From Forbes McIntosh, Government Policy Solutions, WALA Lobbyist
In her testimony before the state’s Joint Finance Committee last Wednesday, Department of Health Services (DHS) Secretary Kitty Rhoades stressed that Gov. Scott Walker’s 2015-17 proposed DHS budget does not eliminate self-directed long-term care, contrary to some erroneous reports.
“It’s unfair to frighten vulnerable people with something that we know is not the case,” Rhoades said during her agency budget briefing before the committee.
“It is important to note IRIS (Include, Respect, I Self-Direct) will still exist,” she said. “IRIS was created statutorily and in this budget we eliminate those statutes but make it very clear in the new Family Care 2.0 there will be self-directed long-term care services. This should be called Family Care and IRIS 2.0. I spent eight years building self-directed services. I fought with some members hard to make sure that we had this in play. I’m not letting up. We will have self-directed long-term care, but they will be in a managed health care program.”
In her testimony, Rhoades noted that the Wisconsin Department of Health Services has almost 6,200 positions and a two-year budget of more than $22 billion. About 80 percent of the Department’s budget is dedicated to the Medicaid program.
Rhoades said what “keeps her up at night” is the aging of Wisconsin’s population, especially north of Highway 29. She said if we assume one-third of those will need LTC at $1,300 per member per month, that’s a significant cost to the state. Rhoades said there are now two categories for the above-65: “elders” and “super elders” in which people live into their 80s, 90s or beyond. Rhoades said the main way the state can rein in health care costs is by management of Medicaid growth, keeping people in their homes longer and encouraging people to plan for their own long-term care needs.
Rhoades said the proposed 2015-17 agency budget seeks to bring greater efficiencies to the Medicaid program in part through ongoing waste, fraud and abuse efforts that include:
- Continued funding for the Office of the Inspector General
- Funds an independent assessment for personal care services to accurately assess the amount of services each person needs. Rhoades said this tool will help DHS ensure it uses taxpayer dollars to meet an individual’s essential needs, while preventing unscrupulous providers from exploiting the system.
- This budget also strengthens estate recovery and divestment provisions so that individuals rely on their own resources as much as possible before seeking help from public assistance programs.
Also under Walker’s proposed DHS budget, Family Care would be expanded statewide and go to an integrated, outcome-based model, she said.
“(The current Family Care) delivery model means there is no coordination of primary care with behavioral care, and there is virtually no coordination of care between a primary care provider and those who provide long-term care services,” she said. “Because the Department does not have the ability to coordinate all aspects of a member’s health and long-term care needs to ensure that the proper care is being delivered in the proper setting, the Department is unable to determine the overall cost of an individual’s care.”
Under the new model, care organizations will provide comprehensive, coordinated health care services to members – long-term care, primary care, behavioral health care and acute care.
Managed care organizations (MCOs) would also operate statewide.
Joint Finance committee member Sen. Leah Vukmir (R-Wauwatosa) said health insurance companies might be the only players able to provide the service under Family Care 2.0 – and it might be difficult for existing MCOs to do so. Rhoades said she estimates that there will be perhaps three competing statewide MCOs under Family Care 2.0 and it would become a more value-added service for consumers to choose between MCOs.
Joint Finance Co-Chair John Nygren (R-Marinette) asked what the changes to Family Care would mean for the Northeast Wisconsin counties that have already been approved for a Family Care expansion into their counties. Rhoades said the Family Care 2.0, if approved by the state Legislature and Centers for Medicare and Medicaid Services (CMS), wouldn’t go into effect until 2017. By moving forward with the expansion into NE Wisconsin as planned, those counties would still have almost two years of Family Care services before the new program goes into effect. Rhoades said DHS would be committed to making the transition to Family Care 2.0 seamless for all counties and consumers in the state.
Rhoades noted that DHS originally created the Division of Long Term Care totally to do enrolling in and expansion of Family Care and to manage MCOs, and if you look at what program services are being delivered by DLTC – such as dementia care – those services should really be in public health. Those types of services will be moved to public health, Family Care into the new Division of Medicaid Services – resulting in the elimination of one division (DLTC).
“The Family Care reforms will strengthen the service delivery system and ensure that members continue to have choice and input in the delivery of their total care,” she said. “Additionally, these reforms will make the program more financially secure into the future and keep members in their own home” – noting that Family Care in its original form was created to keep people out of nursing homes, and Family Care 2.0 goes a step further and would be devoted to keeping people in their own homes “as long as they are safe and well cared for.”