County officials: It's time for Family Care

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Catherine W. Idzerda
Thursday, May 29, 2014

JANESVILLE—It's time to consider moving forward with Family Care.

That's the advice Rock County Administrator Craig Knutson gave to members of the county's developmental disabilities board and human services committee.

Knutson's comments came after a presentation Tuesday by Care Wisconsin, a managed care organization that provides Family Care services elsewhere in the state.

Out of Wisconsin's 72 counties, 64 have Family Care programs in place or are transitioning to it. The state program that changes the way certain services for the frail elderly and adults with developmental or physical disabilities are administered. 

Currently the Rock County Developmental Disabilities Board and county's Long Term Support Programs serve Rock County residents who need such care. For people with developmental disabilities, services include places to live, places to work and day programming.

Knutson acknowledged that people who are currently getting services are worried about them being reduced under Family Care—and service providers are worried about their reimbursement rates.

“But the flip side of that is that we have 250 people on the developmental disabilities waiting lists,” Knutson said. “I can assure that with zero percent levy limits statewide, there isn't any chance that the waiting list will get any shorter. Over time, I think the county will have trouble maintaining the services it currently offers.”

Federal medical assistance dollars fund the programs. In Rock County, $4 million of local tax money supplements the federal funding.

Rock County was ready to go to Family Care in 2011, Knutson said, but then was put off. For a while, it was unclear if the program has going to be expanded to any more counties.

That's changed, Knutson said.

“The state has told the fed that Family Care is going to happen statewide,” Knutson said.

In order to move forward, the state requires the county board to pass a resolution in support of Family Care, Knutson said.

“Even if you did pass that this summer, it doesn't mean that Family Care would start in January,” Knutson said. “It takes a while to put into place.

“A while” could be anywhere from three to five years, county officials said.

Family care is a program that provides services for the frail elderly and adults with developmental or physical disabilities who need long-term care. Now, those services are provided through the county and paid for with federal Medicaid waivers.

We asked county officials and representatives of Wisconsin Care for answers to some of the basic questions.

Q: How would services be paid for under Family Care?

A: Federal medical assistance dollars would go to one or more managed-care organizations serving the county.  A functional screen would be given to each person needing services. That screen would result in a risk score. Federal funding would be based on the total of those scores.

For the first five years, Rock County would pay the managed-care organization a fee: $3.6 million the first year and then a decreasing amount each following year.

Q: How would services be administered under Family Care?

People would go to the Aging and Disability Resource Center, where a county employee would determine what services they needed. Then, they would be directed to a managed-care organization for services.

 Q: What's a managed-care organization?

A: A managed-care organization is a private business that contracts with providers such as nursing services, group homes and day placement centers on behalf of clients.  The organization also works directly with clients.

Clients would have a “care team” that would help them determine what their goals were, what community supports they had or might need and their health issues or limitations.

Q: What are the benefits of Family Care?

A: Family Care requires the elimination of waiting lists for services. About 240 people are on the county's waiting list, and the average wait is between nine and 10 years.

Family Care proponents argue that economies of scale give them an advantage, along with the fact they provide “the right services at the right time in the right place.”

“It's an assessment of an individual and their needs,” said Susan Crowley, vice president of government services for Care Wisconsin. “Not everybody is going to get the same set of services.”

According to a fiscal and administrative audit in 2013, the state's Department of Health Services reported, “The Family Care program has demonstrated that a managed long-term care system increases quality while controlling costs.”  The audit found that Family Care savings came from economies of scale, reducing administrative costs and by creating a “single flexible benefit that includes a large number of health and long-term care services that otherwise would be offered through separate programs.”

Q: What are the downsides?

A: Opponents say the program squeezes group homes, day services or specialized- employment programs, offering them lower rates for their services.

At the Wednesday meeting, Care Wisconsin officials challenged that idea, quoting the Department of Health Services report to the joint committee on finance: “….managed care strategies for controlling costs are not driven by provider rate cuts.”

Opponents also say that people currently receiving services might see those services reduced.

One service provider described it as going from “Cadillac services” under the current system to “Chevy services” under managed care.            `

John Hanewall, head of the Developmental Disabilities Board, said none of his clients are getting “Cadillac” services. Instead, they get the services they need, he said.

“Imagine if you're a mom. You have one kid who has been waiting patiently for that cookie and you give it to him,” Hanewall said. “Now you're going to take it from him and break it in half?”

Hanewall argued that Rock County doesn't have the enough service providers to serve all of the people on the waiting list.

“If you have 250 people on the waiting list for residential placement, and you only have 125 spots total, you're going to have a problem,” Hanewall said.

However, waiting lists have been eliminated in other counties that have Family Care.

At the meeting Wednesday, Wisconsin Care representatives said waiting lists eliminated over a period of 24 to 36 months. Providers step up to offer more services.

The establishment of Family Care would also mean the loss of county positions. Long term support and  the Developmental Disabilities Board employ 30.5 people, according to county budget documents.

Family Care will be implemented over the course of three years, and in that time, the county will “work to make sure long-term service workers have an opportunity to consider open positions within the department and the county,” Human Services Director Charmain Klyve wrote in an e-mail.

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