On March 11, 2021, the American Rescue Plan Act (ARPA) was signed into law. Through ARPA, Wisconsin has access to approximately $350 million dollars in Enhanced Federal Matching Percentage (eFMAP) for Medicaid-eligible activities. States must use this funding for activities to enhance, expand, or strengthen home and community-based services under Medicaid. In Wisconsin, we plan to build on our record of implementing innovative programs that enable people who are elderly and people with disabilities to live their best lives in their homes and communities.
These services include the Family Care, Family Care Partnership, IRIS (Include, Respect, I Self-Direct), Program for All-Inclusive Care for the Elderly (PACE), and the Children’s Long-Term Support programs, as well as additional personal care, private duty nursing, home health, and rehabilitative services provided to other eligible members.
DHS has submitted a plan (PDF) to the Centers for Medicare & Medicaid Services (CMS) about how Wisconsin would plan to use those funds. CMS will review and decide if the initiatives described below are approved.
CMS issued guidance to states providing examples of qualifying activities for this funding. Once this guidance was released, DHS immediately engaged in extensive stakeholder outreach through a series of online meetings. Stakeholders were provided with an overview of the funding, and DHS collected their input on how the enhanced funding should be used to enhance and strengthen services. Meeting attendees included program participants, family caregivers, providers, health equity and long-term care groups, and advocacy groups.
The activities in the proposed plan submitted to CMS fall under four themes: caregiving, policy and program improvement, continuum of care, and fiscal stability.
Direct caregiving workforce
Wisconsin’s direct caregiving workforce is the backbone of home and community-based services. We must better recruit, support, and retain our direct care workforce, and that means we must better understand their challenges, provide quality training, and create opportunities for career advancement. The proposals below, if approved, will address these areas for improvement and support this vital workforce.
Understand workforce challenges
Many other states have used survey results to identify direct care workforce needs. DHS would develop and implement a survey to assess:
- Workforce participation (full and part time)
- Worker tenure
- Wages and benefits
- Existing recruitment and retention strategies
Survey results would inform workforce development, quality improvement, and stability efforts.
High quality training and technical assistance are both key to supporting our caregiving workforce. DHS would implement statewide workforce training modules and grant funding opportunities for providers. Modules would include specialized programs for direct caregivers and managers, and these trainings would also connect with career advancement initiatives.
Expanded opportunities for professional advancement will assist in retaining our caregiving workforce. DHS would implement a statewide professional credentialing and continuing education system. This system would recognize the expertise and tenure of individuals already in the caregiving workforce.
The vast majority of caregivers in Wisconsin are family members, and they need sustained and robust support to best meet both the needs of the individuals they care for and their own needs. DHS would develop an assessment to better understand the needs of family caregivers. DHS would also develop trainings for family caregivers that would teach topics like best practices for providing care, and how to build skills to manage the stress that comes with being a caregiver.
Policy and program improvement
Our current home and community-based services system needs strengthening to meet the needs of Wisconsin’s most vulnerable, and the need for enhanced investment and improvements has only grown during the COVID-19 pandemic. We must better support our aging population, our children with disabilities, and our residents of long-term care facilities. All of these services must also be made more fully and more culturally responsive to the citizens of Wisconsin’s Tribal nations.
Aging and Disability Resource Centers
County Aging and Disability Resource Centers (ADRCs) provide information and referrals to supports and services for older adults and Wisconsinites living with disabilities, functioning as one-stop shops for resources and help. DHS would invest funding to support Medicaid outreach and enrollment, as well as outreach, education, resources, and referrals for other home and community-based services that are not a part of Medicaid. By connecting individuals and families with information and services early on in the process, the need for more intensive and costly intervention services may be avoided later on. With a focus on health equity, DHS would build on this work with ADRCs to better identify and serve populations with specific and significant needs. DHS would also develop a virtual access portal for members of Medicaid long-term care programs to manage their program benefits. This allows ADRCs to spend resources on other implementation goals.
Resources for children with disabilities
Connecting Wisconsin’s children with the resources they need to thrive is integral to our mission at DHS to protect and promote the health of every Wisconsin resident. DHS would develop a virtual Family Resource Center for Children with Disabilities. This virtual center would provide information, self-assessment tools, resources, and referrals. DHS would develop a Children’s Services Navigators and Ombudsman program to follow up with families who use the resource center to reach out for services.
Wisconsin prioritizes data-driven decisions to protect the health and safety of Wisconsin residents. Having accurate and timely data is essential to making well-informed decisions when crafting home and community-based services policy and programs. DHS would pilot an assisted living reporting tool, which would collect information about facilities and residents to better inform facility certification e-renewals and assess the capacity of facilities to serve Wisconsin residents going forward. DHS would develop a member assessment to better understand the needs of Wisconsin residents who access services, both in assisted living and in the community. DHS would improve coordination between state provider licensing, medical services, child protective services, and adult protective services, to explore strategies to use information from different systems to strengthen protections. In addition, DHS would explore ways to strengthen certification standards and improve the quality of oversight for one to two bed adult family home facilities.
The citizens of Wisconsin’s Tribal nations deserve access to services that address their unique cultural and policy needs in addition to their needs as individuals who are aging or who have disabilities. DHS would reinvest funding to further develop Tribal long-term care systems. DHS would increase funding for Tribal aging and disability resource services to a level that honors the knowledge and experience needed to do this work effectively. DHS would identify funding opportunities to further strengthen Tribal long-term care systems and Tribal aging and disability services and supports.
Continuum of care
In order to effectively support Wisconsin residents across a spectrum of needs, we must expand the services included under the home and community-based services umbrella.
Many Wisconsin residents who don't yet receive long-term care services could benefit from short-term, flexible supports to stay independent and healthy. DHS would create a state-funded program that provides short-term, flexible, limited services and supports for Wisconsin residents.
- This program would serve residents who are not currently eligible for Medicaid, or who are Medicaid members but are not currently using long-term care services.
- Supports would help residents’ ability to remain in their homes, which could help manage the increased need for long-term care services as Wisconsin’s population continues to age. These supports could include services like home modifications, limited supportive home care, or respite care.
DHS would create a pilot Independent Living and Caregiver Support program.
- The pilot program would offer annual reimbursements for intermittent and one-time services and supports for qualifying individuals or family caregivers.
- These annual reimbursements would be capped, and the pilot program would span two years.
DHS would also conduct a program evaluation of the pilot to better determine evidence-based best practices and help inform our development of future interventions.
By thinking more expansively about supports and services, we would be able to innovate and discover new best practices for home and community-based services.
- DHS would develop a needs assessment for individuals receiving HBCS, providing a better understanding of the needs of the pre-Medicaid population.
- DHS would create grants to support providers and programs transitioning to a new workforce model for individuals with intellectual, developmental, and other significant disabilities. This model would assist individuals with disabilities in finding and retaining work in competitive, integrated employment.
To ensure members maintain access to a range of essential home and community-based services, we must increase reimbursement rates. DHS would increase rates for all home and community-based services by five percent.
- This rate increase would occur in 2022.
- The increase would address the immediate need for increased funding across all service areas.
DHS would develop a rate schedule for Medicaid long-term care providers, as well as one-time funding for fiscal years 2023 and 2024 to facilitate easier implementation of the new provider rate schedule.