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MADISON, Wis. (AP) — Republicans who control the Legislature's budget committee adopted most of Gov. Scott Walker's plan Wednesday to expand the Family Care program and incorporate elements of the IRIS program into it, pushing aside pleas from minority Democrats and advocates for the disabled to leave both programs alone.
The GOP lawmakers tweaked Walker's plan in places, adding language that guarantees enrollees would still have a say in developing their care plans and would keep receiving state stipends to cover services they need just as IRIS provides.
Advocates for the disabled still balked at the move. They predicted the changes would disrupt the lives of thousands of people who rely on IRIS. Committee Democrats, wearing "Save IRIS" buttons, argued during a hearing that the plan would make people's lives harder.
"Let's just drop it," said Sen. Jon Erpenbach, D-Middleton. "The uncertainties are mind-boggling. We shouldn't even be walking down this road right now."
Republicans dismissed the Democrats' concerns as hyperbole and scare tactics, insisting their plan protects self-directed services for the disabled and would lead to better integrated care.
"Let the circus of political opportunism continue," said Rep. Dale Kooyenga, R-Brookfield. "We're looking to make these programs sustainable. That's where the intent lies."
The committee voted 12-4 to insert the GOP revisions into the budget after 3½ hours of debate. All four Democrats on the panel voted against the changes.
Family Care, a Medicaid program, provides managed long-term care for the elderly and disabled to help keep them in their homes and out of nursing facilities. About 38,000 people were enrolled as of March, according to the nonpartisan Legislative Fiscal Bureau. Right now nine regional managed-care organizations provide Family Care services.
IRIS, which stands for Include, Respect, I-Self-Direct, provides people who qualify for Family Care with an alternative to managed care. Enrollees work with a consultant to develop a care plan addressing daily needs such as bathing, dressing and cooking and receive a monthly stipend to cover services they may need. About 11,500 people were enrolled in IRIS as of December. The program's costs have grown from $113.9 million in 2011 to $255.7 million last year.
Both Family Care and IRIS are available in 57 of Wisconsin's 72 counties. They're scheduled to expand to seven more counties this calendar year.
Walker's budget calls for seeking a federal waiver to allow the state Department of Health Services to contract with statewide managed care organizations to provide Family Care services, in effect expanding the program statewide. DHS would also include a request to end state oversight of the organizations. The spending plan would cut $14 million from the program to reflect anticipated increases in county contributions as the expansion takes hold. The budget would eliminate IRIS but allow Family Care enrollees to self-direct services.
Opponents have argued the changes would allow huge for-profit managed care organizations into Wisconsin's market, reducing options for enrollees and reducing the quality of care.
Walker's administration insists the move would create better-coordinated, more efficient care. But Rep. John Nygren, R-Marinette, and Sen. Alberta Darling, R-River Hills, told reporters earlier this month that they want "a better product" than what Walker proposed.
The plan their fellow Republicans unveiled Wednesday retains Walker's core proposal to seek federal permission to expand Family Care statewide no earlier than Jan. 1, 2017. It fleshes out how enrollees could still self-direct care and receive monthly stipends similar to IRIS but under the guidance of new entities called integrated health agencies. The agencies would help enrollees develop individual plans and manage how they spend their stipends. Providers could be audited. DHS officials would have to consult with stakeholders and the public prior to developing the final waiver request.
The plan also retains the $14 million cut but doesn't specify how state officials should reach that goal.
Lynn Breedlove, co-chair of the Wisconsin Long-Term Care Coalition, said he thinks the plan would still allow for-profit insurance companies to swoop into the state.
"This new plan is just the governor's proposal in sheep's clothing," Breedlove said in a news release. "Thousands of people expressed opposition to dismantling the current system, but the Legislature is doing it anyway. This violates the trust between the Legislature and the public."
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