Senior living providers in Wisconsin are asking lawmakers to act on a proposal to take advantage of a “once-in-a-lifetime” funding opportunity for its Medicaid home- and community-based services programs.
Last week, the legislative Joint Committee on Finance, or JFC, pumped the brakes on a $258 million proposal from the Wisconsin Department of Health Services to invest federal American Rescue Plan Act dollars into the state’s Medicaid HCBS program, Family Care.
DHS proposed setting a minimum Medicaid fee schedule for providers that managed care organizations would be required to pay. Those fee increases — $258 million in the first year — would be funded through ARPA dollars. The state’s annual cost after that first year would be $106 million.
“By adding this funding into the Family Care program, it would recognize current market realities, such as caregiver wages,” Wisconsin Assisted Living Association President and CEO Mike Porchowski told McKnight’s Senior Living.
Pochowski said the Family Care program “woefully underestimates” hourly caregiver wages at $13.02. Approval of DHS’ proposal would have increased hourly wages to $15.75.
Pochowski said the change would not reflect current actual caregiver wages — $17 to $20 per hour — but would be a “much-needed step in the right direction” and would recognize the actual costs of goods and services incurred by assisted living providers.
“We need the JFC to take action on the proposal soon,” Pochowski said. “If the JFC waits until next year to act, we lose the entire $258 million in federal ARPA dollars — a once-in-a-lifetime opportunity could be lost.”
Providers and managed care organizations have been working with the state for almost two years to create a minimum fee schedule for Family Care, LeadingAge Wisconsin Vice President of Policy & Finance Rene Eastman told McKnight’s Senior Living.
“It is unfortunate that the timing of making this critical investment has not matched up with the state’s biennial budget timeline, but we continue to believe that it is the best possible use of ARPA HCBS funding to invest it back into the caregivers through a more sustainable rate,” Eastman said.
For too long, she said, Family Care managed care organizations have made profits by managing rates paid to providers rather than by managing care into less restrictive and lower-cost settings.
“By establishing a minimum rate for these home- and community-based services that is built on a reasonable wage, we will be able to preserve as many providers of those services in Wisconsin as possible,” Eastman said.
Rick Abrams, CEO of the Wisconsin Health Care Association / Wisconsin Center for Assisted Living, told McKnight’s Senior Living that committee members’ concerns about the proposal have nothing to do with the merits of the HCBS waiver program and everything to do with the size of the request.
Some JFC members, he said, are reluctant to make a large financial commitment outside of the state budget 15 months before the beginning of the next two-year budget cycle, which begins on July 1, 2025.
“This is a reasonable and genuine concern,” Abrams said, adding that he looks forward to working with the Legislature and the administration to arrive at a dollar amount that “everyone is comfortable with.”
Eastman expressed optimism that legislators understand the increasing challenge for older adults needing access to services, “given their substantial past support.” She agreed with Abrams’ prediction that a compromise will be reached that expends the ARPA funding and “sets the managed care organizations on a path to fiscal sustainability while maintaining their commitments to other statewide priorities.”
The Family Care program provides long-term care services and support to more than 56,500 older adults and adults living with physical and developmental disabilities, according to DHS.
