IRIS to End and MCOs to be Statewide Entities
From Forbes McIntosh, Government Policy Solutions, WALA Lobbyist
Last week you received information identifying the various provisions in Gov. Scott Walker’s state budget affecting Wisconsin’s long-term care and expanding into primary\acute healthcare systems.
First, the governor’s budget does not propose any reimbursement increases for long-term care providers. However, the governor is proposing significant changes to Wisconsin’s long-term care programs.
The governor is proposing to eliminate the Include, Respect, I Self-Direct (IRIS) program, but specifies that individuals may self-direct their services within the Family Care program. The proposed language would state, “”Self-directed services option” means the option in the family care program in which an enrolled individual selects his or her own services and service providers.”
The other big change – Family Care, PACE and Partnership programs. If the state legislature approves the statutory changes and then the corresponding necessary federal waivers are approved by the Centers for Medicaid and Medicare Services (CMS), Family Care will look much different in both the expansion and type of services and likely major changes with who operates the Managed Care Organizations (MCOs).
Family Care is available in 57 of Wisconsin’s 72 counties (see map). Of the 15 counties where it does not exist, 8 are already in the process of moving to Family Care. Meaning there are only 7 counties where Family Care is not available and that were not planning to move to Family Care in the near future.
Today, 8 Family Care Managed Care Organizations (MCOs) operate\manage the Family Care benefit that serves approximately 42,000 enrollees (enrollment data) in regions around the state. Enrollees are identified as persons that are intellectually disabled (any age), developmentally disabled (any age), physically disabled (any age) and frail elderly (age 65 or older).
If the changes to Family Care are approved, not only will Family Care be expanded statewide (to all counties) and expanded in terms of new healthcare services offered statewide, but the MCOs will be required to operate statewide (no more regions). This could force existing Family Care MCOs to merge, partner or if they cannot compete leave the long-term care marketplace. It will also require them to build\expand networks in primary\acute care or partner with existing managed care (MCO \ HMO) organizations. It could also mean the reverse – meaning existing acute\primary care MCOs and HMOs might decide to enter the marketplace.
How will these changes affect you? We are working now to identify those aspects and identify positions\solutions for the state legislature to consider.
What is the timing of all this? The legislative budget process began this past Tuesday with the budget bill introduction. The Legislature’s Joint Finance Committee that oversees and amends the governor’s budget will likely hold state agency hearings the first week in March and four public hearings held around the state in the last two weeks of March.