The news today felt like a belated Christmas present at first -- Governor Walker held a press event this morning in Madison announcing a proposal to lift the cap on long-term care enrollment that his budget had imposed back in July. People with disabilities and frail elders who need help to live in the community would once again be eligible for that assistance, without being automatically shunted to waiting lists! Three cheers for gubernatorial generosity!
What Walker failed to mention was that he'd been ordered to lift the caps two weeks ago, by the Centers for Medicaid and Medicare Services.
The caps on long-term care enrollment in the Wisconsin budget may have been overshadowed by the attack on collective bargaining and the public-education cuts, but to seniors and people with disabilities, the consequences were immense. Wisconsin's Family Care program was initiated under Republican governor Tommy Thompson with bipartisan support, providing cost-effective assistance via a combination of Medicaid waiver and county funding for people to live in their own homes rather than having to rely on institutional care. The program expanded under Governor Jim Doyle (D), and even Scott Walker was a proponent during his years as Milwaukee County Executive.
However, Walker's budget as governor slammed the doors shut for potential new enrollees as of July 1. Here's an account of some of the immediate damage: (from a July 23 opinion piece in the Milwaukee Journal Sentinel):
The cap began July 1, and already, we feel the pain in Milwaukee County. Within one week, the Aging Resource Center received desperate calls from families of three elders aged 98, 100 and 108, all of whom counted on receiving services from Family Care. They had spent down their limited savings, believing in the promise of Family Care - but now that promise has been broken.
The Mental Health Complex already has admitted three patients enrolled in Family Care who must be unenrolled on admission to the hospital. Because of the cap, they may not be able to re-enroll and may lose community services and their homes. The option will likely be a long, expensive and unnecessary stay at the complex.
The cap will lead to violations of the Americans with Disabilities Act, which mandates the right of people with disabilities to live, work and receive services in the most integrated setting - and not be forced into nursing homes.
Thanks to the hard work of both grassroots and professional advocates, before and after the passage of the budget bill, the Family Care issue began to get attention from both legislators and the public. In the photo below, Assembly Minority Leader Peter Barca (D) speaks at a June press event held by the grassroots group Wisconsin Families Forward, flanked by disability advocates and stand-up photo representations of some of the people who stood to lose so much due to the caps:
A couple of days before the caps went into place, Governor Walker stated in an interview that he would look into the possibility of lifting the caps before the end of the year. But the months went by, and there was no further word from the governor's office.
Suddenly today, just days before the end of the year, came the surprise announcement -- Gov. Walker was pledging to lift the enrollment caps! Disability and elder-care advocates were invited to speak, and sent out jubilant press releases:
“The Governor has done the right thing here,” says Maureen Ryan, Director of the Wisconsin Coalition of Independent Living Centers, Inc. “Wisconsin has always been a leader in providing innovative community-based services to people with disabilities. Now we can continue on that path.”
Legislative action will still be necessary to enact the lifting of the caps, and the Republican reaction was fascinatingly mixed. There were Republican legislators at the press event, and (up-for-recall) Republican state senator Van Wangaard issued a press release praising the proposal to lift the cap. However, state senator Robin Vos (R), chair of the Joint Finance Committee, had the following to say:
Expanding another unsustainable program is irresponsible. Perhaps before expanding, we should figure out how to make it work under sustainable parameters. Poorly planned rapid expansions by the last administration are what caused the current budget problem. For future budget health, I’d prefer we take a different course.
And then the Journal Sentinel broke the real story: Walker lifts cap on long-term care after federal agency orders change:
Walker touted the $80 million plan with advocates for the elderly and disabled at a Capitol news conference, but made no mention of a recent order from the federal Centers for Medicaid and Medicare Services directing his administration to lift the cap in the Family Care program.
State officials released the letter from CMS hours later at the request of the Journal Sentinel.
[snip]
"We are directing the state to identify any individuals not currently enrolled onto the Family Care or Self-Directed Supports waivers since the July 1, 2011 implementation of the newly instituted enrollment caps, and immediately enroll those individuals in the waiver programs," said the letter from Verlon Johnson, the associate regional administrator for CMS's Division of Medicaid and Children's Health Operations.
Democrats blasted the governor for taking credit for the plan after they learned of the CMS letter.
I'll tell you what this feels like to me.
It's like setting someone's house on fire, then coming back and putting the fire out and trying to take credit as a fire-fighting hero -- except that the coming-back and fire-dousing wasn't even voluntary.
As one of the grassroots advocates who's been "on" this issue myself, I have to remind myself that the lifting of the caps is more important than who gets the credit.
But maybe the exposure of this degree of gubernatorial hypocrisy is not a bad outcome either.
