Under Medicaid guidelines, a disabled adult or a frail elderly person would need to go into a nursing home to be able to access Medicaid funding to pay for their care. However, each state has a waiver program that allows the person to divert that money into community-based support services that allows the person to remain in the community, if not in their own home.

In Wisconsin, there are three programs that offer this type of waiver. One is Family Care, which can provide such things as residential services, day programming and personal cares. Another is Partnership, which does the same thing as Family Care, but includes an HMO component for medical care. The third is IRIS, which allows the person to self-direct their services.

At least one of these programs is offered in 57 of the 72 counties in Wisconsin. Many of them have two options, Family Care and IRIS. Of the remaining 15 counties, eight of them are already in the process of transitioning to Family Care.

Until now.

In his 2015-17 proposed budget, Scott Walker wants to make sweeping changes to these programs and the way they are administered.

One of the biggest changes would be the elimination of IRIS. The effect of this will be devastating for a lot of these people and their families:

Beth Swedeen is the Executive Director of the Wisconsin Board for People with Developmental Disabilities. She says one of the biggest concerns they are hearing about is the possible elimination of the Include, Respect, I Self Direct, or IRIS Program. IRIS allows qualifying people the ability to make their own choices about many healthcare options instead of being institutionalized, on Family Care, or regular Medicaid. “People with significant disabilities and older adults are using long-term care where they are self directing their own support, so they’re hiring their own care workers, and they’re making decisions about the budget that they are allowed to have in ways that make sense for them and their families, so we’re really concerned about that. I’ve gotten a lot of calls from folks who are really concerned about the elimination of that program.” Swedeen says one of the many benefits of IRIS is the member gets to choose who their caregivers are. “When you have people in your home doing things that are very personal to you, like helping you with a bath or helping you get dressed, you want to make sure that’s a person you are comfortable with, and somebody that is safe and that is somebody you’ve chosen rather than somebody that an agency has chosen.”

Other changes include dissolving the regional districts and making Family Care contracts available only to companies that can operate state wide, such as Big Insurance companies. Walker would also allow the state to contract with anyone for for the Aging/Disability Resource Centers (ADRCs), which are currently run by the counties. Walker would also abolish ADRC governing boards and long term care councils.

Walker would also award all of these contracts in a no bid process.

And to show that the care of these vulnerable adults are not his priority, Walker wants to take oversight of these programs from the Department of Health Services and give it to the Commissioner of Insurance.

In other words, Walker wants to force the frail elderly and disabled adults into a single, expensive program. He then wants to give these contracts - worth more than $3 billion - in a no bid process to large for profit insurance companies, who will have little or no oversight.

Gee, do you think he is fishing for the Big Insurance campaign donations with this immoral giveaway?

Ah, but that's not all. With all things Walker, there is more. There is always more.

Walker is not satisfied with just going after the disabled adults and frail elderly. He wants to go after disabled children as well.

Included in Walker's budget is the elimination of the Family Support Program, which helps families with disabled children to get special equipment or services that are not covered under Medicaid.

Just when one might think that Walker has hit the depths of maleficence and greed, he finds a way to prove us wrong.

Walker and his apologists will point out that his budget calls for expanding Family Care to all 72 counties so that no disabled person or frail elderly person would go without these "services."

Don't be fooled by this claim.

The only reason Walker is doing that is that the federal government slammed him a few years ago when he tried to put a cap on Family Care and told him in no uncertain terms that he could not deny services to anyone eligible for them:

Because the currently approved waiver includes and entitlement to waiver services, we are instructing the State to operate the waiver as it was approved by CMS. Therefore, 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. This includes individuals living in any counties who had or would have had an entitlement to the waivers as of July 1, 2011, and includes individuals who were or would have otherwise been selected for enrollment from other participating counties.

In ancient history, people would put their frail and disabled people out into the cold for the wolves. Walker is doing a modern day version of this where he is throwing these vulnerable citizens to the corporate wolves.

Cross posted at Cog Dis