Wisconsin Department of Health and Family ServicesDivision of LongTerm Care

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Wisconsin Managed Long-Term Care and
EmploymentEnsuring Quality Employment
Opportunities for People with Disabilities
involved in Wisconsins New Managed Long-Term
Care System

• Wisconsin Department of Health and Family
  Services/Division of Long-Term Care
• Financial Support for the Task Force is provided
  by the
• Centers for Medicare and Medicaid, Medicaid
  Infrastructure Grant (MIG), CFDA No. 93.768,
  through DHFSs Office of Independence and
  Employment/Pathways to Independence.

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Wisconsin Department of Health and Family
Services (DHFS)

• DHFS is the state agency responsible for
  long-term care for people with disabilities and
  frail elders.
• DHFS supports community integration and consumer
  choice in how and where long-term care services
  are provided.
• DHFS believes that people with disabilities
  should be able to spend their days in meaningful
  activities.

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Moving to Managed Long-Term Care Goals for
Reform

• Give people choices about where they live and the
  care they receive
• Streamline the system simplify access and
  funding structure
• Prepare for the aging of the baby boom
• Promote wellness prevent need for expensive
  care
• Promote individual planning and responsibility
  for future needs
• Control and better manage public costs

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Moving to Managed Long-Term CareFamily Care

• DHFS has been piloting managed long-term care for
  frail elders and people with physical and
  developmental disabilities for over five years in
  certain counties.
• Governors plan is to expand Family Care
  statewide by 2011.
• Family Care, the Departments managed long-term
  care program provides
• Choice Among types, settings and providers of
  long term care services
• Access Creates entitlement to community
  services, eliminating waiting lists
• Quality Improved quality of care and quality of
  life
• Cost-Effectiveness For services and the system
  as a whole

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Moving to Managed Long-Term CareFamily Care

• Managed Care Organizations (MCOs) are paid a
  monthly capitated rate for each person they
  serve. Rates are set based on functional needs
  of the people being served and the cost of
  providing services in the area.
• All MCOs cover long-term care services in the
  capitated benefit package. Long-term care
  services include personal care, vocational
  supports, therapy, case management, and other
  services
• Some MCOs also cover acute and primary services
  in the capitated benefit package

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Moving to Managed Long-Term Care Role of
Managed Care Organizations

• Help consumers determine the outcomes they want,
  based on their interests and preferences
• Include consumers in decision-making and creating
  a plan for services that is focused on helping
  the individual achieve his/her identified
  outcomes.
• Provide services to the consumer, either with
  staff from the MCO or by contracting with
  providers. Ensure that a sufficient choice of
  providers and services are available
• Make sure that quality services are provided at
  all times

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Wisconsin DHFS Moving Toward A New Set of
Values

• DHFS recognizes that all citizens are expected to
  contribute to their communities.
• DHFS believes that all people with disabilities
  can contribute to their communities.
• DHFS recognizes that employment is one of the
  most common ways people contribute to their
  communities and one of the most satisfying and
  meaningful ways in which people spend their time.
• DHFS believes that the long term care system
  should support people in their desires to
  contribute to the community and engage in
  meaningful activities through employment.

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The Challenges We Face

• Most people with developmental disabilities
  served by the long-term care system are currently
  in segregated, non-work day services or employed
  in segregated settings, earning sub-minimum wages
  and experiencing increasing downtime.
• There are a limited number of supported
  employment providers available at present with
  limited capacity.
• Many people with developmental disabilities have
  come to accept either not working at all, or
  working at jobs that are not in integrated
  settings, that do not provide significant income,
  and do not reflect individual choices and
  ambitions.

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The Challenge We Face

• Many people with developmental disabilities and
  those that support them, including long-term care
  system staff, believe people with disabilities
  cant work for decent wages because they will
  lose their benefits and Medicaid eligibility.
• Employers still have relatively little experience
  of employing people with developmental
  disabilities, largely because up to now, our
  system has not been able to support significant
  numbers of people with developmental disabilities
  to seek employment.
• Because our system pays for services by the hour,
  the cost of supporting people in integrated
  employment can appear to be much higher than
  other day/vocational service options.

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The Current Reality for People with Developmental
Disabilities in Wisconsin
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The Managed Care and Employment Task Force (MCETF)

• Convened by the Administrator for the Division of
  Long-Term Care.
• Chaired by the Deputy Administrator of the
  Division.
• 28 members, including wide range of stakeholders.
• Seven issue committees
• Meeting May, 2007 through May, 2008.
• Final report due June, 2008.

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Charge to the Task Force

• Develop a blueprint for a comprehensive
• strategy that
• Can be implemented within the managed long-term
  care system being expanded throughout Wisconsin
• Will expand work options for adults who rely on
  the community-based, long-term care system
• Will effectively integrate all resources
  available to support consumers employment goals
  
• Will support and advance the four key values of
  Wisconsins managed long-term care system
  choice access quality and cost-effectiveness.

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Goal of Task Force Process

• To ensure that best practices, at all levels,
  for supporting individuals to consider, pursue
  and maintain gainful employment are fully
  supported and encouraged by the managed long-term
  care system.

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Task Force Areas of Focus
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Task Force Areas of Focus
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Task Force Areas of Focus
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Task Force Areas of Focus
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Task Force Work to Date

• The Task Force and its issue committees are
  spending considerable time learning about best
  practices used in other states.

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Examples of Best Practice Areas

• Ensuring informed choice and sufficient attention
  to employment in the assessment member planning
  processes.
• Use of state policy, contracting mechanisms,
  quality assurance and data collection systems to
  encourage focus on employment and improved
  employment outcomes.
• Use of funding incentives and different provider
  reimbursement strategies to promote expansion of
  employment choices.
• Developing understanding of how to blend funding
  and services available across different
  systems, including the K-12 school system,
  vocational rehabilitation, One-Stops, the managed
  long-term care system and the Ticket to Work.

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Examples of Best Practice Areas

• Determining support, funding, training and
  technical assistance that providers need to focus
  more on employment, particularly integrated
  employment services (e.g. integrated
  pre-vocational services DVR-funded services
  supported employment services personal
  assistance services in the workplace
  transportation for employment assistive
  technology for employment etc.)
• Helping providers learn about and adopt the best
  and most cost-effective models for job
  development job training job coaching
  developing natural supports etc.
• Determining employer outreach, education,
  incentives and supports that will encourage
  intentional hiring initiatives, positive
  recruiting practices and participation in
  providing long-term support for employees
  with disabilities.

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No Stone Left Unturned

• Considering all policy, funding and
• programmatic changes needed for
• people with disabilities to have a full range
• of employment options available to them
• and adequately supported by Wisconsins
• managed long-term care system.

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Support for Implementation of Task Force
Recommendations

• Wisconsins Medicaid Infrastructure Grant
• Expected to be available through 2011.
• Housed in DHFS.
• One of the largest MIG grants in the country.
• Can only be used for integrated employment
  systems change.

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For More Information

• Mike Linak, Developmental Disabilities Section
  Chief
• 1 West Wilson St., Room 418 Madison, WI 53701
• LinakMJ_at_dhfs.state.wi.us [phone]
• Lisa Mills, Task Force Lead Staff Person
• 1 West Wilson St., Room 951 Madison, WI 53701
• MillsLA_at_dhfs.state.wi.us [phone]