Wisconsin Family Care Transition To An Insurance Plan update

The Wisconsin Family Care Program is on schedule to transition approximately 55 thousand beneficiaries to an insurance plan which includes long term care, acute care, and primary care.  The documented steps of this transition will not reflect the actual operational changes occurring with administration and delivery.

Lawmakers have authorized this change as a means to eliminate multiple varied administrative expenses.  Essentially the 2012 DHS paradigm required that each large multi-county region should offer 2 Family Care MCO's, IRIS, and straight Medicaid Fee For Service.  Lawmakers have been instructed on how each of these varied approaches employs a large separate administrative staff. 

With the State Budget Committees announcement requiring DHS to submit a plan and seek a Federal Waiver for the new Family Care/IRIS 2.0 the provider network has been disassembling.  MCO's have completely closed  locations merging  offices with the approaching change.  Providers have completely closed or transitioned their service to deliver alternative products. 

Home Care Path predicts the State will facilitate greater access to once defined regions for coverage by existing MCO's operating near the area.  This will be published as DHS opening up varied regions to additional MCO's to demonstrate evidence of competition.

The essential piece of this is that the new Family Care/IRIS 2.0 operating expense will be compared to the 2016 operating expense of the current delivery model.  Because of the predicted disassembling of the current Family Care model utilization has decreased.  As the system of service disassembles the costs rapidly drop. 

The important thing for community planners to understand is that the drop in operational expense is secondary to the loss of service provision and not an accurate estimation of the real needs of the beneficiary population.  Expect DHS to push MCO's into additional regions.

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