ABLE Accounts - What You Need to Know - Family Voices of ... · PDF fileABLE Accounts - What You Need to Know ... related to raising a child with signi cant disabili es ... Co-Directors

Fall 2015

ABLE Accounts - What You Need to Know Currently many public programs for children and adults with disabili es limit eligibility to those who have very low income and few assets (e.g., under $2000). Over the course of many years, families and disability organiza ons advocated for new policies to allow families to save for future needs of a family member without worrying that they would become ineligible for cri cal public programs, including Wisconsin Medicaid, SSI and long term care programs such as Family Care.

In December 2014, Congress passed the Achieve a Be er Life Experience (ABLE) Act. The ABLE Act was also included in the 2015-2017 State Budget. The Act allows families to set up and contribute to ABLE accounts.

What is an ABLE account?

ABLE accounts are tax advantaged savings accounts for individuals with disabili es. Income earned by the accounts would not be taxed. Contribu ons to the account made by any person (the account beneciary, family and friends) would not be tax deduc ble. These accounts will work much like 529 Edvest college savings accounts.

Why the need for ABLE accounts?

The ABLE Act recognizes the extra and signicant costs of living with a disability. These include costs related to raising a child with signicant disabili es or a working age adult with disabili es. Funds saved in ABLE accounts can pay for such things as accessible housing and transporta on, personal assistance services, assis ve technology and health care not covered by insurance, Medicaid or Medicare.

Are there limits to how much money can be put in an ABLE account? The total annual contribu ons to an ABLE account by individuals, including family and friends, is $14,000. The amount will be adjusted annually for ina on. Only one account is allowed for each eligible person.

Which expenses are allowed by ABLE accounts?

A “qualied disability expense” means any expense related to the designated beneciary as a result of living a life with disabili es. These include educa on, housing, transporta on, employment training and support, assis ve technology, personal support services, health care expenses, nancial management and administra ve services and other expenses which will be further described in regula ons to be developed by the U.S. Treasury Department.

What is the meline for se ng up ABLE accounts?

ABLE Accounts will likely be available star ng around July 1, 2016. The WI Department of Administra on (DOA) is charged with wri ng rules. Federal regula ons must also be nalized before ABLE accounts become available in Wisconsin. Communica on from the DOA and from advocacy organiza ons including Family Voices will help families know when they can start contribu ng to ABLE accounts. Stay informed by going to the Family Voices website under Wisconsin Policy at www.familyvoicesofwisconsin.com

Adapted from the Na onal Disability Ins tute material at www.realeconomicimpact.org/news/?id=460

The Home of Wisconsin’s Family to Family Health Informa on and Educa on Network in Partnership with the Wisconsin Children and Youth with Special Health Care Needs Program

Fall 2015

Family Voices of Wisconsin has a new website! Check out all the resources and helpful materials for families at www.familyvoicesofwisconsin.com

Any person over the age of 18 is legally an adult, and is presumed to be able to manage his or her own nances, choose where to live, consent to medical treat-ment, vote, marry, and exercise his or her own legal rights as an adult. This presump on does not change because a person has a disability.

When a person is unable to do some or all of these, some form of supported decision making is needed. It is important that families learn about the full range of op ons and start having the conversa on about decision making with their family members early. While guardianship is the most widely used legal tool, there is a growing use of less restric ve op ons to support a young adult’s ability to have control over his/her own life, allowing them to determine their own future as an adult. Decision-Making — A Skill that Requires Prac�ce and Experience* Decision-making is a learned skill. If we give young children the opportunity to choose what they wear, eat or want to do for fun, we encourage their self-condence and their ability to make decisions that direct their own life. All youth and adults make mistakes in decision making at mes and these mistakes usually help their ability to make be er decisions in the future. If youth (including those with special needs) are not given the opportunity to choose and make mistakes they are less likely to develop these skills and may not believe they are capable of decision making as adults.

As a family considers a young adult’s ability to make their own decisions they may want to think about the following:

What do you worry about as you consider your child’s future – is guardianship necessary or would a less restric ve op on do?

