This article was last modified on September 18, 2012.

Empire Strikes First: The FamilyCare Story

While this column generally tackles issues of a national or international nature, this month we bring the attention on a much more local issue: FamilyCare. Perhaps you have not heard of this program. I confess that until recently, I had not. But despite being a small program, it is also a very important one and very likely helps someone you know live a fuller, more productive life.

FamilyCare was developed in 2001 and then received bipartisan support under Governor Tommy Thompson. While targeting individuals eligible for Medicaid, the FamilyCare programs turn away from the traditional approach of putting our elderly and disabled in nursing homes. Instead, a nurse and care manager work with the member and develop a plan designed to keep participants healthy and give them new options for achieving independence and life goals. Many of our needy neighbors do not need to be put in a “home” but simply need someone to support them in order to keep on living in their own home and being involved in their communities. The program is a “win” for those involved, but it is also a “win” for the counties and taxpayers — this targeted care is actually cheaper than a nursing home, sometimes saving a county up to 50% per person.

To start the program, five Wisconsin counties were selected to test the effectiveness of FamilyCare. An independent group found that the program not only achieved high marks from the new consumers, but achieved the anticipated savings in Medicaid funding. This savings was primarily due to a decrease in hospital visits from the program members, who were now receiving adequate checkups and community support. The program, proven successful, expanded under Governor Jim Doyle, and was even supported by Milwaukee County Executive Scott Walker, apparently realizing the financial incentive the program brought to his county. Today, FamilyCare is in 57 of 72 Wisconsin counties, with Outagamie County joining in 2010.

Outagamie County Executive Tom Nelson had FamilyCare on his radar even before taking office, and from day one identified the program as the number one “budget buster” for the county. Without it, there would be an additional cost to Outagamie County between $1 and $3.5 million and many residents would be left without basic long-term care services. If any program should be protected — and expanded — it is FamilyCare.

Enter Governor Scott Walker. While he had previously voiced support of FamilyCare, Walker now saw it as one more government program to be cut under the ruse of saving the taxpayers’ money. Of course, cutting the program would do precisely the opposite — it would force those receiving superb care at affordable rates to enter programs where they receive less care at higher rates. A person with a mental illness does not just disappear when you cut a program helping them live a normal life, but instead end up in a jail or emergency room. The fact is that as much as we may not want to pay for our neighbors, if we spend nothing now, we end up paying a much heftier price later.

After failing to get Governor Walker’s ear, County Executive Nelson wrote Health and Human Services Secretary Kathleen Sebelius on June 27, 2011 asking her to reject the governor’s proposed changes to FamilyCare. Unlike many state or county policies, FamilyCare falls under the Medicaid umbrella, is partially funded by the federal government and changes must therefore receive federal approval in order to take effect. If Walker continued on without federal approval, Wisconsin would lose 60 percent of program funding. This, of course, would either be the death of the program or require counties to find millions of dollars in revenue they do not have.

While not outright cutting the program, on July 1, 2011 a cap went into effect. Maureen Ryan, executive director of the Wisconsin Coalition of Independent Living Centers, said even a cap would end up costing counties more. “Our big concern is that people are going to end up in hospitals, emergency rooms, inpatient stays, or costly nursing homes, stays that could be preventable and are more costly.” Again, Executive Nelson was at the forefront, saying, “At every turn, Governor Walker and Republican legislators have ignored the pleas of local officials and the families of our elderly and disabled.” Nelson called the cap a “cold-hearted, misguided policy” and further said “this misguided, expensive overhaul will do nothing but hurt our elderly and disabled and cost local taxpayers millions.” Executive Nelson had promised to make FamilyCare his hallmark issue, and when time came to take action, he was the first county executive to speak out on behalf of his constituents.

Within the month, seven counties and 37 legislators joined Outagamie County in petitioning Secretary Sebelius to reject the FamilyCare cap. Nelson personally spoke with Senator Herb Kohl, who in turn spoke directly with Secretary Sebelius. She was invited by Nelson to Outagamie County in order to see FamilyCare’s effects first-hand.

Feeling the growing pressure, Walker responded by telling a Milwaukee newspaper the freeze on enrollment may be “modified or dropped later this year (2011).” To the best of my knowledge, he made no effort to discuss the issue directly with the county executives.

After almost six months with the cap in place, the possible “drop” happened, as a complete surprise to almost everybody. On December 28, 2011, Walker, surrounded by the elderly and disabled people, some of whom were probably on the waiting list, announced he had changed his mind and was lifting the cap. “It’s a great program to help people in need,” he announced. The state had now allocated $72 million to fund the program, claiming to be following through on a promise he had made during the summer.

The press conference raised some eyebrows among the governor’s critics. “It’s pretty shocking that he is using the community he’s almost ground under foot in this budget as props,” said Democratic Party spokesman Graeme Zielinski. “This is like the arsonist calling the fire department and looking for a reward afterward.” Hours after the press conference, the reason for Walker’s change of heart came to light: he had received a letter from the Centers for Medicare and Medicaid Services on December 13 ordering him to lift the cap because it was not in compliance with federal regulations and to immediately enroll those who had been denied service since the cap went into effect.

Upon learning of the letter, Executive Nelson released a statement: “I was reluctant to applaud the governor’s decision yesterday and what we learned later in the day confirmed that suspicion. What is so unfortunate about this episode is this is yet another example of the disingenuous approach this governor has taken with the people of Wisconsin. His lack of candor on this issue is appalling. He owes the thousands of families affected by the wrongful FamilyCare restriction and the entire state an apology.” Nelson today refers to the letter as “the smoking gun”.

Nelson tells me that, politics aside, the counties and state are “attached at the hip” on many issues — health care, road construction, etc — and it is crucial that there “is a level of honesty between the state and local elected officials”. He likens the relationship to a business involving clients and suppliers where you must “take for granted that you can trust that person.” Once you have a business partner you no longer trust, “you stop doing business with them.”

Walker spokesman Cullen Werwie struck back at Zielinski and Nelson, saying the letter had only talked of “permanent caps” and was not the impetus behind Walker’s decision. “The governor always planned to lift the FamilyCare cap, just as he shared with news outlets earlier this year.”

Regardless of whether Walker was forced or freely saw the error of his ways, in January 2012, Assembly Bill 477 was introduced to officially remove the cap on enrollment of FamilyCare. Unanimously passed the Committee on Aging and Long-Term Care in February, but died in the Senate in March. But fear not, as its “death” was only a red herring! At the same time, the similarly-worded Senate Bill 380 was passed and signed into law by Governor Walker, much to his chagrin.

Since the imposition of the cap in July 2011 until the time it was removed in April 2012, Outagamie County’s waiting list had grown to 330 individuals. Multiply that by all the counties involved and you have a significant number of people receiving inadequate and overpriced care. But once the cap was removed and the world was put right, Nelson has been pushing to get as many people off the list an receiving care as possible. By August 2012, more than 100 people were removed from the waiting list and everyone is projected to receive coverage by April 2013.

As of now, Outagamie County and the other counties looking to provide better care for the elderly and disabled, while saving taxpayer money, have won the battle. But the war is far from over so long as other counties remain uncovered. Representative Robin Vos, a powerful state Republican, was against the lifting of the cap and remains firmly against the program’s growth. “I haven’t seen the entire plan, but I have a hard time seeing how we can expand FamilyCare right now,” he says.

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