Includes Family Care Expansion, End to IRIS, Move of People Off SeniorCare onto Medicare Part D
Board on Aging and Long Term Care:
Ombudsman Specialists: The Governor recommends providing expenditure and position authority for a lead ombudsman specialist and two ombudsman specialists to provide services and assistance to residents of long-term care facilities and consumers of home and community-based services. ($235,800 FY17)
Broadband Service Expansion: The Governor recommends providing expenditure authority for additional bandwidth to support the board’s information technology operations. ($17,000 FY17)
Merger of Department of Financial Institutions and Department of Safety and Professional Services into a new agency – the Department of Financial Institutions and Professional Standards effective January 1, 2016.
Department of Children and Families:
CBRF: Under current law, subject to certain exceptions, a facility where five or more adults who do not require care above intermediate level nursing care reside and receive care, treatment, or services that are above the level of room and board must be licensed as a community−based residential facility (CBRF). This bill provides that a facility licensed as a foster home, group home, or residential care center for children and youth (facility) that provides care for a person 18 years of age or over, but under 21 years of age, who is placed in the facility under an order of the juvenile court, a voluntary transition−to−independent−
Office of Children’s Mental Health: The Governor recommends transferring appointment authority for the director of the Office of Children’s Mental Health from the Governor to the secretary of the Department of Health Services.
Department of Health Services:
Family Care Reform: The Governor recommends improving outcomes for the state’s elderly and disabled residents by reforming the Family Care program. These reforms include: (a) requiring all counties to participate in the program by January 1, 2017, or upon federal government approval; (b) offering benefits through several statewide managed care organizations (MCOs), which must offer primary and acute care services to members, including self-directed care; (c) providing members with a choice of MCOs in order to determine which best meets their needs; and (d) ensuring consumer protections by regulating MCOs as insurance entities under the jurisdiction of the Office of the Commissioner of Insurance. These reforms will improve health outcomes by breaking down silos of care and enhancing the capabilities of members and their families to navigate the system. In addition, the Governor recommends providing additional resources to the Board on Aging and Long Term Care to improve patient advocacy and ensure their rights are protected.
The bill requires DHS to obtain the necessary federal approval to implement changes to Family Care, FCPP, and PACE including all of the following changes: eliminating long−term care districts; allowing DHS to add primary and acute health care services to the Family Care benefit, allowing CMOs to provide services statewide and not only in a specified geographic area; allowing DHS to contract with any applicants that it certifies as meeting the requirements to be a CMO and eliminates the requirement that DHS solicit proposals for contracts; generally allowing Family Care enrollees to switch CMOs only in an open enrollment period; and requiring administration of Family Care statewide. The bill eliminates the separate IRIS program but specifies that individuals may self−direct their services within the Family Care program. The bill also eliminates the requirement that CMOs obtain a permit from OCI but specifies that when the Family Care program begins to operate statewide CMOs are insurers and may be regulated as insurance by OCI. Once Family Care operates statewide, DHS is allowed to discontinue enrollment in certain other long−term care programs as specified in the bill.
Resource Centers: Resource centers currently provide information and referral services among other functions, including determining eligibility and assisting individuals to enroll in a CMO. Currently, resource centers are required to provide all services specified by law. The bill allows DHS to contract with a resource center or a private entity for some or all of the services. The bill also eliminates the requirement that a resource center has a governing board and eliminates the requirement to create long−term care advisory committees.
Physician Assessments: Under current law, DHS must, after the start of each fiscal year, estimate the total amount of its expenditures for department operations for that fiscal year. Based on that estimate, DHS assesses certain health care providers for the estimated total amount, less certain amounts received for administrative purposes. The Governor recommends restraining health care costs and reducing the costs of practicing medicine by eliminating the physician assessment.
Drug Testing and Treatment for Food Share Employment and Training Participants: The Governor recommends requiring the department to submit a waiver request to the U.S. Department of Agriculture to allow screening of FoodShare Employment and Training participants for drug use as a condition of eligibility and, if such a waiver is granted, to implement the program.