Does your child have skills and strengths in some areas of decision making, but not in others (e.g., could they decide what classes they want to take but not be able to make nancial decisions)?

Would support from friends, family, technology or professionals be enough to assist the young person with their decisions?

How important is the decision they need to make and what are the consequences of a wrong decision?

Legal Tools to Support Decision Making There are a variety of legal op ons for families. These include signing Release of Informa on forms, Power of A orney for Health Care, Power of A orney for Finance, Power of A orney for Educa on, and full or par al/limited Guardianship. (See Web Watch for links to related resources including the Wisconsin Guardianship Support Center.) To learn more see the new fact sheet called, Supported Decision Making for Transi on Age Youth, available on the Family Voices website under “Resources” at www.familyvoicesofwisconsin.com

Did You Know? Now You Know!

Supported Decision Making for Transition Age Youth

WEB WATCH For addi onal resources related to the ar cles in this newsle er, you can visit the following sites:

Na�onal Office of Family Voices

www.familyvoices.org

Family Voices of Wisconsin www.familyvoicesofwisconsin.com

(This is a new website address!!)

Na�onal Disability Ins�tute/ ABLE Accounts

www.realeconomicimpact.org/public%20policy/able%20act

Wisconsin Guardianship Support Center

h p://www.gwaar.org/for-seniors-and-families/elder-law-and-advocacy-

center/wisconsin-guardianship-support-center.html

Na�onal Resource Center for Supported Decision Making

www.supporteddecisionmaking.org

Marketplace “Find Local Help” localhelp.healthcare.gov

*Adapted from: Got Transition, Center for Health Care Transition Improvement, Guardianship and Alter-natives for Decision Making Support

CYSHCN REGIONAL CENTERS

Call with your ques ons!

Northeast Region Children’s Hospital of Wisconsin - Fox Valley

1.877.568.5205

Northern Region Marathon County Health

Department Wausau

1.866.640.4106

Southeast Region Children’s Hospital

Milwaukee 1.800.234.5437

Southern Region Waisman Center

Madison 1.800.532.3321

Western Region

Chippewa County Dept of Public Health

Chippewa Falls 1.800.400.3678

Great Lakes Inter-Tribal

Council (GLITC)

Lac du Flambeau 1.800.472.7207

Children and Youth with Special Health Care Needs News

Family Voices of Wisconsin Training Schedule

October 15: Appleton - A Did You Know? Now You Know! training. To register contact the Northeast Regional Center at 877-568-5205 or [email protected]

October 24: Milwaukee - A What’s A er High School transi on training for Spanish speaking families. To register call 414-643-0022 or Alasinc@Alianzala nawi.org

November 2: Hudson - A What’s A er High School transi on training. To register contact the Western Regional Center at 1-800-400-3678 or [email protected]

November 5: Appleton - A What’s A er High School transi on training in partnership with NAMI Fox Valley. To register contact the Northeast Regional Center at 877-568-5205 or [email protected]

November 14: Janesville - A Did You Know? Now You Know! training. To register contact the Southern Regional Center at 1-800-532-3321.

November 19: Kenosha - A Did You Know? Now You Know! training. To register contact the Southeast Regional Center at Center at 800-234-5437 or [email protected]

2015-2017 State Budget Summary The Survival Coali on of Wisconsin Disability Organiza ons State Budget Summary is included in this newsle er to help families understand the implica ons of the budget for families who have children or other family members with special needs. To read more go to www.survivalcoali onwi.org/

Policy/Legisla ve Update

DHS To Hold Public Hearings on Changes to Family Care and IRIS The Wisconsin Department of Health Services is holding public hearings

around the state in September and early October on the new long term care system.

