Family Care serves state's elderly, disabled

http://www.jsonline.com/news/wisconsin/120327199.html

BySteve Schultzeof the Journal Sentinel

April 20, 2011|(44) Comments

When Jeanne Fehr got word after a 10-year wait that her 31-year-old daughter, Nealy Rothe, would likely get state funding to live on her own, Fehr was thrilled.

Rothe, who has Down syndrome, works a part-time job but would need help managing money, taking the bus and with some chores if she were to move from the Milwaukee home she shares with her mother. Rothe said she is looking forward to having her own apartment.

But that excitement was tempered with Gov. Scott Walker's proposed freeze on enrollments in the state's Family Care program, which helps pay for community care of elderly and disabled people.

Unless Rothe's name comes off the waiting list soon or state lawmakers rewrite Walker's Family Care freeze, Rothe and Fehr might have to wait longer.

"I'm not going to live forever," said Fehr, 63, expressing a common fear parents of disabled children face as they get older. Who will care for Rothe when Fehr is no longer able?

Fehr said she was told by Milwaukee County officials there was a chance her daughter's name could come up for a spot in Family Care before July, when the Legislature is slated to approve a 2011-'13 budget.

Even so, that leaves many other families - including those with elderly members who were counting on Family Care once most of their money was gone - facing similar predicaments. New candidates could be enrolled only when someone else leaves the program, under the governor's proposal.

Program beneficiaries

Family Care provides community services to some 35,000 frail elderly and those with physical or developmental disabilities in the state, including almost 8,000 in Milwaukee County. It runs on a yearly budget of some $1.4 billion statewide and $260 million in Milwaukee County, with about 60% of the money from the federal government and the rest from the state. The program started in 1998 with five counties and has since expanded to 48.

The average cost for Family Care services is about $2,800 a month per client in Milwaukee County.

It is one of a cluster of social programs threatened in Walker's budget and part of his solution to a $3.5 billion state budget shortfall.

In Milwaukee County, the impact could be serious, though the governor has not identified how $500 million in proposed cuts in Medical Assistance would be parceled out, said Geri Lyday, interim director of the county's Department of Health and Human Services. Services potentially affected include outpatient mental health, community health, delinquency services and alcohol and drug treatment, she said.

While those trims are unknown for now, the Family Care freeze poses serious problems, county officials said.

"I just can't say how much we are disappointed about the cap on Family Care," Lyday said.

Walker's budget cuts funding for the program by more than $284 million over the next two years.

The governor wanted the freeze pending results of a state audit on the Family Care program, Kitty Rhoades, deputy secretary for the state Department of Health Services, said Wednesday. The department wants data on cost effectiveness, quality of care and the "fiscal sustainability" of the program, Rhoades said.

"Until we have those questions answered it doesn't seem logical to continue bringing people into the program," she said.

Rhoades described the freeze as temporary, but said it wouldn't be lifted until any problems raised in a forthcoming state audit are addressed. A report on the program will be issued by the end of the month, said State Auditor Janice Mueller.

"We put the freeze in (the budget) for two years because that's the worst-case scenario," Rhoades said. "Once the audit comes out and everything's coming up roses, then the caps don't need to be there," she said.

Rhoades said questions had been raised about program costs and effectiveness.

'No safety net'

County officials had been counseling frail elderly clients to spend down to their last $2,000 - the level for eligibility for Family Care services - in the expectation that the state would then cover a significant portion of costs for assisted living or adult group home care. That advice could prove harmful, said Stephanie Sue Stein, who heads the county Department on Aging.

Some seniors in assisted living or adult family day care could find themselves out of luck due to the proposed freeze, Stein said. People with disabilities, like Rothe, would have to wait longer to enter the program.

"There are going to be dire consequences," Stein told county supervisors. "There is no safety net left." Her department has been working to place as many seniors as possible in Family Care before the freeze is imposed, she said.

"It's a really bad thing to do to people," Stein said of the proposed freeze. Hundreds of seniors planning on Family Care "really have no recourse" besides nursing home care, at a cost of $5,000 a month or more, she said - nearly double what the state pays a month for seniors in Family Care.

Stein said the county also should expect lawsuits over denial of Family Care.

With a freeze, the county would re-establish a waiting list for seniors, who now apply for the program at the rate of about 150 a month. About 90 leave the program monthly, due mostly to death, which suggests a Family Care waiting list would grow by about 60 people a month.

In Milwaukee County, more than 2,000 people with disabilities are on waiting lists for Family Care, about one quarter of the statewide total. The state has had no waiting list for seniors in the program since 2002.

Among other changes in the governor's budget, the state SeniorCare program for prescription drug coverage gets downgraded, which would likely shift people into more expensive Medicare Part D coverage. It would mean $35 higher monthly costs and larger co-pays.