"You have got to be kidding!"
“You have got to be kidding!” a Chippewa Valley advocate responded when I told her about a plan to potentially turn Family Care over to a for-profit insurance company.
Family Care and its fee-for-service sister, IRIS, provide thousands of Medicaid-eligible frail elderly and disabled people the help they need to remain in their homes. Services could include help getting places; keeping a job; managing money; preparing meals; keeping healthy; bathing and dressing.
People who benefit from Family Care or IRIS might easily end up in an expensive institution. Personal care and other workers help them stay in their own home – and many times – stay gainfully employed.
If the current version of the governor’s budget becomes law, it will mean big changes to care for frail elderly and disabled people of modest means. For the rest of us, it could mean many more of our neighbors and family members end up in expensive institutions. Worse yet, folks could be stranded at home without the services they need to independently live and work.
Buried in the mammoth state budget is the elimination of IRIS as we know it. IRIS serves more than 11,000 people statewide. The philosophy of the program is in its name: Include, Respect, I Self-direct. People hire their own workers who perform many tasks including meal preparation, bathing, and getting people to work.
As Jason Endres of Eau Claire told me, “Without these services, the way IRIS provides, it would prevent us from being part of our community.”
Also eliminated are local centers to assist elderly and disabled people find services. Known as Aging and Disability Resource Centers (ADRCs), these publically run centers would close and their citizen oversight boards disband. They could be reopened by a private company but with no requirement to be conveniently located or to tell people about all the services for which they may qualify. For example, the woman I wrote about in last week’s column who is served by SeniorCare, said without the help of local ADRC staff she would not have known about SeniorCare.
Family Care is a managed care program serving over 40,000 elderly, physically disabled, and developmentally disabled folks. A large number of developmentally disabled people use Family Care in the Chippewa Valley because of the closure of Northern Center. Services such as residential homes, mental health services and job coaches help folks stay in the community. Local providers work with non-profit Managed Care Organizations that oversee service delivery.
Services are tailored to the needs of the individual as determined by an independently completed functional assessment. This way services are based on the needs of the individual and not on what the provider has available.
Changes in the budget would eliminate most of the Managed Care Organizations. Their job could be taken over by a very large for-profit insurance company. Budget language gives the state Department of Health (DHS) authority to hire the insurance company in a no-bid contract and removes any legislative oversight of the contract between DHS and the insurance company.
This new insurance company could become the gatekeeper for all medical, rehabilitative, personal living and employment services for over 50,000 people (DHS enrollment numbers from 2014).
In essence, every service needed by the disabled or frail elderly person of modest means would need approval by potentially one for-profit insurance company.
“This takes the personal choice right out of it,” an Eau Claire woman told me.
It also makes it more likely people will not receive the care they need. Insurance companies are very good at denying care and shifting the cost of care to patients and families.
Jason said to me, “One for-profit, national insurance company in a no-bid contract? It makes me very sad. It’s no longer about local choices. It’s about big business making decisions about very personal things.”
Advocates are working hard to save these important programs. People can learn more at www.saveiris.org. Jason reminded me to thank Amber and Nancy for this awesome website. Check it out. You’ll see Amber, Jason and read many more amazing stories.