The Wisconsin Long-term Care Coali on has developed talking points with key principles that must be included in a new system – go to www.wilongtermcarecoali on.org/

Marketplace Open Enrollment 2016 Open enrollment for health insurance through the federal Marketplace starts November 1, 2015 and runs through January 31, 2016. This is a shorter enrollment period than in the past. New plans and subsidy op ons may be available for your family so check the Marketplace website - go to www.healthcare.gov/

“Find Local Help” A lis ng of local navigators, agents, brokers and assisters to help you apply for a Marketplace plan is now available as part of the federal Marketplace website - go to h ps://localhelp.healthcare.gov/

Individuals can also participate via webcast. Comments can be sumbitted online, through the mail or at one of the public hearings. The deadline for comments is October 11! To learn more go to www.dhs.wisconsin.gov/familycareiris2/index.htm

Fall 2015

Volume 10, Issue 3

About Family Voices of Wisconsin

Family Voices of Wisconsin Post Office Box 5070

Madison, Wisconsin

53705

Family Voices of Wisconsin (FVW) is a state affiliate organiza�on of the na�onal Family Voices organiza�on and serves as Wisconsin’s Family-to-Family Health Informa�on Center. Addi�onally, FVW is recognized as the Family Leadership Hub for Wisconsin’s Children and Youth with Special Health Care Needs (CYSHCN) partnership. Family Voices focuses its work on health care and community supports in three areas:

Educa�on and informa�on development and dissemina�on, including trainings, fact sheets, and newsle�ers; Family leadership ac�vi�es, including the annual Advocacy for Change ins�tute; and Public policy and systems change ac�vi�es.

Feedback Welcome

We want to make sure that this newsle�er is an effec�ve resource for you. If you have any comments, or wish to provide news and informa�on for us to publish, please con-tact Lynn at [email protected]. We look forward to hearing from you!

LIKE US ON FACEBOOK AND JOIN THE FAMILY ACTION NETWORK LISTSERV ([email protected])

Would you prefer to have this newsle er emailed to you?

Contact Lynn at [email protected]

Contact Us Family Voices of

Wisconsin

P.O. Box 5070

Madison, WI 53705 www.familyvoicesofwisconsin.com

(new website address)

608.220.9598

Co-Directors

Liz Hecht ([email protected]) Barbara Katz ([email protected])

Training & Outreach

Lynn Renner ([email protected])

Family Network Rachel Crites ([email protected])

Community Educa on Brigit Frank ([email protected])

This newsletter is supported by the Health Resources and Services Admin-istration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H84MC21690-01-00. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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PAID

Madison, WI

Permit No. 1222

Effective July 1, 2012, families and individuals enrolled in BadgerCare Plus will see major changes, including premium

Fall 2015

Volume 10, Issue 3

About Family Voices of Wisconsin

Family Voices of Wisconsin Post Office Box 5070

Madison, Wisconsin

53705

Family Voices of Wisconsin (FVW) is a state affiliate organiza�on of the na�onal Family Voices organiza�on and serves as Wisconsin’s Family-to-Family Health Informa�on Center. Addi�onally, FVW is recognized as the Family Leadership Hub for Wisconsin’s Children and Youth with Special Health Care Needs (CYSHCN) partnership. Family Voices focuses its work on health care and community supports in three areas:

Educa�on and informa�on development and dissemina�on, including trainings, fact sheets, and newsle�ers; Family leadership ac�vi�es, including the annual Advocacy for Change ins�tute; and Public policy and systems change ac�vi�es.

Feedback Welcome

We want to make sure that this newsle�er is an effec�ve resource for you. If you have any comments, or wish to provide news and informa�on for us to publish, please con-tact Lynn at [email protected]. We look forward to hearing from you!

LIKE US ON FACEBOOK AND JOIN THE FAMILY ACTION NETWORK LISTSERV ([email protected])

Would you prefer to have this newsle er emailed to you?

