Family Care program undergoing uncomfortable shift
An ominous deadline for several St. Croix County residents quietly came and went Friday, May 6. The guardians for 21 mentally disabled adults in western Wisconsin were served notice in early April that their loved ones would have 30 days to find a new place to live.
Those vulnerable adults live in small, residential group homes that help care for their needs and offer limited independent living in a community setting.
The goal of such facilities is to avoid placing developmentally disabled and physically disabled people in large institutions that may not be cost effective and may not do as good a job caring for the individuals.
In St. Croix, Pierce, Polk and several adjoining counties, Aurora Community Services is one group home service provider that serves about 100 clients. It has been providing that service for 25 years, according to Executive Director Holly Hakes.
Over the past several years, however, it's become increasingly difficult to make ends meet for the business, Hakes said.
Funding for Aurora's residential services and other similar facilities in western Wisconsin was cut by 14% in 2009, according to Hakes.
"And that was a cut in an industry that was already thin as far as margins go," she said. "At that time, we were able to manage those cuts."
Last month, Aurora and other facilities that receive funding from Community Health Partners, the managed care organization (MCO) that serves St. Croix, Pierce, Dunn, Eau Claire and Chippewa counties, received word that another big funding cut was coming.
Hakes said the new cuts amount to about 11% of the agency's reimbursement for services.
The cuts, it appears, have hit a few disabled residents particularly hard. The reimbursement level for these Family Care clients dropped significantly and prompted their group homes to re-evaluate whether they can continue to serve them any longer.
Richard, 56, of New Richmond has been living in his present group home with three other residents with mental and developmental handicaps for nearly a decade. He's been served by Aurora for 20 years.
According to his sister, Karen Kortum, a retired teacher from Hudson who now lives in Florida, Richard has grown to love his community, his caregiver and his job at St. Croix Industries.
All four of the residents in his group home have received notices from Aurora stating that they must move out.
"It's hard for me to believe that this is really happening," said Kortum, who traveled to New Richmond this past week to work out a solution to the issue. "To be taken away from your family -- and that's who they are, family -- and your work and your community. They really have no voice in all this."
Kortum said her brother's reimbursement level for 24-hour supervision dropped from about $104 a day to $70 a day due to funding cuts. Also, an annual "functional screening report" showed Richard failed to qualify for the higher levels of service he's received for years.
Kortum said her brother's capabilities haven't changed, just the way his disabilities are measured has apparently changed.
While Richard makes occasional meals at his group home, Kortum said he needs someone supervising him. Even though he also can pick up his medication at Family Fresh and go to the bank, Richard needs close supervision doing that, she claimed.
"He needs constant supervision," Kortum said.
Richard was supposed to have moved out of his group home by Friday, but the situation remains in a holding pattern. He will remain in his current home until a suitable alternative is found.
Kortum said there are only eight current group home openings in the area, so it's unclear where the 21 displaced residents could end up if forced to move.
Kortum returned to Florida on Tuesday without knowing how the situation will play out in the end.
Families seek help
Robert Pledl, a Milwaukee attorney, is representing about two dozen families facing similar circumstances in western Wisconsin. Pledl said he's represented families dealing with the Family Care process for years, but this is the first time he's handled so many cases at one time. All of Pledl's current cases involve Community Health Partners (CHP).
Pledl has filed appeals with the Wisconsin Department of Health Services on behalf of the families. The hope is that a resolution can be negotiated without having to go to court, he said.
Pledl said officials with CHP may claim that a change in a client's disability status has brought about the decrease in reimbursement levels, but that's not the case.
For all of his clients, their individual situations haven't changed or have only changed slightly, thus reimbursement levels should not be dramatically cut, he said.
Pledl charged that the reimbursement reductions have more to do with CHP's desire to cut costs, partly in response to a recent Family Care audit that showed the managed care organization is one of three MCOs in Wisconsin that is in danger of insolvency.
Aurora was the first group home provider in the area to send out service discontinuation notices to clients, but it likely won't be the last, Hakes said.
Other providers are waiting to see if a fix comes from the state before deciding what to do, she claimed.
"It's just a big mess," she said. "We're all wondering what we're going to do. And the guardians are all fired up."
Aurora couldn't delay sending out notices, in light of the significant reimbursement cuts it was facing, she explained.
"We can't do it for the daily rate they are paying," she said. "We don't have a money tree."
Group home workers are underpaid as it is, Hakes said, and there is no room for more cuts in Aurora's and other group homes' operations.
While she understands the Wisconsin's looming financial crisis, Hakes said she hopes the state budget isn't balanced on the backs of vulnerable adults.
If the state wants to "radically redesign" how it delivers services to residents with mental and developmental disabilities, Hakes said, a slower and more thoughtful approach is needed. Certainly more than 30 days should be provided to come up with a solution, she said.
"We're all scratching our heads over this," she said. "We, quite frankly, don't know what's going to happen."
Dean Mathwig, marketing and communications manager with CHP, said "due to financial deficits" the regional MCO is modifying the way it determines the level of need for each client.
"That's what's helping drive some of these changes," he said.
He confirmed that, in some cases, those receiving reimbursement are seeing a significant drop in funding.
The cuts were inevitable, Mathwig said, when the state shifted the responsibility for Family Care from the counties to the regional MCOs. Prior to that shift in 2008-09, counties received state funding to serve disabled residents but the counties also supplemented the cost of services with local tax dollars.
Now the MCOs must provide the same level of service with fewer dollars, Mathwig said.
That fiscal reality, along with the fact that reimbursement levels tend to be higher in western Wisconsin compared to other parts of the state, make adjustments necessary, he explained.
This part of the state also has a higher level of demand for service, Mathwig noted, which puts even more strain on the limited dollars available.
The trouble is, families have become accustomed to a certain level of service and any talk of scaling back isn't well received, Mathwig said.
"There's some fear of the unknown here," he said. "This doesn't come without its challenges. You're dealing with people's lives, and you're dealing with budgets and funding."
The challenge is to provide clients with the highest possible quality of life, yet "maintain the fiscal viability of the system," he said.
CHP is ready and willing to meet with families to work out a sustainable plan for those who are served by Family Care, Mathwig said.
"We're willing to sit down and talk together," he said. "But there has to be a willingness to adapt to change."
Former State Rep. Kitty Rhoades, Hudson, is Wisconsin's deputy secretary for the Department of Human Services. The department oversees the Family Care program.
In a phone interview last week, Rhoades said western Wisconsin needs to get more in line with other areas of the state in terms of reimbursement levels, noting the CHP's financial trouble needs to be addressed now to ensure the program's viability into the future.
"This has been a precarious operation for a while," she said. "We need to build a sustainable, long-term solution."
Rhoades admitted it's unfortunate that families were given just 30 days notice to find an alternative, but the state is trying to work with families and care providers to bring about an acceptable resolution. The ultimate goal is to "avoid relocations" of the residents, she said.