Staff shortages, sale of nonprofits threaten Wisconsin's Family Care, advocates say

Wisconsin's Family Care program, already confronting a caregiver shortage in serving people with disabilities and the frail elderly on Medicaid, faces more uncertainty as for-profit companies acquire two of four local nonprofits that run the program, advocates said Wednesday.

"People are concerned about quality. They're concerned about access," said Patti Jo Becker, co-chair of the Survival Coalition of Wisconsin Disability Organizations.

Louisville, Kentucky-based Humana's purchase of Inclusa, of Stevens Point, has passed state agency reviews. Molina Healthcare, based in Long Beach, California, said this month it completed its acquisition of My Choice Wisconsin, of Wauwatosa, which has a sizable presence in Dane County.

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Brookfield-based Community Care, one of the two remaining local nonprofits, is talking to potential partners, including national insurance companies, as it tries to stay viable, CEO Kenneth Munson said.

The Humana and Molina acquisitions have "changed the competitive landscape," Munson said during a Wisconsin Health News panel discussion about Family Care. "How do we compete?"

Meanwhile, a bill requiring long-term care facilities to give residents 90 days of notice, instead of 30 days, for evictions — sometimes occurring as providers exit Family Care, claiming rates are too low — had a hearing last week in the state Legislature.

Family Care, which started in 2000 as an alternative to county-run services, provides home care, transportation, job support and other services to about 58,000 people to keep them out of nursing homes. The program has helped Wisconsin retain a good reputation for long-term care, with the state ranking third nationally on a 2020 scorecard.

But a caregiver shortage, fueled by low wages and few benefits, is causing delays and wait lists for care, advocates and providers say. The average hourly wage for such direct-care workers is $13.53, according to a state report, though some get up to $18 to $20 for some types of care through certain programs.

With employers such as Kwik Trip often offering higher wages, providers "are just not able to compete," said Lisa Davidson, CEO of the Madison-based Disability Service Provider Network.

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The state budget passed this summer boosted wages for direct-care workers in Family Care by 5%, which advocates said helps but doesn't go far enough.

Now, the entrance of Humana and Molina in the market could further alter Family Care, which years ago was run by more than 10 nonprofits around the state. Lakeland Care, the other remaining nonprofit, in Fond du Lac, is also talking to national insurers and other potential partners, CEO Sara Muhlbauer said.

Jamie Kuhn, Wisconsin's Medicaid director, said the Department of Health Services is working on a minimum fee schedule to make sure Family Care providers get paid enough. But the Legislature needs to approve it, she said.

The agency has boosted training and certification for certified nurse assistants to make the job more of a career path, Kuhn said. To address concerns about Humana and Molina, she said DHS has strengthened its contracts with the companies, such as requiring them to maintain at least 50% of their staff in Wisconsin and requiring six months' notice, rather than 90 days, to terminate a contract.

Eviction notices

Some assisted living facilities have evicted residents with short notice after facility operators decided to leave Family Care, sometimes to switch from lower Medicare payments to higher rates from private-pay residents.

Assisted living residents in Madison told they must move within 60 days

Cedarhurst of Madison told two dozen residents last October they had to move within 60 days, the Wisconsin State Journal reported at the time. Emerald Bay Retirement Community in Hobart, near Green Bay, gave 15 residents 30 days' notice in February that they had to find another place to live.

Three weeks after moving to another facility, a 91-year-woman with dementia who had been at Emerald Bay died, with her daughter saying her decline was precipitated by the move, the Washington Post reported.

State Rep. Joy Goeben, R-Hobart, and state Sen. Robert Cowles, R-Green Bay, are lead sponsors of the bill requiring 90 days' notice of eviction, instead of 30 days.

At a hearing before the Senate health committee last week, long-term care associations said they're opposed to the idea, saying it could make them accept low Medicaid rates longer during negotiations with managed care organizations.

Goeben, in written testimony, said residents and families deserve more time.

"Consider the amount of stress that could be alleviated or prevented if residents and their families were given a reasonable amount of time to make arrangements," she said.