Home and Community-Based Services for Older People and Younger Adults with Physical Disabilities in Wisconsin

HOME AND COMMUNITY-BASEDSERVICES FOR OLDER PEOPLE ANDYOUNGER ADULTS WITH PHYSICALDISABILITIES IN WISCONSINFINAL REPORTPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Joshua M. Wiener, Ph.D.The Urban InstituteandSteven M. Lutzky, Ph.D.(formerly of) The Lewin GroupAugust 19, 2001This research was supported by Health Care Financing Administration ContractNo. 500-96-0005. In this contract, the Urban Institute is a subcontractor to theLewin Group. The opinions expressed in this report are those of the authors and donot necessarily reflect the views of the Health Care Financing Administration, theUrban Institute, or the Lewin Group. We gratefully acknowledge the many peoplein Wisconsin who generously answered our many questions HOME AND COMMUNITY-BASEDSERVICES FOR OLDER PEOPLE ANDYOUNGER ADULTS WITH PHYSICALDISABILITIES IN WISCONSINFINAL REPORTPrepared for:U.S. Department of Health and Human ServicesHealth Care Financing AdministrationPrepared by:Joshua M. Wiener, Ph.D.The Urban InstituteandSteven M. Lutzky, Ph.D.(formerly of) The Lewin GroupAugust 19, 2001This research was supported by Health Care Financing Administration Contract No. 500-96-0005. In this contract, the Urban Institute is a subcontractor to the Lewin Group. Theopinions expressed in this report are those of the authors and do not necessarily reflect theviews of the Health Care Financing Administration, the Urban Institute, or the LewinGroup. We gratefully acknowledge the many people in Wisconsin who generouslyanswered our many questions Table of ContentsINTRODUCTION...........................................................................................................................................................................1THE LONG-TERM CARE SYSTEM IN WISCONSIN.........................................................................................................2ADMINISTRATIVE STRUCTURE.........................................................................................................................................10ELIGIBILITY AND ASSESSMENT........................................................................................................................................12CASE MANAGEMENT..............................................................................................................................................................13NONMEDICAL RESIDENTIAL SERVICES........................................................................................................................16CONSUMER DIRECTION.........................................................................................................................................................18QUALITY ASSURANCE...........................................................................................................................................................19COST CONTAINMENT.............................................................................................................................................................21REDESIGNING LONG-TERM CARE: FAMILY CARE...................................................................................................27CHALLENGES FOR THE FUTURE............................................................................................27 Final Report1HOME AND COMMUNITY-BASED SERVICES FOR OLDER PEOPLEAND YOUNGER ADULTS WITH PHYSICAL DISABILITIES IN WISCONSININTRODUCTIONWisconsin is a relatively small Midwestern state with a total population of 5.3million people in 1999, of whom 13.2 percent were age 65 and over.1 The state'seconomy is strong and only about 8.5 percent of the total population lives in below thefederal poverty level, well below the national average.2 Wisconsin provides home andcommunity-based services to a substantial number of older people and younger adultswith physical disabilities through the Medicaid home health and personal care benefit, afairly large Medicaid home and community-based services waiver, and some significantstate-funded programs. Wisconsin has a national reputation as a leader in innovative andflexible home and community-based services, relying heavily on consumer-directedhome care and nonmedical residential services. Despite these innovations, of theapproximately 71,000 elderly and disabled Wisconsin residents receiving publicly fundedlong-term care in the 1998/1999 budget period, two-thirds of clients were receiving carein an institutional setting rather than in the community.3 Wisconsin is currentlyembarking on an ambitious "Family Care" demonstration project that will provide the fullrange of long-term care through capitated, county-run Care Management Organizations,which the state hopes will create incen