May 4, 2011
Staying as independent as possible is a goal for Mark. He lives in an adult home with other developmentally disabled residents.
Recently Mark’s mother contacted me very concerned for her adult son. She was afraid budget cuts would jeopardize her son’s living arrangement.
Mark receives care through a state program called Family Care. Established in 1998, the program provides care for the frail elderly and those with physical or developmental disabilities; people like Mark who has Down’s syndrome, Janet who has cerebral palsy and Andrew who was paralyzed from a fall.
Last week the Legislative Audit Bureau released a long awaited audit of Family Care.
Concerns about the program expressed by family members, adult family homes and other providers along with the Family Care organizations led the Audit Committee, under my leadership as Co-Chair, to authorize the audit last summer. The audit reviewed the program and evaluated its effectiveness.
The audit looked at how the state and the local Family Care entity, called Managed Care Organizations (MCOs), did business. In western Wisconsin there are two MCOs: Community Health Partnership in Eau Claire and Western Wisconsin Cares headquartered in La Crosse.
Clients were provided care in a prompt, accurate and high quality manner. The audit found the MCOs provided the appropriate care. Auditors discovered only a 1% error in the proper level of care. More than 80% of participants were satisfied with the care received and less than 1% of the time did MCOs not meet regulations and requirements.
The audit showed a surprisingly large number of developmentally disabled people receiving care. Over 40% of the almost 30,000 people served were developmentally disabled. Many of these clients had behavioral problems that added to the cost of their care.
Family Care was an innovative idea to move clients from institutions into home-like settings. This helped the individual live more independently and the state saved the cost of running very expensive institutions. You may remember the closing of Northern Center in Chippewa Falls. Many of the clients now live in the Eau Claire area and are served by Community Health Partnership (CHP).
Like every MCO, CHP receives a set dollar amount for the care of a client. Case workers arrange for and monitor the care of the client. The set dollar amount gives the organization an incentive to seek the lowest cost care; regulations and state monitoring require high quality care be provided.
Audit results show several MCOs statewide, including CHP, face severe financial problems. Five borrowed and have not repaid state-mandated reserve funds; three are operating at a deficit; three owe more than they are worth and two reported their chief executive officer salaries were over two hundred thousand dollars.
I examined the audit details and found the MCOs in the worst financial shape were those with the highest cost clients. At the top of the list is Eau Claire-based CHP. Auditors reported it was difficult to determine if MCOs like CHP could have done a better job managing their operation. For example, administrative costs are quite low. Only four and a half dollars of every hundred are spent on administration at CHP – better than only the very best in the health field.
Closing Northern Center brought new freedom to previously institutionalized patients. But these patients had very severe care needs that still have to be met. Even the Department of Health told auditors rates paid for high cost clients do not cover their necessary services.
We now face a difficult situation as local homes cannot meet clients’ care needs and must discharge clients. In many cases there is no one else to take up the care of these vulnerable people.
If proper care is to be provided for Mark, Janet and Andrew, local homes must be properly paid. This will not happen if the state fails to acknowledge that care provided to some folks just costs more.
A tough sell in tight fiscal times, but very necessary if we are to continue providing care for our most vulnerable citizens.
The full Legislative Audit Bureau report on Family Care can be found at the following link: http://legis.wisconsin.gov/lab/reports/11-5full.pdf