Dane County Families Have Concerns as DHS Makes Switch to Long-Term Care Programs

This story appeared on WisPolitics.com on 9/15/2017.  It appears on arcdanecounty.org with permission.  For the most up to date news in Wisconsin politics, visit www.WisPolitics.com.


In February, the Dane County long-term care program that 41-year-old Sara Yochum has relied on since high school will be phased out.

Sara, whose seizures as a child led to permanent brain damage and weakened muscles, got a job through the program when she graduated high school at 21. Twenty years later, Sara is in a wheelchair, works part-time at the World of Variety store in Cross Plains and is trying to find another job after the nursery where she worked shut down this month. Her father, Paul, said her jobs give her a chance to come home, open up the envelopes with her paychecks and “tell people she got paid.”

So Paul and his wife, Marcia, are worried about the major changes their daughter and nearly 2,300 other Dane County adults will see when they transition to programs managed by the state Department of Health Services instead of the county.

Paul says Dane County has spent decades to develop the “Cadillac of services” so residents with disabilities and frail elderly adults don’t have to go to a nursing home, can get help with daily activities, such as cooking or getting dressed, and can find a job in their community.

That’s why, he says, 60 percent of Dane County residents with developmental disabilities have a job — compared to fewer than 20 percent in other Wisconsin counties.

“We’re nervous as to whether or not our Sara is going to be able to continue to get the same or better services,” Paul said.

DHS says those concerns are natural and that it’s holding member forums to help people understand the transition to Family Care and IRIS, two different programs the agency says provide similar services at lower costs. A more cost-effective model, the agency says, will help meet demand in the future as the state’s population ages, helping ensure Medicaid costs don’t spiral out of control.

DHS also says the two programs’ expansion, which lawmakers signed off on, will eliminate a waitlist for Dane County’s program because the county doesn’t have enough money to offer services for everyone. The county currently serves about 2,300 people — about 1,530 of them with developmental disabilities, 330 with physical disabilities and 410 frail elders.

And the county’s current wait list for those groups is nearly 500.

“Once we have all of the counties in Family Care or IRIS, we will have no wait lists in Wisconsin. That’s incredible,” said JoAnna Richard, associate director at DHS’ Bureau of Adult Long Term Care Services. “You don’t find that anywhere else, and it’s a system that’s honored and celebrated by other states.”

Critics say the county’s wait list is actually lower. Many people on the list, they say, are already getting some services such as employment help — but they’re waiting to get services that help them live on their own instead of with their family, for example.

But DHS says any person on a wait list is too many.

Lynn Green, the director of Dane County’s Department of Human Services, said ending the wait list is “absolutely a plus” and said her agency is having ongoing discussions with the state, families and providers to make sure the current services stay in place.

“We knew Family Care was coming. It was inevitable,” she said. “And I think now, we’ve put our energy toward making this a positive transition.”

Gov. Scott Walker highlighted the Family Care and IRIS expansion last week, accepting a Pacesetter Prize from the SCAN Foundation for the state’s long-term care system and options that residents have.

DHS has expanded both programs to a handful of counties in the state in recent years and now has two left. Dane County will come onboard in February, and a legal dispute over the bidding process has delayed Adams County’s entry.

Family Care is run by managed care organizations, or MCOs, which get a set amount of money for their enrollees and hire or contract with providers who can help people with daily routines and employment services.

Under the IRIS program, members have more flexibility to “self-direct” their services, getting a monthly budget they can use for those services with the help of an IRIS consultant. The program’s name stands for ‘Include, Respect, I Self-Direct.’

Advocates worry Dane County’s high outcomes could be at risk

Sara is one example of why Dane County vastly outperforms others in the state when it comes to employment figures.

Like others who went to high school in Dane County, she developed a transition plan that ensured she landed a job before she graduated.

That process, observers say, is a big reason why 92 percent of Dane County students with developmental disabilities get a job once they graduate, much higher than the national figure of 26 percent.

Critics of the switch worry that those outcomes could be at risk — and question why the state isn’t adopting the Dane County model elsewhere.

“It seems like we’re missing the opportunity here to build on the Dane County lessons,” said Lynn Breedlove, the co-chair of the Wisconsin Long Term Care Coalition.

DHS rebuts suggestions that participants could see cuts in services

So families like the Yochums are watching how much DHS will pay the Family Care managed care organizations — and in turn how much those MCOs will pay the providers who offer services.

As Dane County spends more on its members than other counties, setting those rates too low could lead to benefit cuts.

DHS says it will factor in the county’s current costs when setting the rates that Family Care MCOs will get, countering suggestions the new model would lead to cuts.

“There’s no analysis that would suggest to me that the initial provider rates would be lower,” said Curtis Cunningham, the assistant administrator of DHS’ Division of Medicaid Services.

Richard, the other DHS official, also praised Dane County’s “wonderful approach to employment” and said participants who make employment a goal on their plan will see their offerings designed to meet that goal.

But Melissa Mulliken, who represents providers as advocacy coordinator for the Dane County Disabilities Coalition, said there’s more DHS could do to ensure the strengths of the current program are maintained after the transition.

She noted, for example, the partnership between Dane County and Madison Metro to help people get to their jobs and the intense focus on employment that the county’s had for decades.

“It’s magical thinking to believe that without preserving infrastructure, planning, transportation and collaboration in Dane County, that people with disabilities will continue to see the outstanding outcomes that they have seen historically here,” she said.

DHS has already named the two MCOs that will manage Family Care benefits in Dane County: Care Wisconsin and My Choice Family Care. The agency also named the IRIS consultant agencies that will help participants in that program: Advocates4U, Connections, First Person Care Consultants and TMG.

Maria Ledger, the CEO of My Choice Family Care, said Dane County has “done a really great job” since its program’s inception to ensure people are employed in their communities. And she said her organization will learn from what Dane County has done to ensure other counties’ rates go up.

Ledger said she’s asked the state to take into account that the providers in Dane County are generally paid more than those elsewhere when setting those rates, saying she wants to ensure “providers are reimbursed fairly and continue to provide high quality services.”

Ledger also said she’s in talks with transportation providers and DHS to try to figure out how to keep the “really rich and generous” transportation benefits that members currently get.

“We’re all going to have to work on it together, or we will sink separately,” she said. “So I think everybody’s going to be putting forth a lot of collaboration on this and hopefully some creative solutions.”

But Paul Yochum, who attended one of the DHS forums on the topic, said the “jury’s still out” on whether his daughter’s services will stay the same.

For now, Yochum, the former executive director of the Arc-Dane County advocacy group, says he’s advising families to ensure that when the change-over happens, they talk to their MCOs and make sure they know all of the services they currently receive so that they can try to keep them in the future.

“Family Care has been touted to provide the same or better care,” he said. “We’ll believe it when we see it.”

See information on the DHS forums and the transition:

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