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Wednesday, Oct. 26, 2011

Milwaukee County Is in Walker's Crosshairs Again

Medicaid changes could hinder progress

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Milwaukee County has made great strides in reducing the long waiting list for Family Care and is in the midst of a comprehensive reform of its mental health services.

But the Walker administration's plan to cut $554 million from the state's Medicaid programs—including the popular BadgerCare programs—and also cap Family Care enrollment could hinder Milwaukee County's progress.

The county is in the midst of redesigning its mental health services so that more consumers are served in the community, with enhanced and more efficient outpatient and crisis-intervention services.

Currently, many of the individuals served by the county use the state's Medicaid- and state-funded BadgerCare Plus Core program to pay for these services.

But state Department of Health Services Secretary Dennis Smith, a former senior fellow at the ultraconservative Heritage Foundation, has proposed shifting 215,000 children and adults off of the BadgerCare Plus Core plan and onto alternative “benchmark” plans.

The problem is that the current “benchmark” plan doesn't cover some services that are vital to those with mental illnesses, including crisis intervention, community support programs, comprehensive community services, outpatient mental health services in the home and community, and substance-abuse residential treatment.

These are the services that Milwaukee County hopes to build on in its mental health reforms. Even a little help in this area can enable people to better function in their jobs and lives and make a larger contribution to the community.

“According to our initial analysis, many of the folks who had been covered will no longer have coverage for these services,” said Geri Lyday, interim director of the county's Health and Human Services Administration.

In Friday's public hearing in Milwaukee, Smith argued that the changes wouldn't affect those who have a disability.

“But community-based mental health services are available to people who have not been identified as having a disability,” countered Susan Moeser, financial services director of the county's Behavioral Health Division.

Lyday told the Shepherd that the county would continue to work with the state to ensure that its mental health redesign goes forward.

Family Care Cap Rolls Back Milwaukee's Progress

Lyday is also deeply concerned about the enrollment cap on Family Care, which was enacted in the state budget and is not part of Smith's $554 million Medicaid cuts.

Thanks to increased funding provided in 2009, the county has been able to reduce or eliminate the waiting list for Family Care, which provides long-term care and support to those with disabilities. In November 2009, more than 3,000 adults were on the waiting list in Milwaukee County; but after taking about 130 individuals off each month through July 2011, that waiting list has been sharply reduced. About 500 children had been on the waiting list in 2009. That had been eliminated when the enrollment cap was implemented in July.

“Now, the waiting list is growing for people between 18 and 60,” Lyday said. “There's a new waiting list for kids and the families. And they can't wait for services.”

The alternative is to place more individuals in nursing homes, which is more expensive, hinders independence and provides a reduced quality of life. Besides, Lyday said, there are not enough nursing home beds in the county for those not able to stay in their homes with Family Care support.

“It's tragic,” Lyday said. “For counties like us that had been moving along and making progress, to now cut us off—it's devastating. The people on the waiting list had thought there was hope.”

Lyday is urging legislators and Gov. Scott Walker to lift the Family Care enrollment cap at the same time the state works to find efficiencies in the system.