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State Budget Proposal Threatens Vital Supports for Wisconsin's Most Vulnerable Citizens

090603/01

Watertown, Wis. (June 3, 2009) -- Bethesda Lutheran Homes and Services reacted with great concern to the proposed budget released on May 29, 2009 by the Wisconsin Legislature’s Joint Committee on Finance.

The Administration and Legislature’s failure to address sustainable funding for people with intellectual and developmental disabilities who need intensive, 24/7 medical and personal supports has put Wisconsin’s long-term care system in crisis. Intermediate Care Facilities (ICFs) are a small but vital part of Wisconsin’s developmental disabilities services system, providing Medicaid-funded care to people with significant developmental disabilities and severe medical or other problems in need of intensive, 24/7 medical and personal supports. To live in an ICF, a court must conclude that an ICF is the most integrated environment appropriate for a person’s needs, a review and authorization that is repeated annually. About 480 people live at the few remaining ICFs not run by the state. These ICFs continue to be funded at rates far below their actual cost of operation.

The lack of sustainable funding for people needing ICF supports has caused the closure of most ICFs, and the few remaining teeter on the brink of extinction. In the past 10 years over 70 percent (27 of 38) of Wisconsin ICFs have been forced to close, which includes two facilities that recently announced and are in the process of closure.

The Legislature did acknowledge concern over the extinction of ICFs by authorizing a preservation study of the ICF system; however, given the rate of closures, the few surviving ICFs may be lost if sustainable funding is not included in the current biennial budget.

"The 120 people with developmental disabilities who receive supports at Bethesda’s Watertown ICF receive on average $228 per day in Medicaid funding," explained Debborah Zubke, Northern Division Operations Officer for Bethesda. "Our cost to support a person is $370 per day. At the Watertown Campus, we provide high quality services, and focus on social opportunities and quality of life. And we operate very efficiently. In comparison, the cost to support individuals with similar needs at a state center is $723 per day – a cost the taxpayers pay in full."

"We understand that the Wisconsin state legislature was forced to make tough budget decisions in a weak economy," adds Ardis Loeber, Bethesda’s Watertown Campus Regional Director. "But it is hard to understand its failure to sustainably fund people in ICF facilities like the Watertown Campus. Wisconsin already has begun to receive $1.24 billion in federal stimulus money specifically targeted to help Wisconsin’s Medicaid programs. This stimulus money was given to Wisconsin so that problems like this could be fixed."

On February 17, 2009, President Obama signed into law the stimulus bill, called the American Recovery and Reinvestment Act. The bill included $87 billion in temporary, additional Medicaid funding to the states, paid by increasing the federal government’s share of a state’s Medicaid payments. Through March 31, 2009, Wisconsin received $163.1 million in additional Medicaid funding. Wisconsin will receive $1.24 billion in additional Medicaid funding by December 31, 2010. See Kaiser Commission on Medicaid Facts: ARRA Medicaid and Health Care Provisions at http://www.kff.org/medicaid/7872.cfm.

Alternative supports for people needing intensive ICF services do not presently exist, there are significant practical and resource barriers to their creation, and ICFs are in danger of disappearing faster than these supports can be fully developed – thus putting people who need intensive supports at risk. "Wisconsin regulations do not allow these people to live in group homes if they need more than a few hours of nursing care per month, unless a special waiver from the state is obtained. The regulations do permit them to live alone in an apartment, with 24/7 personal and medical care," explained Loeber. "Finding and keeping nursing staff to provide care in the community is very difficult and frequently impossible. If, as often happens, a person is admitted to a hospital, their at-home nurse suddenly has no work and they frequently quit to get a more reliable source of income. Access to other medical care in the community is difficult, too. For example, we have to drive a person who lives in Waupun all the way to Milwaukee to receive dental care, because that is the closest dentist willing to treat him."

The lack of sustainable funding, coupled with Wisconsin’s ICF bed tax, are driving the few surviving ICFs to close their doors. According to Mike LaGrassa, administrator at Racine Residential Care, before announcing its closing his organization was losing $5,000 to $7,000 a month due to the bed tax. The bed tax is a Wisconsin state tax that an ICF must pay on all its beds. Currently the bed tax is $638 per bed per month; it is increasing to $678 in July. The ICF bed tax has to be paid even on unoccupied beds and is not reimbursed by the government, which results in financial loss for the organization. "A small business can’t eat this expense," LaGrassa says, "and the state is making money off of this tax."

"Our ability to take any client with Medicaid is disappearing," says Phil Borreson, executive director of Trempealeau County Health Center. "The state is shifting the financial responsibility to the property tax payer and eventually people will be without services."

Wisconsin’s ICFs are on the brink of extinction. While most people with developmental disabilities can live in community settings like group homes or apartments, a small class of people with significant disabilities needing intensive medical and personal supports will continue to need ICF services. If the lack of sustainable funding is uncured, this vital human services resource will be lost. The Legislature should use a small portion of the $1.24 billion Wisconsin will receive in increased federal Medicaid funding to sustainably fund people in need of the supports provided by Wisconsin’s ICFs.

If you have any questions regarding this release, please contact Ardis Loeber, Bethesda’s Watertown Campus Regional Director, at 920-988-8385.

Now in its second century of service, Bethesda Lutheran Homes and Services, Inc. provides services and supports to individuals with developmental disabilities throughout the country and around the world. Bethesda offers many different types of services for individuals and their families, including a variety of residential settings, supported-living programs and outreach services.

For more information on Bethesda public policy matters, go to BethesdaVoices.org, call the public relations office at 800.369.4636, ext. 3817, or e-mail: pr@mailblc.org.