Contact Lynn at [email protected]

Contact Us Family Voices of

Wisconsin

P.O. Box 5070

Madison, WI 53705 www.familyvoicesofwisconsin.com

(new website address)

608.220.9598

Co-Directors

Liz Hecht ([email protected]) Barbara Katz ([email protected])

Training & Outreach

Lynn Renner ([email protected])

Family Network Rachel Crites ([email protected])

Community Educa on Brigit Frank ([email protected])

This newsletter is supported by the Health Resources and Services Admin-istration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H84MC21690-01-00. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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Organiza on

U.S. Postage

PAID

Madison, WI

Permit No. 1222

Effective July 1, 2012, families and individuals enrolled in BadgerCare Plus will see major changes, including premium

INTRODUCTION

People with disabilities, their families and advocates across Wisconsin have spent the last several months testifying at hearings, making phone calls, and sending messages to legislators, sharing their ideas for improving the lives of people with disabilities by engaging in the state budget process. The Survival Coalition of more than 30 disability organizations in Wisconsin has assembled the following summary of the state budget’s impact on the disability community.

It includes an assessment of the impact on the lives of people with disabilities, their families, and allies across

a series of issues areas.

Medicaid Overview

The 2015-17 state budget is a mixed-bag for the Medicaid program. After making major changes to

BadgerCare eligibility in the last state budget, the Governor and Legislature again approved changes to the

BadgerCare program that will likely result in individuals losing coverage if they are approved by the Federal

government. However, the budget does include some positive provisions such as increased Medicaid

funding to meet current program needs, implementation of the ABLE Act in Wisconsin and an attempt to

address low Medicaid reimbursement rates for dental services.

BadgerCare Restrictions. The budget requires the Department of Health Services to ask the Federal

Government for permission to do the following: Limit BadgerCare enrollment to 48 Months for

childless adults; charge monthly premiums to childless adults; require childless adults on BadgerCare

to undergo a yearly health risk assessment and require individuals with risky health behaviors to pay

higher premiums; require childless adults to undergo drug screening before receiving BadgerCare

coverage.

Medicaid “Cost-to-Continue” Funding. The budget provides additional funding to Medicaid to ensure

that programs can continue to provide the same types of services and serve the estimated number of

Medicaid enrollees during the two-year budget cycle.

ABLE Act. The budget authorizes Wisconsin to create the ABLE Act accounts. Individuals with

disabilities and their families will be allowed to save money in tax-free accounts without losing access

to Medicaid programs. Money saved in ABLE Acts can be withdrawn to pay for disability-related

services such as employment supports, education and health care.

Dental Reimbursement Rate Pilot. The budget temporarily increases Medicaid reimbursement rates for

pediatric and adult emergency dental services in Brown, Polk, Marathon and Racine Counties.

Medicaid Expansion. The budget did not accept federal funds for Medicaid expansion. Instead, the budget

again provides $15 million in each year of the biennium for the state to make payments to hospitals that cover

a high percentage of low-income patients.

Division of Medicaid Services. The budget merges the Division of Health Care Access and Accountability and

the Division of Long-term Care to create the Division of Medicaid Services.

Prior Authorization. The budget moves Medicaid Prior Authorization from the Office of Inspector General

and into the new Division of Medicaid Services, in part in response to Survival’s concerns about repetitive

and burdensome reviews of medically necessary service requests.

EMPLOYMENT OVERVIEW

Survival Coalition’s biennial budget requests focused on public policies that would increase integrated employment

at competitive wages as the first and preferred outcome of public programs for people with disabilities. None of the

following budget requests were addressed:

Employment performance targets in state programs that support people with disabilities to show continued

improvement.

State agency reports annually to the Legislature on progress toward improving employment outcomes for people

with disabilities.

Increase statewide funding for programs that result in improved integrated employment outcomes.

Changes to state use contracting laws to ensure Wisconsin is a model employer by requiring all workers on state

contracts to earn minimum wage or higher.

Statewide effort within departments to hire people with disabilities in state government jobs.

Business-to-business technical assistance system for businesses wanting to hire people with disabilities.

Expand and improve employment service provider quality and capacity to help people with disabilities achieve

integrated employment outcomes.

Restructure service provider payment systems to assure that integrated employment is rewarded as an

outcome and segregated employment is discouraged.

Direct DHS to use data it collects on expenses for integrated employment services compared with all other services

as a basis for shifting funds toward higher investments in integrated employment supports.

