State wants to take over Family Care
JASON STEIN
608-252-6129
April 7, 2007
Terry Smith of Madison has one good thing going for him - he's held the same job for 29 years and he's still happy with it.
"I'm the oldest one there," said Smith, a developmentally disabled man, about the pizzeria where he does cleaning work. "I won't ever give up."
With the help of programs championed by Dane County, Smith, 47, has sliced out for himself an independent life with a steady job and a stable living arrangement.
The county's system for helping disabled adults has been called a national leader.
Now, however, the state is attempting to take it over and likely offer fewer long-term care services to the county's low- income disabled and elderly, county officials and advocates said.
The state takeover - in the form of a Medicaid program called Family Care - would have the advantage of serving more people and eventually doing away with the county's waiting list, which currently numbers 700 elderly and disabled people.
So far, Dane County officials say it's a bad tradeoff. They've halted work on planning for Family Care, which is voluntary for counties, until the state responds to their concerns.
The big sticking point? To make the program work here, the state wants to take $20.2 million in property taxes and other locally controlled money that Dane County spent to help provide long-term care for 1,900 disabled and elderly clients in 2005.
Because Dane County spends so much more for its model program than is spent by other counties, the $20.2 million is nearly three times the sum the state plans to take from any other county in Wisconsin, including Milwaukee County. But state officials aren't planning higher levels of service for Dane County residents in exchange for those extra costs.
The state will end the waiting list, but it will do that in all counties - including those that aren't kicking in such large amounts of money.
Dane County Executive Kathleen Falk said that decision rewards counties that haven't spent their own money on long-term care and penalizes those - like Dane County - that have.
"What the state would like is to take that local money to make their model work, and we're not willing to do that for a whole variety of reasons, not the least of which is we then lose control of the program so the state may not require as high a level of service as we now provide to those most vulnerable residents," Falk said.
So far, the Doyle administration isn't compromising.
Sinikka Santala, an administrator in the Wisconsin Department of Health and Family Services, would say only that the state is committed to working with Dane County, which she acknowledged is in a "unique" position.
"I firmly believe that Family Care is going to be better than what we have now, but I do respect the concerns that people have," Santala said.
At its heart, the dispute between the state and county is a clash between two ambitious programs that are recognized as national leaders in helping people live independently. Both offer a broad range of services - from live-in caregivers for disabled adults to meals on wheels for the elderly.
Dane County leads the state in spending on long-term care services to residents like Smith, with $78.1 million in local, state and federal money going to care for elderly and disabled residents in 2005.
"People come from around the country and other countries to look at how services are provided here because we're doing something right," said Kim Turner, chairwoman of the Developmental Disabilities Coalition of Dane County.
Lifetime of seizures
Smith uses the county programs because of developmental disabilities that stem from a lifetime of seizures now held in check by medications. He earns $7 an hour doing clean-up at a Rocky Rococo's restaurant and has lived in an apartment on the same street with a disabled roommate and a caregiver for two decades.
The caregiver helps Smith take his medications, manage money and the other basics of an independent life.
His father, Jack Smith, calls the county's system "a godsend." But Jack Smith, a retiree, said he worries what might happen if that support slackens.
"It's just kind of scary," said Smith, 72, who also wonders what will happen when he and his wife are too old to look out for their son. "Someday we won't be here to do that."
Turner said that her group was also concerned for Terry Smith and others like him.
"They might end up in situations where they have to choose between 'Do I continue to live in my apartment with one roommate or do I give up my job because there's not enough money to do both of those things?'" Turner said.
That's because it can be cheaper to place disabled clients in living arrangements where one caregiver can look out for more than one or two residents.
Dane County officials estimate in 2005 they spent an average of about $3,700 per person each month for people in the programs the state wants to replace with Family Care.
By contrast, 2005 spending per person in the five counties involved in the pilot Family Care program averaged between $1,800 and $2,300 per person per month - a little more than half the Dane County amount, according to state figures.
Family Care uses managed care organizations similar to HMOs, which adjust service levels to keep spending on participants at or below those per- person cost limits.
Jim Canales, who runs Family Care in Portage County, said residents there "are in a much better place" than when the program started there as a pilot in 2000. There are no waiting lists for care, more providers to choose from and the system is easier to navigate, he said.
But because Portage County, like Dane, once provided higher levels of service, some changes had to be made to keep costs below the state's per-person rates, Canales said. That's meant fewer developmentally disabled participants living alone, he said.
Jack Smith said he thinks those arrangements would be a bad outcome for his son.
"I think he'd be very unhappy," Smith said.
Turner said she believes caregivers often can give more attention to each client's needs and desires when they have fewer clients to care for.
'Interest and excitement'
Santala wouldn't address those services issues directly, saying only the state was committed to determining each participant's needs with Family Care and then meeting those.
Santala said Family Care has an important advantage - it ends the waiting list for people to receive Medicaid-funded care outside of a nursing home or institution. That waiting list for in-home care forces many elderly residents out of their homes and actually costs the state more money in the process, she said.
"There is just a tremendous amount of work and interest and excitement," Santala said of the program.
Tom Frazier, executive director of the Coalition of Wisconsin Aging Groups, agreed, saying he believes Family Care will be a good deal overall for the elderly in Dane County.
"I hope Dane County would do everything to negotiate something that is not only fair to Dane County but create a system that provides better services to all eligible people and not just a few," he said.
Craig Thompson, a lobbyist for the Wisconsin Counties Association, said his group had asked that Doyle's proposed budget allow counties like Dane to phase out their contribution to help run the Family Care program over five years.
Doyle didn't include the provision, though talks about it are ongoing, Thompson said.
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