Keeping Our Promise to the Most Vulnerable

“I don’t understand what is happening,” the woman wrote me. “Why is it necessary to
change all the services for vulnerable populations in our area?”

The woman was concerned about the closing of the Eau Claire based Community Health
Partnership (CHP) a non-profit managed care organization that provides care for over
3,000 people in western Wisconsin.

I shared her concern so I hit the road and started asking questions. Over the past several
weeks I’ve talked with many disabled individuals, advocates, guardians, parents, service
providers and state officials to understand what happened and why.

CHP was one of the first pilot managed care organizations (MCOs) designed to find a
new way to bring care to our most vulnerable. CHP serves as the Chippewa Valley
region’s coordinator of Family Care service for poor frail elderly, and those with
developmental and physical disabilities.

The state will not renew their contract with CHP and all members who receive care
through two programs called “Partnership” and “Family Care” will see changes.

To understand why this is happening, it helps to remember that Chippewa Valley is home
to many developmentally disabled people who once lived at the state institution -
Northern Center. The state decided to reduce the population in Northern Center and serve
them through Family Care. Local people created many group homes or other residential
facilities to care for these vulnerable citizens when they were discharged from Northern

As budgets tightened, the Department of Health Services began an effort to reduce
spending on health care. State officials put pressure on the MCOs - the coordinator of
Family Care - to lower costs.

With fewer dollars to go around, the MCOs looked for places to cut costs. They cut rates
to providers – those who serve the poor elderly and disabled. The biggest target was the
highest cost part of the budget - residential homes.

Residential homes – group homes, adult family homes, community-based residential
facilities - take up nearly 40 percent of the state Family Care budget. Officials and MCO
managers sought to lower payment rates to residential care providers. They encouraged
people to live in their own apartments or homes of family members.

“It is very hard to find affordable housing for disabled people,” one social worker told
me. “There are long waiting lists. In some areas only substandard housing exists at the
price we can afford to pay.”

Some clients simply could not function in such an independent setting – for years
someone helped them get up and get dressed every day.

The dramatic lowering of rates to residential homes led to a crisis for family members.
The often small family-run residential centers could not survive with the lower payment
rates. In many cases, severely disabled people had to move back into the homes of family
members; some with elderly parents unable to provide care.

Other care-givers tried to hang on with dramatically lower rates. They lost staff as they
were unable to offer benefits or competitive wages.

“The provider system is near financial collapse,” a long-term care professional told me.
“Even profitable MCOs had to cut their rates due to state benchmark expectations.” This
led to a downward spiral of payment rates. The result is less access for services and
housing for our most vulnerable. And fewer options for the disabled in a program that
prides itself in creating options.

CHP was caught in this cascading of events. CHP began with a number of very high need
individuals, many from Northern Center. The recent Family Care audit showed CHP with
the highest percent of high cost members in the state. Consequently they had the poorest
financial situation; even though their administrative costs as a percent of total costs were
one the lowest in Wisconsin.

Now CHP will dissolve by the end of this year. Recently, state officials announced that a
new MCO will take its place. But the question remains: will the same fate CHP faced
await the new MCO five years from now?

There are lessons to be learned about what happened to Chippewa Valley’s most
vulnerable citizens. We have a moral responsibility to use the lessons learned to keep our
promise to the most vulnerable among us.