WORKFORCE ISSUES

The 2015 – 2017 State Budget failed to address the need for the recruitment and retention of a quality

direct care workforce. Thousands of older adults and people with disabilities rely on direct care

workers for their daily support needs in the home and community. High turnover, non-competitive

wage rates, and growing regulations lead to unpredictability in the sustainability of the long term care

system in Wisconsin. The approved State Budget creates concern and uncertainty for the entire long

term care industry, and increases threats to the direct care workforce. Most home care providers

estimate that their Medicaid Personal Care (MAPC) service costs are at least 15% to 20% above the

current reimbursement rate of $16.08 per hour. The MAPC rate has only increased by $0.24 over the

past 10 years, and no rate increases have been received since July 1, 2008.

The current stagnant reimbursement rate makes it incredibly difficult for the industry to

maintain, let alone grow, the workforce to meet the projected demand increase of 26% by

2020.

The State Budget includes a provision which requires an independent assessment process be

established for medical assistant personal care services. As the department moves forward to

implement this provision, Survival requests the following industry threats be considered;

o Increased administrative costs and subsequent strain on the already challenged

Medicaid budget.

o Uncertain standards for the qualifications of the assessors could jeopardize the

necessary services for all disability target groups.

o Lack of process efficiency could result in risks to health and safety of Wisconsin’s

vulnerable citizens.

o Inadequate communication strategies could limit industry’s ability to provide

services in a safe and effective manner.

CHILDREN NEEDING LONG-TERM SUPPORTS

Children with significant disabilities and their families struggle with access to an overly complex system

of supports and services, waiting lists for services, and a lack of needed information. The 2015-2017

state budget addressed in part several of the recommendations of Survival and took no action on

others. Specifically:

New funding to address those waiting for supports and services will be available through: a

3% annual increase in the Children’s Long-Term Supports (CLTS) program; excess federal

funds from school-based services (amount unknown); and $1.8M (state and federal) expected

to serve 50 children. An estimated 2800 children and youth with significant disabilities are

waiting for essential supports.

The legislature eliminated the Family Support Program and created in its place a new

Children’s Community Options Program (COP). Language changes proposed by Survival to

protect flexibility and county involvement were not included. Family involvement in the local

advisory committees for Children’s COP will be essential as policies are developed.

One change to improve Medicaid prior authorization, an inconsistent and repetitive process,

was passed. This would move operation and resources for prior authorization from the Office

of the Inspector General responsible for monitoring fraud and abuse to the Division of

Medicaid Services effective March 2016.

Survival recommendations for short-term assistance, expansion of a single point of entry

(Threshold), Medicaid efficiencies and measuring family outcomes to inform

improvements to CLTS were not addressed in the budget.

EDUCATION OVERVIEW

Students with disabilities received limited funding increases and a requested change to open

enrollment policy in the 2015-17 budget. Various other changes made by the Legislature and

Governor are expected to impact students negatively.

What Happened in the Budget that Impacts Students with Disabilities?

Survival Coalition had requested that the state increase special education funding to meet 44% of costs and fully fund high costs students (those who have costs above

$30,000/year) to address decades of eroded funding.

o The Legislature continued flat special education funding (reimbursement at 26% of costs) but increased reimbursement for high costs students by providing an additional $5,000,000 GPR in Fiscal Year 2017. The fund will reimburse district costs at 70% of costs for these students (estimated 1,000 students).

Survival Coalition had opposed voucher expansion, including the creation of a Special Needs Voucher program, which had been defeated twice by parents and advocates. Students with disabilities do not retain essential IDEA rights in voucher schools.

o The Legislature created a statewide Special Needs Voucher Program that will begin accepting

students in 2017. Students must first be denied open enrollment and have an IEP in place. There is no income limit and no statewide cap.

o The Legislature expanded the state’s parental choice program; beginning in the 2015-17 school year the total number of students who can use a voucher to attend a private school outside of Milwaukee and Racine will start at 1% of a district’s enrollment and increase annually until the cap is lifted in a decade. Voucher funding will reduce public school funding by $48 million over the next two years.

