Door County Human Services Director Joe Krebsbach has waited patiently for the state to approve the Family Care services available in 57 other counties. / Ramelle Bintz/Door County Advocate
Fifteen years ago then-Gov. Tommy Thompson gave hope that waiting lists for services for all of Door County’s impoverished frail elderly, and physically and developmentally disabled adults, would soon be a thing of the past.
“The current long-term care system is intimidating, complex and often inefficient,” Thompson said when he unveiled the managed-care proposal for Family Care and the Wisconsin Partnership Program during his January 1998 State of the State address. “There are 40 ways to access the system. People don’t know how to get the appropriate care because it’s so complicated, and the concerns of families are often ignored.”
Republicans and Democrats alike agreed the system needed revamping. As a result the state developed a new method of delivering services, with managed care funded by the state to counties grouped by region rather than 72 separate county agencies.
Today 57 counties belong to regional Family Care organizations; 53 of them no longer have a waiting list for services and the remaining four expect to eliminate their lists by next April. People who are eligible and live in one of those counties can immediately receive long-term care services.
That’s still not true for Door County, where 78 eligible people have been waiting literally for seven or eight years for county services. That costs the state and county more money, since they use their Medicaid card for their medical needs but, in the absence of Family Care, are forced into nursing homes or go without services because they have no other option.
In anticipation the state would soon provide funding to the remaining 15 counties, Door and six other counties — Brown, Kewaunee, Shawano, Oconto, Menomonee and Marinette — formed Northeast Wisconsin Family Care in 2010 to deliver long-term care benefits. It was March of that year that Rolf and Jean Hanson moved from the Twin Cities to Fish Creek so Rolf could begin his new job as planning director for the newly formed organization, commuting to his office in Green Bay.
“It’s a government agency, and I had until October of that year to establish it,” Hanson said.
But then a political freeze set in and the program couldn’t be expanded until the Department of Human Services was audited and the district could complete a five-year financial projection proving there would be a savings to the state. Legislators worried that with the graying of the population, offering the same long-term care services to more people would not be financially feasible.
The reports showed “Family Care achieves economies of scale, provides opportunities to providers to develop new and expanded services and consistent pricing across the region,” Hanson said.
In 2010, the average cost per member per month costs were $3,188 for Family Care compared to $3,761 for the current system known as “legacy waivers,” according to a report sent from the Department of Human Services to the Joint Legislative Audit Committee last August.
“It would save Door County $67,000 the first year,” said Door County Board Supervisor Mark Moeller, who also chairs the county Human Services Board. “After five years that’s about a quarter of a million dollars.”
That’s one reason the County of Door and all other counties in the northeastern district recently passed resolutions urging the Legislature’s Joint Committee on Finance to finally authorize this region’s Family Care program. The committee will decide on a motion put forth by state Rep. Garey Bies, R-Sister Bay, to proceed and begin enrollment no later than March 2015.
Bies said he will try to move Family Care forward in one of two ways: If the Joint Committee on Finance fails to bring it into the biennial budget being considered this month, he will introduce it as a separate bill.
“I’m always optimistic,” Bies said.” We’re hopeful it will work our way.”
Gov. Scott Walker said he would be willing to consider Family Care expansion if the Legislature inserts funding into the 2013-15 state budget.
“It depends on how they pay for it,” Walker said during a May 3 appearance in Sturgeon Bay. He said his 2011-13 budget did include additional Family Care funding but lawmakers removed it.
The process has had numerous fits of starts and stops.
“We thought we were going to Family Care in March 2012 in the entire district,” said Door County Human Services Director Joe Krebsbach. “At this point our hope is it will move forward so people on the waiting list can receive services.”
The process to get off the waiting list takes up to 36 months, so whenever it goes forward only 1/36th of those on the list will come off. Across the seven northeastern counties nearly 1,000 people are on waiting lists.
Whether someone receives help from a caregiver through managed care in the Family Care program or the current fee-based program should not make a difference to the client in the services they receive, Krebsbach said, but it will improve rate compensation for providers and free up resources the county can use for other services, such as mental health.
Door and other counties already were awarded the money to gear up for Family Care and in January opened the Aging and Disability Resource Center at the County Government Center in Sturgeon Bay to determine who is eligible. Roughly half of those 78 on the current waiting list are elderly or physically disabled, and the other half are developmentally disabled. But about 85 percent of those who go to ADRC are not eligible and are referred for other services.
Door County is a unique county, Krebsbach said, because there are a lot of people over the age of 65 but many are too affluent to be financially eligible.
“You have to meet both a functional and a financial criteria,” he said. “So sometimes their functioning may be low—they may have dementia—but the their assets are too high. Until their assets are depleted, they are not eligible for Family Care.”
Even when Family Care gets the green light, it will take at least a year to make the transition, as Hanson needs to hire staff to manage caseloads for all seven counties. In the meantime, the seven caseworkers currently employed in Door County have been working not knowing if or when their positions will be eliminated. All will have the opportunity to apply with the new Family Care office in Green Bay. The biggest savings comes from pooling resources and reducing staff at both the county and state levels.
The prospect of changing caseworkers is not good news for Bob Rauter, Sturgeon Bay, whose stepson, Don Skrobuton, now receives care as a developmentally disabled adult. Don, 58, lives with Bob and his wife, Shirley, and works regularly at the Sunshine House in Sturgeon Bay.
The Rauters said they are happy with the services they now receive both through the county and the Sunshine House. In fact the quality of care is one of the reasons the family relocated permanently to their second home in Door County from Florida several years ago.
“That loss of a personal contact with a caseworker will not be replaced,” Bob said. “The paperwork for these programs can be so confusing.”
The change in delivery of long-term care has been on the back burner so long, he was surprised the issue was even simmering. Sunshine House CEO James Meyer said the arrival of Family Care to Door County is inevitable but he, too, expressed some apprehension.
“It will be coming,” Meyer said of Family Care. “Its intentions are good and we support it. Our only concerns are for adequate funding to be able to continue to provide the high quality of care efficiently and effectively.”
In the meantime, Rolf Hanson said counties are looking for some resolution for a firm date to plan. The contract funding his job ends in June.
Contact Ramelle Bintz at firstname.lastname@example.org.