By LeAnn R. Ralph
MENOMONIE — “Where in the world did this come from?”
And thus began the discussion of the Dunn County Aging and Disability Resource Center (ADRC) Advisory Committee March 16 on how to fight against Governor Scott Walker’s proposal in the 2015-2017 budget to eliminate existing programs for people over the age of 60 and the developmentally and physically disabled and put them under the Family Care program.
Those who are opposed to the changes say that Family Care is not as flexible to fit the needs of individual participants and would be more expensive.
The governor’s proposal would eliminate IRIS (Include, Respect, I Self Direct), a program that helps the disabled to stay in their own homes, as well as the ADRCs, which serve people over the age of 60, along with the developmentally and physically disabled, and turn long-term care over to a single Health Maintenance Organization to oversee the entire state on a no-bid contract.
The ADRCs, with their local ADRC advisory committees, were designed to provide the disabled and the elderly with assistance in one location, rather than the disabled and the elderly having to drive around to different agencies to find assistance.
“They want to disassemble everything quickly … (and) turn it over the Commissioner of Insurance,” said Sarah Kennedy, county board supervisor from Menomonie and chair of the ADRC committee.
Long-term care programs currently are under the state’s Department of Health Services.
Gary Stene, county board supervisor from Colfax and member of the ADRC committee, suggested setting up meetings with legislators who represent this part of the state.
“They should have to answer to the local people they represent,” he said.
“There are some programs they look at for five years before they change anything,” Stene said, in reference to the sweeping policy changes included in the governor’s budget.
The governor’s proposed budget also would eliminate $15 million in funding over the next two years for Senior Care and would require senior citizens enrolled in Senior Care to enroll in the federal Medicare Part D program.
Senior Care costs $30 per year, Medicare Part D can cost more than a hundred dollars per month, said Kristin Korpela, director of the Dunn County Department of Human Services.
More than 80,000 Wisconsin residents are enrolled in the Senior Care drug coverage program. Medicare Part D plans cost between $15 and $130 per month.
“It does not appear there is much empathy in Madison,” Stene said.
Under the governor’s proposed budget, all counties in the state, along with the programs for the physically and developmentally disabled and the elderly, would come under Family Care.
Family Care would be operated by a state-wide Managed Care Organization that is able to be licensed as an HMO, and if the proposal goes through, the MCO/HMO would operate under a no-bid contract, Korpela said.
“The state could select whoever they want. No bids. Nothing competitive,” she said.
“This did not come from DHS. This came from the governor’s office, (and the governor) does not have a clue of how it works,” said Cheryl Huenink, who retired as director of DCDHS in 2012 and is a member of the ADRC committee.
An HMO could be successful, but not at Medicaid rates, Huenink said.
If Family Care services are reimbursed at Medicaid rates, “it is set up to fail,” she said.
“It would be a wrenching change to go to an HMO. It has not been done anywhere with disabled adults,” Huenink said.
The governor’s proposal eliminates the requirement that an HMO or MCO would have to contract with any of the counties, Korpela said.
In other words, “there would be no obligation for a state-wide provider to provide services,” she said.
Under the IRIS program, the developmentally disabled, the physically disabled and the elderly have a choice about who they hire as caregivers, Korpela said.
The participants receive a budget based on their functional need, and then they decide how to spend their budget, she said.
The IRIS program “helps them to stay in their own home,” Korpela said.
By eliminating IRIS, the self-directed aspect of their care would “go away,” she said.
All together, about 12,000 Wisconsin residents are enrolled in IRIS, Korpela said.
IRIS would be eliminated, and the participants would be covered under Family Care, but no one knows what that means, she said.
The governor’s proposal eliminates long-term care districts, and it eliminates ADRC advisory committees, Korpela said.
“What is frightening is that not one current MCO believes they could do this because of the insurance piece,” Huenink said.
Wisconsin has 55,000 people enrolled in long-term care, and 12,000 enrolled in IRIS, she noted.
“That a huge number of vulnerable people,” Huenink said.
As many people as possible must make an impact at the Joint Finance Committee’s public hearings, she said.
St. Croix County already has appointments set up with legislators, so Dunn County, Eau Claire County and Chippewa County could go with them, Korpela said.
Korpela urged committee members to write letters to their legislators, to send e-mails and to make telephone calls.
“They matter,” she said.
Members of the ADRC committee also approved a resolution to forward to the Dunn County Health and Human Services Board opposing Governor Walker’s proposals.
According to the resolution, the Dunn County ADRC “has successfully provided an entry point for anyone interested in public or private long-term care services, reducing consumer confusion and increasing awareness of available community resources.”
The resolution notes that the Dunn County ADRC has had 23,171 contacts for information and assistance and 2,090 contacts requesting service from the disability benefit specialist.
According to a statement included with the resolution, “This is arguably the most significant public policy change in the history of Wisconsin’s long term care service system. If implemented, people with disabilities and frail elders would be impacted significantly by the movement from a person-centered and community-centric model of long-term support toward a medically-focused and insurance-based model … This budget completely overhauls the long term care program of Family Care. This is not something that consumers asked for, nor did advocates, the Department of Health Services, legislators, nor the providers.”
If the health and human services board approves the resolution, the Dunn County Board could take action on it at the April meeting.
“Our best opportunity to stop it is now, before it is approved in the budget,” Huenink said.