Survival Coalition had supported DPI’s proposal to add $5.8M to create a youth transition incentive payment ($1,000/student) to reward schools that demonstrated that students with disabilities had secured jobs or were enrolled in postsecondary education or training one year out of school.

o The Legislature provided $100,000 for transition incentive payments in Fiscal Year 2017.

Survival Coalition requested that the Legislature eliminate discriminatory open enrollment provisions.

o DPI requested, with input from stakeholders, and the Legislature approved, a change to the

public school open enrollment program beginning in FY17 to eliminate undue financial burden (resident district can no longer deny an application for open enrollment for this reason; denials based upon lack of space remain) and establish a $12,000 open enrollment transfer amount for students with disabilities.

Survival Coalition had requested that the state implement a Special Education Quality Improvement Plan, including developing a fund to target resources and technical assistance to districts/schools that are not making adequate progress in addressing the achievement gap. Survival ultimately opposed and requested a veto of the Opportunity Schools Partnership Program.

o The Legislature passed the Opportunity Schools Partnership Program that will turn selected Milwaukee public schools over to types of schools that currently do not serve students with disabilities in the same proportion, or are not required by law to educate students with disabilities. The proposal removes local control from Milwaukee Public Schools, transferring it to the County Executive. This proposal is significantly different from Survival’s Quality Improvement request and will potentially impact 7,564 students with disabilities.

The following Survival requests were not addressed in the budget:

Investment in the Wisconsin Special Education Mediation System (WSEMS);

Recognition of a uniform definition of disability across all school settings; o Development of alternatives to classroom removal and out of school

suspensions; o Support for a clear transition policy directing competitive integrated

employment as the preferred outcome;

o Establishment of a school based mental health study committee; o Development of a stakeholder committee on Act 125 –seclusion and restraint law; o Inclusion of County Children with Disabilities Education Boards (CCDEBs) in the

statewide accountability system

TRANSPORTATION OVERVIEW

People with disabilities asked for a number of improvements in access to transportation. For the most

part, Gov. Walker did not include our requests or those of the Dept. of Transportation related to people

with disabilities in his budget bill. The Legislature had a difficult time agreeing to transportation

provisions in the budget bill, primarily because of a shortfall in the Transportation fund and the

extensive reliance on bonding for highway projects.

Preserve the state investment in local transit by increasing Transit Operating Aids.

o The approved budget for 2015-17 does not restore Transit Operating Aids. o The approved budget does not create a Supplemental Transit Expansion program to provide for

new routes for ridership, jobs and economic development as proposed by Wis- DOT.

Increase funding for the specialized transportation assistance program (Sec. 85.21).

o The approved budget includes a 1% increase as Wis-DOT proposed but does not appropriate additional funds as requested to address long-term issues identified by the Governor's Transportation Finance and Policy Commission.

Actively pursue coordination of funding streams as counties have demonstrated to increase rides within existing funding.

o The approved budget does not require DHS to participate in coordination despite the fact that

its programs, including Non-Emergency Medical Transportation are the biggest providers of

human services transportation.

o The approved budget does not enhance the ability of local governments to coordinate transportation programs in their region in support of nor provide new funds for mobility management programs.

The budget eliminated state Transportation Alternatives Program funding for projects that help people with disabilities get around easier and safer in their communities.

Ensure that the Medical Transportation program provides safe, efficient transportation for medical needs.

o The approved budget does not consider NEMT recommendations of the Audit Committee as the report came out late in the budget process, nor does it require DHS to consult with consumers and other stakeholders in development of the system.

o DHS still does not provide independent advocacy for people experiencing difficulty with medical rides.

MENTAL HEALTH OVERVIEW

The Legislature provided significant new funding for mental health services in the 2013-2015 biennial budget. Survival Coalition sought additional funding for 2015-2017 to support these investments and address some areas of “unfinished business” from last session. However, the Legislature did not address any of the following Survival Coalition priorities.