Childless Adult Reforms: The Governor recommends reforming health care coverage for Wisconsin’s Childless Adult population by requiring the department to seek a waiver from the federal Department of Health and Human Services to impose monthly premiums for all enrolled childless adults and additional premiums for behaviors which increase an individual’s health risks. Additionally, the waiver will seek the authority to require health risk assessments and screening for drug use to receive benefits. Finally, enrollment for childless adults will be for a maximum of 48 months. These changes will help ensure that childless adults remain insured for a reasonable period of time while making common sense reforms to safeguard state resources.
SeniorCare Reform: The Governor recommends reduction of funding of SeniorCare by $15 million in order to ensure alignment with Medicare Part D. Under current law, DHS administers the Senior Care program, which provides assistance to the elderly in the purchase of prescription drugs. To be eligible for Senior Care, a person must be a resident of the state, be at least 65 years of age, not be a recipient of prescription drug coverage through Medical Assistance, have a household income that does not exceed 240 percent of the federal poverty line, and pay a program enrollment fee. This bill adds as a requirement for eligibility for Senior Care that the person must apply for and, if eligible, enroll in Medicare Part D, which is a federal prescription drug assistance program.
Personal Care Independent Assessments: The Governor recommends reforming personal care services to Medicaid enrollees by requiring an independent assessment for all prescribed fee-for-service personal care to ensure that the right amount of care is being provided to members at the right time and in the right settings, and reduce fraud and abuse in the Medicaid program. (-$4,412,700 FY16, -$15,135,700 FY17)
Medicaid Reform and Savings Initiatives: The Governor recommends the following modifications to the state Medicaid program in order to improve service delivery and efficiency: (a) eliminate the three-month waiting period for enrollment in BadgerCare Plus for certain children and pregnant women, (b) transfer up to an additional $10 million annually from the University of Wisconsin System for Medicaid health maintenance organization claims, and (c) treat promissory notes as countable resources for Medicaid eligibility purposes. The Governor also recommends the following reforms to the Funeral and Cemetery Aid program: (a) requiring life insurance policies to be included in Estate Recovery, and (b) reducing the reimbursements for decedents who own life insurance policies with a face value above $3,000. Lastly, the Governor recommends reimbursing Wisconsin’s Federally Qualified Health Centers at the federal Prospective Payment System rate. ($1,447,500 FY16, -$9,442,900 FY17)
Medicaid and FoodShare Administration Reestimate: The Governor recommends providing funding to reflect a reestimate of the costs of administering the Medicaid and FoodShare programs. ($9,454,100 FY16, $10,748,000 FY17)
Division of Medicaid Services: The Governor recommends improving the management of the Medicaid program by merging the Division of Health Care Access and Accountability and the Division of Long-Term Care into a new Division of Medicaid Services. The initiative recognizes the changing dynamic between primary and acute care and long-term care, and will provide enhanced focus on providing the appropriate amount of benefits to eligible individuals while ensuring careful use of state and federal resources. (-$588,400 FY16)
Pharmacy and Nonemergency Medical Transportation Benefit Reforms: The Governor recommends adjusting funding to reflect moving pharmacy and transportation benefits into provider contracts. (-$692,800 FY16, -$1,532,000 FY17)
Transfer of Food Safety and Recreational Licensing Activities: The Governor recommends transferring the following activities, and corresponding funding and position authority, from the Department of Health Services to the Department of Agriculture, Trade and Consumer Protection: the licensing and inspection of all restaurants, vending machines, food commissaries, licensed campgrounds, recreational camps, swimming pools, hotels and rooming houses, beginning in FY17.
Community-Based Residential Facilities and Hospice Plan Review: The Governor recommends consolidating plan review of community-based residential facilities and hospices into the Division of Quality Assurance in order to streamline the process and create efficiencies.
Transfer of Independent Living Centers Grant Program: The Governor recommends transferring the Independent Living Centers grant program from the Department of Workforce Development to the Department of Health Services.
Intensive Supervision Program: The Governor recommends transferring the intensive supervision program from the Department of Transportation to the Department of Health Services to align with similar programming offered by the department.
