WISCONSIN

Wisconsin continued to build on its long-established base of programs and services for people with disabilities, including its pilot Family Care program, a redesign of the state's long-term care system for the elderly and adults with physical and developmental disabilities. Key to the program are care management organizations and managed long-term care in the pilot counties, which had a total enrollment of 7,900 people as of November 2003.

Although state fiscal problems appeared to have slowed expansion of the demonstration program beyond the five counties in which it had been implemented, a July 2003 evaluation of the program reported that Family Care had "... substantially met the goals of increasing choice and access and improving quality through a focus on social outcomes," according to Department of Health and Family Services (DHFS) officials. The evaluation report noted that the program eliminated waiting lists for services in the pilot counties, and that resource centers in those counties offered a "... successful model of centralized information and assistance."

In July 2003, the DHFS secretary created the Wisconsin Council on Long-Term Care Reform to advise the department ".... on goals and strategies for implementing statewide reforms of long-term care for elderly people and adults with disabilities." Key tasks for 2003-2004, the council said, included addressing mental health and substance abuse issues in the state's long-term care system, and developing statewide networks of the resource centers that currently are operating only in Family Care pilot counties.

Council activities also include seeking a demonstration waiver from the federal government to make some immediate and longer-range changes in the state's approach to long-term care. One such initiative, "pre-Family Care," involves a combination of waiver and Medicaid personal care, home health care benefits, and independent nursing in a risk-based, capitated program in Wisconsin communities that currently are not operating the Family Care program. For people with mental illness and alcohol and drug abuse needs, the waiver would provide authority to create a new home and community-based program for those who otherwise would be served in nursing homes. The proposal also calls for expanding all the state's current home and community-based programs for people with disabilities and downsizing nursing homes and facilities for the developmentally disabled. The proposal included a request for $185 million per year for four years, to be financed by Intergovernmental Transfers.

A council task force on residential options set a January 2004 deadline for recommending to the council "policy goals to guide reform efforts related to residential care," defined as nursing facilities; facilities for the developmentally disabled (DD); assisted living; and "safe, affordable, and accessible" housing options. By September 2004, the task force expects to produce a draft reform plan. Another council committee, the New Freedom Initiative Committee, was charged with monitoring Americans with Disabilities Act (ADA) goals and recommendations that had been put forward by an ADA Title II committee in two stages (in January 2002 and January 2003).

In 2002, county long-term support agencies for the first time registered people on the Human Service Reporting System who were requesting community-based support services, were likely to be eligible based on a preliminary review, and who were waiting for resources to become available. A total of more than 9,000 were waiting for services as of December 31, 2002, which included almost 2,400, and 3,600 people with DD. In his 2003-2005 biennium budget proposal, Governor Jim Doyle (D) proposed almost $62 million in additional funds to reduce those waiting lists and to increase the rates paid to service providers. This funding was deleted, however, during the 2003 legislative session.

The state received $1.2 million in federal grants in October 2003 to improve and expand community care for the disabled. One funded project, "Bringing Quality Close to Home," is expected to help county agencies improve the quality of the community long-term care system. The other project, "Money Follows the Person," will help to move people with DD out of institutions. DHFS projects that about 200 people with DD will move from institutions to community settings during the three-year grant period.