A revamped Medicaid program for more than 55,000 disabled and elderly Wisconsin residents will involve three agencies in each of three regions, health officials said Wednesday.
The program will continue to allow people to hire their own caregivers if they want, the state Department of Health Services said in a “concept paper” about the changes.
The state budget last year called for changes to the Family Care program and an alternative called IRIS — Include, Respect, I Self-Direct. Dane County and seven other counties that haven’t switched to Family Care will have to adopt it.
The changes, expected to begin next year, are designed to keep spending in check for a population that makes up 20 percent of Medicaid enrollment but 40 percent of the Medicaid budget, with long-term care expected to cost $3.4 billion this year, officials said.
“These reforms work to slow the growth of expenditures by improving health rather than more drastic options of decreasing eligibility or reducing benefits,” the health department said in the concept paper.
Lynn Breedlove, co-chairman of the Wisconsin Long-Term Care Coalition, said the changes could save money but might cause some disabled or elderly people to lose their current housing or job assistance.
The agencies running the new program, some of which could be from out of state, “may dump a whole bunch of current providers,” Breedlove said. “That’s a big deal for people.”
Public hearings will be held Monday in Eau Claire and Madison. The Madison event is scheduled for 4:30 to 7 p.m. at the Exhibition Hall of the Alliant Energy Center.
Currently, eight regional managed-care organizations, or MCOs, oversee home care and other supportive services for about 43,000 disabled and elderly people through Family Care. An additional 12,000 people use IRIS to choose their own caregivers.
The programs are designed to keep people out of nursing homes. People in both programs get medical care through other Medicaid coverage.
Under the changes, the MCOs will be replaced by integrated health agencies, or IHAs. The IHAs — three in each of three regions — will provide participants with supportive services as well as medical care, and offer an IRIS-like option. The concept paper didn’t specify the regions.
The agencies will be paid set amounts for each person enrolled, which will “incentivize IHAs to provide high-quality, cost-effective care,” the concept paper said.
Breedlove said he’s glad the state plans to keep benefits the same, allow continuous enrollment and use national quality indicators to assess the IHAs.
But after three years the IHAs could stop contracting with current providers of housing, job assistance and other services, and it’s not clear if the self-direction option will work as well as under IRIS, he said.
In addition, the large size of the three regions means it’s unlikely many of the eight MCOs operating today will have the resources to become IHAs, opening the door to out-of-state companies, Breedlove said.
Madison-based Care Wisconsin, however, has said it intends to apply to become an IHA.
Aging and Disability Resource Centers around the state will continue to help people find services, the concept paper said. Earlier documents suggested the centers might be replaced by other entities.
Dane County has contributed extra money, which brings in federal matching money, to provide supportive services that county officials say are richer than those in Family Care. There is a waiting list, however, which is supposed to go away under Family Care.
The health department plans to submit a final version of the concept paper by April 1 to the state Legislature’s Joint Finance Committee, which must approve the changes.