When Dane County released its actuarial study of Family Care last month, the results confirmed advocates' worst fears: The state's new long-term-care plan for the elderly and disabled would not pay as much for services as does Dane County's current program. The study found a nearly $1,800-per-person monthly gap between the two programs.
"To me, that says people are going to have a reduction in services," says Supv. Barb Vedder, a member of the county's Health and Human Needs Committee. "We're going to see big changes, and I think it's going to be difficult."
Kim Turner, chair of the Developmental Disabilities Coalition, predicts the funding gap will lead to "more congregate services, more congregate living and not much of a self-directed services option." In other words, people will have to share access to services or lose them altogether.
State officials defend Family Care, which they see as a panacea for lengthy waiting lists and unequal services across the state.
"We feel very strongly that this is the right thing to do," says Sinikka Santala, head of the state's Division of Long Term Care. "We are seeing the end of waiting lists. It's magnificent work we're doing."
Family Care is currently operating in 14 counties, with 12 more set to switch by the end of the year. It's unlikely Dane County will get Family Care before 2010, but county officials are already scrambling to figure out how the program will work here. They wonder about the state's ability to fund the program adequately, the quality of its services, and who would operate it. Dane County must decide if it wants to run Family Care, or turn the program over to a nonprofit managed-care organization.
But the biggest concern is that Family Care might force cuts in the county's service network, which has been hailed as a model for the nation.
"I have expressed concerns ever since we learned about Family Care," says Dane County Executive Kathleen Falk. While she's careful not to criticize her political ally, Gov. Jim Doyle, Falk does ask, "How can the state be certain that consumers here get the same high level of services that they do now?"
To hear the state tell it, Family Care is a miracle program that will end waiting lists and provide quality services, all for less money.
"Family Care is much more flexible and tailored," says Judith Frye, head of the state Office of Family Care Expansion. "It's not one-size-fits-all."
Frye says the program cuts costs by doing a more thorough screening of a person's needs. She shares the story of an elderly woman who wanted to move from her own home into a more costly facility. The woman was lonely and wanted to be closer to her friend, who was living at the nursing home. Instead of moving her, Family Care simply arranged for her to visit the friend more often.
Dane County couldn't have made a similar arrangement, says Frye, because "they don't have at their disposal the same sort of flexibility."
Santala notes that Family Care also includes a nurse on every team, to prevent health issues from escalating. "People stay healthy longer and avoid going to an institution," she says.
The program has been praised for ending waiting lists. "It's a huge step forward," says Lynn Breedlove, executive director of Disability Rights Wisconsin.
But there is concern that the state can't afford to adequately fund the program in all 72 counties. Under Family Care, each county must operate an Aging and Disability Resource Center, where people are initially screened for services. When the state first began Family Care, it helped counties launch the resource centers by funding the first six to nine months. Now, the state only offers funding for two months.
"The state budget's a little tight," admits Frye, but she adds that larger counties, such as Dane, could get more money for the resource center. "Waukesha got four months because we know it's a bigger county."
Service agencies in Family Care counties have also reported a delay before they are paid by the managed-care organizations. Turner says she heard from a provider in Ozaukee County who hadn't been paid by the private HMO in three months and was burning through a line of credit at the bank, trying to stay solvent. "He doesn't know what to do," she says.
Frye acknowledges that when Family Care is up and running, it can take a couple months before the service agencies are paid. But she says those rough spots eventually smooth out.
"It's been a learning process for us all," she says. "Just a little change is going to be a challenge for people."
The state's funding issues, combined with the $1,800-per-person monthly budget gap, has some advocates worried that Dane County will be forced to reduce services.
"The idea of Family Care is a good one: Don't have waiting lists," says Vedder. "But in Dane County, our consumers will be receiving a lot less. We have to do what we can to keep what we have."
Breedlove notes that while Dane County's services for developmentally disabled have been an "object of envy" around the state, the same is not true for its aging programs. The elderly, he says, "don't feel like they have a lot to lose by switching to Family Care. They might have something to gain."
Frye insists Dane County's developmentally disabled consumers will not lose benefits with the state's program. "All the services they are currently getting are in the benefit package for Family Care," she says, before implying that Dane County spends too much on its services anyway. "You can't just keep throwing money at it."
Falk bristles at the suggestion the county has not been efficient with its human services budget. "I'm a pretty frugal county exec," she says. "We continue to make sure our dollars are spent as smartly as possible."
County taxpayers currently contribute nearly $20 million a year in extra funding for people with disabilities - money the state demands Dane County use to pay for Family Care instead.
"That's not acceptable," says Falk. "That's not some federal pot of money. That's our local tax dollars."
An analysis of state statistics by advocacy groups shows that people with disabilities in Family Care counties moved steadily from community-based programs to congregate services. In four of the pilot counties, people with disabilities lost supported employment, such as job coaches, and were sent in increasing numbers to sheltered workshops or adult day care. Portage County saw the most dramatic increase, from 38% in sheltered employment in 1999, before Family Care, to 62% in 2005, after Family Care.
The pilot counties also saw a slight increase in the number of people living in group homes or institutions, from 29% in 2004 to 31% in 2006.
Vedder sees this as contrary to the county's philosophy of inclusion. "In Dane County, it's more about integration in the community, living on the same scale with other people," she says. "We've felt this is the lifestyle people should have."
Frye doesn't see why Dane County needs to spend additional money on services not offered under Family Care: "If you do an individual care plan and identify a person's needs, what else is there that you would need to spend money on?" But she says the state won't tie Dane County's hands. "They can give money away if they want to."
Vedder hopes the county continues to support programs that keep people working and in their own homes.
"These are the things that the state thinks are fluff," she says, adding the county needs to hear more from stakeholders about what they want from Family Care. "It's us who are going to be directly impacted by it. We should have some say in it."