What a great discussion about Self-Determination and the State Budget Proposal on the Coffee Break yesterday morning! Special thanks to Lynn Breedlove for joining us as our special guest! There were several points discussed. Some of them include:
- DHS says self-determination will be folded into Family Care, but the specifics of that remain unclear.
- This heavily relies on Federal Waivers. Its assumed DHS will get the waivers, although this is uncertain. Lynn pointed out that CMS has become less rigid in what they approve. This budget proposal includes no-bid contracts with new insurance companies. This means DHS can contract with whomever they choose, with no bids.
- The big difference between self-direction in IRIS and Family Care is that in IRIS people have full authority over their budget, full employer authority, and an open market to select services. This is not the case in Family Care.
- Theres a huge concern over people being limited to which healthcare providers they can use. This is especially concerning to older adults as it takes a long time to develop a relationship with a trusted provider. Its also concerning to anyone with significant health care needs or disabilities who has had to work to find a provider who understands their particular health care situation and works well with him/her. Its expected that provider networks will be smaller in the future because the budget removes the any willing provider requirement.
- Another big concern is that its very unclear how this transition would occur if the budget passes as is.
- There are many theories as to why this came up in the budget proposal.
- Lynn encourages people to contact their legislatorsthis is a huge change in Long Term Care that came up overnight, with no input from the people who use services, the organizations that provide support through Family Care and IRIS, or local communities.
- Its not believed there is any continuity of service providers in the budget meaning people would be forced to leave some of their current providers.
- Another huge issue is DHS doesnt think its important to cap the percentage that the new MCOs could make in managing LTC. Many find this very alarming.
- As of now, expansion of IRIS is going forward in Northeastern Wisconsin.
- As far as we know, Kanas is the only other state doing the same thing. Some of the other states doing it exclude people with developmental disabilities.
- Its unclear whether CMS changed its opinion on requiring a self-directed alternative to managed care.
- Questions as to how this would impact community living, integrated employment, etc remain.
Share your questions, as well as your resources, information, experiences, and ideas about the budget proposal in this discussion.
updated by @sd-network: 02/23/16 04:43:48PM
