Holmberg says IRIS gives her freedom to find providers she trusts, and who are matched well to her daughter’s needs.

Participants could lose relationships and possibly their doctors under the proposed Family Care overhaul, according to Kit Kerschensteiner, an attorney with the group Disability Rights Wisconsin.

“If your doctor that you have now isn’t part of that network, doesn’t choose to become part of that network or isn’t approved in that network then you will be…sounds like, it appears…that you would be changing your doctor,” Kerschensteiner says.

Kerchensteiner says Wisconsin’s long-term care system was set up to include regional managers who could remain in close contact with the people they serve. She fears those management organizations won’t be able to offer all the benefits the new model promises, and meet all the new regulations.

“It’ll be a whole new ball game. It seems likely that there would be out-of-state national kinds of insurance entities that would come in and fill that void,” she says.

Kerchensteiner hopes lawmakers put the brakes on plans to redesign Wisconsin’s long-term care programs, so stakeholders can get together and brainstorm improvements.  She admits Family Care and IRIS aren’t perfect, but believes their current design best meets families’ needs.