Allocate targeted funding to support the significant investments made in the last budget. The

targeted programs include:

o Development of the Mental Health Certified Peer Specialist (CPS) and parent peer specialist (PPS) workforce.

o Needed activities for the new Office of Children’s Mental Health.

Improve the criminal justice system’s response to individuals with mental illnesses.

The identified programs include those to expand reentry services, afford prompt access to health services upon release from prison, allow special courts to divert individuals with mental illness in the absence of a co-occurring substance use disorder from the criminal justice system and work with families of incarcerated youth, to support reintegrating children upon release.

Reduce the stigma and discrimination experienced by people diagnosed with mental illness and their families

Increase access to paid respite care for families of children with serious emotional disorders.

LONG-TERM CARE OVERVIEW

Fifteen out of sixteen Survival’s long term care budget requests were not addressed. Unbeknownst to

the disability community, the budget includes language that will replace the existing long term care

system (Family Care/IRIS) with an unknown and untested model. The budget does require the eight

remaining legacy counties to come into Family Care, however Survival Coalition’s budget request was to

expand the existing Family Care system (not expand and simultaneously change the system).

The 2015-17 budget:

Eliminates IRIS as a separate Medicaid Waiver program and folds self-direction under the

umbrella of managed care when the new long term care system is authorized.

Requires Family Care and the new self-direction option within Family Care to provide

medical care in addition to long-term care services

Creates new entities called Integrated Health Agencies (IHAs) that will operate Family Care and

the self-directed services option within Family Care, and medical services such as primary care

and more serious medical care like hospitalization. An IHA could include Wisconsin’s current

Managed Care Organizations or national, for-profit insurance companies.

Gives DHS the authority to determine the geography of managed care regions with no

minimum number of regions required

Retains the current any willing provider” provision, which makes it difficult for MCOs to restrict

their provider networks, to continue for at least three years.

Establishes an annual open enrollment period for people to enroll or change their IHA.

Currently people can change their MCO at any time.

Directs DHS to submit a waiver to federal Centers for Medicare and Medicaid Services (CMS)

which will contain details on the kinds and levels of services offered and how the new long

term care system (Family Care) will operate. The shift to the new long term care system will

happen after CMS approves a waiver.

Directs the Department of Health Services (DHS) to develop a “Concept Plan” on the

Department’s proposed changes to long term care system between now and April 1, 2016.

Requires the legislature’s Joint Finance Committee (JFC) to have a “yes” or “no” vote on

whether to approve DHS’s plan for the new long term care system. A JFC “yes” vote give DHS

authority to submit a waiver application to CMS.

Requires DHS to have two public hearings on the new waiver that will change the long term

care system.

Requires DHS to involve stakeholders, however it is unknown what the stakeholder

process will be, how much feedback will be solicited and reflected in the DHS’s final plan,

and who will be invited to participate in the stakeholder process.

Requires DHS to evaluate the functional screen and options counseling for reliability and

consistency among ADRCs and report back to the legislature; requires DHS to assess ADRC

governing board responsibilities and propose statutory changes to remove duplications; and

requires DHS to study the integration of income maintenance consortia and ADRCs and report

back to JFC. These actions could result in future changes to ADRCs.

To learn more about these changes visit the Survival Coalition website: www.survivalcoalitionwi.org or link to the FAQ: Long-Term Care State Budget Outcomes: http://www.survivalcoalitionwi.org/wp- content/uploads/2015/07/SurvivalCoalition_FAQ_LTCStateBudgetOutcomes_071315.pdf

FOR ADDITIONAL INFORMATION CONTACT SURVIVAL COALITION CO-CHAIRS:

Maureen Ryan, 608-444-3842 [email protected]

Beth Swedeen, 608-266-1166 [email protected]

Kit Kerschensteiner, 608-267-0214 [email protected]

Visit the Survival web site at: www.survivalcoalitionwi.org

Real Lives, Real Work, Real Smart, Wisconsin Investing in

People with Disabilities