Here Comes Family Care

Close to 1,000 people in Northeastern Wisconsin who have been on waiting lists to receive long-term care benefits through the Family Care program can now see the light at the end of the tunnel after Gov. Scott Walker announced on April 21 that seven of the 15 counties without Family Care in Wisconsin are now eligible to provide that service.

Brown, Door, Kewaunee, Marinette, Menominee, Oconto and Shawano counties will be included in the Family Care system. Eight counties remain outside the Family Care system:  Adams, Dane, Florence, Forest, Oneida, Rock, Taylor and Vilas counties.

The inclusion of the seven Northeastern counties also requires approval from the Joint Finance Committee, which is expected without too much discussion since the committee last year commissioned the Department of Health Services (DHS) to issue a report on the viability of the expansion.

The report, released in December 2013, found that Wisconsin’s aging population is projected to grow from a little more than 900,000 people in 2015 to more than a million people by 2020. “This growth in the aging population,” the report stated, “will require a cost-effective system of quality supports to manage limited public resources to ensure that the needs of Wisconsin’s most vulnerable citizens are addressed.”

It went on to say, “The Family Care program has demonstrated that a managed long-term care system increases quality while controlling costs.”

The DHS report also pointed out that “operating parallel long-term care systems with differing administrative structures and unequal access to long-term care services” throughout the state just doesn’t make sense, fiscally or otherwise.

“Support for these parallel, publicly funded, long-term care systems is an inefficient use of DHS resources and artificially inflates the public costs of providing long-term care.”

Finally, DHS said, “Expansion of managed care into the remaining 15 counties in Wisconsin will strengthen Wisconsin’s long-term care system. Broader access to less intensive and less expensive services, as well as the Family Care service and funding models will make publicly funded long-term care in Wisconsin manageable despite a growing population of people in need.”

All seven county boards had issued resolutions in support of expanding Family Care, and State Representative Garey Bies (R-Sister Bay) introduced Assembly Bill 428 to expand the program to Northeast Wisconsin.

“(Monday’s) announcement was great news for the elderly and disabled individuals living in our communities,” Bies said in a press release. “Through their tax dollars they’ve been contributing to a program for years that they’ve never been able to access themselves.”

The final question is how long before those eligible can enroll in the expanded Family Care?

“The Department believes that it now has the support it needs to move forward with the expansion of Family Care, hence the recent announcement of the seven counties that we believe are ready to participate in the program,” said Stephanie Smiley, communications director of the Wisconsin Department of Health Services.

She said much of the groundwork has been done in the seven counties for the expansion, “so we believe we are in a good spot to move forward from that standpoint. The following two things can happen simultaneously,” Smiley said. “1. Joint Finance Committee review. This is up to that committee’s discretion on when they might take this up.

“2. DHS must go through the procurement process to identify willing and qualified providers to serve the region. This is the process that can take some time. It can take between six to 18 months to complete. Given that we have been through this process several times, we believe that this timeframe will be on the shorter end (i.e., the Department won’t have to write a Request For Proposal from scratch), however, this is dependent on outside factors that may affect the timeline, e.g., if a proposer protests the intent to award, etc. Then DHS must certify that the Managed Care Organization(s) have adequate provider network, that their financials are stable, etc. The certification process can take three months. After that certification process is complete and we have a signed contract, we can begin enrollment into the program.”

You can read the DHS report at dhs.wisconsin.gov/publications/P0/p00590.pdf.