Expand Medicaid Coverage for Residential Substance Abuse: The Governor recommends expanding substance abuse treatment options in Wisconsin by making the treatment portion of residential substance abuse treatment a covered service under Medicaid. ($2,566,500 FY16, $5,386,300 FY17)
Children’s Community Options Program: COP is one of the programs that DHS may discontinue once Family Care is available. The bill also creates a Children’s Community Options Program (Children’s COP) that provides long−term community support services to individuals up to age 22 who have a disability. Children who seek services are assessed for Children’s COP and a county department or private nonprofit agency will create a case plan and arrange for services. The bill requires DHS to create a scale for assessment of a fee for Children’s COP based on ability to pay. DHS seeks a waiver of federal Medicaid law to obtain federal funding for Children’s COP. The bill eliminates the Family Support Program.
County Crisis Services Grant Funding and Emergency Detention Standardization: The Governor recommends aligning the emergency detention process in Milwaukee County with other counties in the state and requiring counties to provide community-based crisis assessment by a mental health professional prior to an emergency detention to improve response to mental health crises. ($1.5 million, FY16)
Dementia Care Specialists: The Governor recommends providing funding to support the costs of dementia care specialists in selected aging and disability resource centers across the state. ($1.128 million FY17)
Allocation of School-Based Services: The Governor recommends directing the state’s share of school-based services in excess of $42,200,000 in FY16 and $41,700,000 in FY17 to the Medicaid trust fund and that any excess revenues received are spent on reducing waiting lists for children’s long-term care services or other projects benefiting children.
Elimination of the Physician Assessment: The Governor recommends restraining health care costs and reducing the costs of practicing medicine by eliminating the physician assessment. (-$47,300 FY16, -$47,300 FY17)
Streamline Community Mental Health Appropriations: The Governor recommends consolidating and aligning mental health funding to create efficiencies in the distribution of funding to counties.
SeniorCare Reestimate: The Governor recommends reestimating SeniorCare costs to reflect changes in caseload and the cost and utilization of prescription drugs. ($20,069,200 FY16, $32,247,100 FY17)
Income Maintenance Consortia Reestimate: The Governor recommends fully funding the Income Maintenance consortia based on updated caseload assumptions and program requirements. ($10,836,600 FY16, $9,079,300 FY17)
Supplemental Security Income and Caretaker Supplement Reestimate: The Governor recommends increasing funding to reflect a reestimate of the caseload for the Supplemental Security Income program, including the Caretaker Supplement. ($2,099,700 FY16, $4,629,900 FY17)
MA Eligibility: To be eligible for certain MA programs, especially those providing long−term care services, including family care, an individual must satisfy certain income and asset requirements. This bill provides that, when determining or redetermining an individual’s financial eligibility for an MA long−term care program, or any other MA program that counts assets for determining or redetermining financial eligibility, DHS must include as a countable asset a promissory note for which the individual or his or her spouse provided the goods, money loaned, or services rendered, that is entered into or purchased on or after the effective date of the 2015−17 budget act, that is negotiable, assignable, and enforceable, and that does not contain any terms making the note unmarketable. The bill provides that a promissory note is presumed to be negotiable and that its value is the outstanding principal balance at the time of the individual’s application or redetermination of eligibility for MA, unless the individual shows by credible evidence from a knowledgeable source that the note is nonnegotiable or has a different current market value, which will then be considered the note’s value. Under current law, with certain exceptions, if an institutionalized, or noninstitutionalized, individual or his or her spouse transfers assets for less than fair market value on or after a specific date (which is generally 60 months before the individual applies for MA), the institutionalized or noninstitutionalized individual is ineligible for certain MA services for a specified period of time. Under current law, the purchase by an individual or his or her spouse of a promissory note is a transfer of assets for less than fair market value that triggers a period of ineligibility for MA unless all of the following apply: the repayment term is actuarially sound; the payments are to be made in equal amounts during the loan’s term with no deferral and no balloon payment; and the loan’s terms prohibit cancellation of the balance upon the death of the lender. This bill provides that if an individual or his or her spouse enters into or purchases a promissory note on or after the effective date of the 2015−17 budget act, it is a transfer of assets for less than fair market value that triggers a period of ineligibility for MA unless all of the following apply to the promissory note: it satisfies the previously stated requirements under current law; and it is negotiable, assignable, and enforceable and does not contain any terms making the note unmarketable.
We will continue to review the entire budget in coming days and will report more information to you as the full impact of Gov. Walker’s budget becomes clearer. The budget now goes to the state Legislature and the Joint Finance Committee for review and amendments.
Click here to read the budget bill.
Click here to read the budget document.