Governor Scott Walker’s proposal to lift the enrollment cap and increase funding for Wisconsin’s Family Care program will seem like good news to many people.
However, I share a deep disappointment, along with many Family Care stakeholders, that it has been 9 months since the release of the Legislative Audit Bureau’s report on Family Care and the Governor still has not offered a solid proposal to address chronic problems and bring much needed reforms to this program.
Simply put, I want to see our tax dollars go to families who need them, not CEOs who are already overpaid.
While Family Care has great potential to provide cost-effective and critically needed care for adults with disabilities, the managed care concept at the heart of the Family Care model creates a Santa Claus-sized incentive for abuse. Under Family Care, many Managed Care Organizations (MCOs) collect fixed payments for as many clients as possible, while feeding a growing layer of administrative bureaucracy and skimping on spending for services that actually benefit Family Care clients. Some of the state’s MCOs collect far too much taxpayer money while providing too little actual care.
The Legislative Audit Bureau report on Family Care from April 2011 revealed startling information about the extent of overhead expenses at some MCOs. At a time when budgets are tight and we should be evaluating how we spend every public dollar, it’s inexcusable that taxpayers fund annual salaries of more than $250,000 for the CEOs of “non-profit” organizations when there are public employees who could perform the same functions while being paid less than half of that.
I call on Governor Walker and Department of Health Services (DS) Secretary Dennis Smith to begin developing the kind of reforms that will restore the public’s faith that our $936 million annual investment in Family Care is being well-spent:
• Perform a detailed audit of administrative expenses, including salaries and benefits, paid to MCOs;
• Establish metrics for MCO benefit/cost ratios that will guarantee a minimum percentage of capitation rate dollars are actually used to fund services to Family Care members;
• Establish salary caps for MCO administrative positions paid with public dollars that are comparable to public employees with similar responsibilities;
• Require MCOs to develop and promote the “self-directed care” option that is established under current law. While this option exists in theory, eligible participants are rarely aware of it and MCOs often discourage members from using this option;
• Provide for a fair, independent process for grievances and appeals available both to Family Care members and care providers. This could be done by increasing funding, independent of DHS, for Disability Rights Wisconsin to operate as a program advocate, and by assuring that all members know their rights to be involved in their own care management decisions and authority to question decisions by MCOs that affect them.
Changes such as these will help assure that before we expand Family Care, we address serious existing problems in a way that is fair to citizens who need Family Care support and to the taxpayers who pay for it. Especially in today’s fiscal climate, it would be irresponsible to put more funding into any program without assuring it is being used in the most cost-effective way.