People First: Invest in Public Health and Long-Term Care

The COVID-19 pandemic has further highlighted the importance of community preparedness and high quality care for Wisconsin residents of all ages. To bounce back together, Governor Evers’ budget invests in our public health, community health, and long-term care systems, ensuring every Wisconsinite can live their best life.

Improve our state public health system

In the past year, the importance of a robust and responsive public health system has become more evident. We need a modern and well-funded public health system at all levels to keep our residents protected from all communicable diseases, and to be prepared to address diseases that have been with us for generations, like illnesses from food, insects, and sexually transmitted diseases, as well as those that arise once a century like COVID-19. Our current public health system and funding are not enough, our current fight against COVID-19 is not sustainable, and our response to other current and future communicable diseases are not possible without investments and increased flexibility.

State Support for Communicable Disease Response

Our current staff of epidemiologists, disease intervention specialists, and infection prevention specialists have been indispensable during COVID-19, but they are stretched too thin, and we are over-reliant on staff from the federal Centers for Disease Control and Prevention.

Twenty-three full-time staff will work on communicable disease outbreaks, supporting local health officials and focusing on Wisconsin-specific needs instead of federal priorities.

  • Five disease intervention specialists will concentrate on testing and contact tracing of sexually transmitted diseases.
  • Five infection prevention specialists will concentrate on drug-resistant infections in health care settings.

Emergency Medical Services Supports

Ambulance service in our state consists of over 800 EMS organization, and volunteer EMS providers are responsible for staffing the majority of Wisconsin’s ambulance providers.

Increasing grants to local municipal and non-profit EMS agencies will strengthen the first responders providing our emergency health services.

  • EMS providers routinely administer emergency care, stabilize patients with serious illnesses and injuries, and transport patients.
  • During the COVID-19 pandemic, EMS providers have also helped support public health efforts through mass clinics and by administering medications, vaccinations.

By converting State Trauma System staff out of federal Hospital Preparedness Program funds, Wisconsin will be in compliance with federal guidelines and increase funds for local preparedness efforts.

Data to Support Surveillance and Response Coordinators

Data is key to detecting and tracking communicable diseases, and to coordinating patient care.

Advanced data modeling and statistical analysis can provide early warning of diseases that are present in or a threat to Wisconsin. Funding these resources at a state level will help support communicable disease response.

Grants supporting Health Information Exchange will make it possible for health care providers and patients to access and share medical information securely. This will improve the quality, speed, and safety of patient care, as well as reduce cost.

Harm Reduction Strike Team

Our proposal builds of the success of strike teams in other states, where they have been used effectively for hepatitis vaccinations, to respond to communicable diseases related to the opioid epidemic. By traveling to the location of the outbreak, the team will provide access to much-needed services, including vaccination, testing, counseling, and insurance enrollment.

Fund our local health departments

Wisconsin ranks 46th in the nation in per capita public health spending. Because we are largely dependent on federal funding and priorities, local and tribal health departments are limited when it comes to responding to health concerns that are specific to their communities.

Local Resources for Communicable Disease Response

Our local and tribal health departments are primary line of defense keeping communities safe from infectious disease, but they are significantly underfunded.

  • A ten-fold increase in state funding to local agencies will make it possible for local health departments to response immediately to major disease outbreaks.
  • By providing this funding, local and tribal health departments will not only continue their COVID-19 response but also be ready to respond to any new infectious diseases.

Improve our long-term care system

Our current long-term care infrastructure is inadequate to meet the needs of Wisconsin’s most vulnerable. Skilled nursing facilities face significant financial challenges. While occupancy rates are lower, facility and payroll costs are high. COVID-19 has added more financial pressure due to supply and equipment costs, testing, and disruptions in admissions and discharges.

Nursing Home Funding Increase

While Medicaid funds the majority of care in nursing homes, current Medicaid rates only cover about 72% of the cost of caring for a resident.

By increasing the Medicaid reimbursement rates, Medicaid will cover about 86% of the cost of resident care. This will make the rate consistent with current reimbursement rates for other residential care, such as rehabilitation hospitals. Medicaid reimbursement rates will see an 11.5% increase in fiscal year 2022, with an additional 11.7% increase in 2023.

Nursing Home Quality Improvement Projects

The federal Centers for Medicare and Medicaid Services collects fines from skilled nursing facilities when those facilities are not in compliance with federal requirements. Wisconsin then receives our share of those funds to use in ways that benefit nursing home residents. Funded projects are designed to protect the property, health and welfare of residents, as well as improve facility operations.

This additional position to manage the DHS Nursing Home Grant Program will enable us to conduct more outreach to nursing homes, identify and fund a greater number of innovative projects to benefit nursing home residents, and manage existing grants.

Home and Community-Based Services Waiver Programs Rate Bands

Managed care organizations contract with health care providers to deliver long-term care services to consumers. A rate band concept can improve consistency and transparency by developing guidance for managed care organizations on setting reimbursement rates for home and community based services.

This proposal came from the Governor’s Task Force on Caregiving and ensures that members can maintain access to a range of essential long-term care and home and community based services and providers.

We will develop a statewide rate band proposal for home and community based long-term care supports, for implementation in the 2023-25 biennium.

Strengthen our caregiving workforce

Working in direct care is important and difficult work, and we must better recruit, train, support, and retain our direct care workforce.

Family Care Direct Care Investment

Developing and managing a network of care and services, Family Care managed care organizations need to ensure quality staff.

By increasing funding supplements to managed care organizations, the provider networks will be able to increase wages, bonuses, and paid time off for direct care workers. These benefits will reduce turnover, making it easier for providers to retain staff and improve care.

Personal Care Services

Personal care service agencies make it possible for people to live in their own homes by providing assistance with activities of daily living.

By increasing Medicaid reimbursement rates for direct care costs, agencies will be able to more effectively recruit and retain staff.

Caregiver Quality

Our Office of Caregiver Quality investigates reports of neglect, abuse, and theft of property in health care setting across the state, including nursing homes, adult family homes, behavioral health treatment programs, and facilities serving individuals with developmental disabilities.

In 2020, we responded to a total of 6,773 reports, 57 percent of which were reported by health care providers, and 43 percent by members of the public. By increasing staffing, the Office of Caregiver Quality will be able to help protect individuals who receive services and help assist health care providers to promptly respond to incidents.

Home Care Registry

Wisconsin currently has no statewide registry to connect direct care workers with individuals and families in need of home and community-based services. This proposal came from the Governor’s Task Force on Caregiving.

A one-year pilot to procure a free, safe, secure statewide home care registry will address this gap.

Direct Support Professional Training

The direct care workforce is made up of many different caregiving professions and care settings, and each has unique requirements and standards.

By developing a pilot program to provide training on standards of practice and creating a “career ladder” for caregivers to use for potential nurse aide certification, we will help improve caregiver recruitment and retention.

Support family caregivers

The vast majority of caregivers in Wisconsin are family members, and with the current challenges retaining the direct care workforce, these family caregivers are in need of more support. In addition to the following provisions, Governor Evers’ budget invests over $200 million to support family caregiving by creating a Caregiving Tax Credit of up to $500 through the Department of Revenue.

Aging and Disability Resource Centers

County aging and disability resource centers and Tribal aging and disability resource services provide information and referrals to supports and services for older adults and Wisconsinites living with disabilities.

This increase in funding will expand services for family caregivers. Expanded services for family caregivers makes caring for loved ones more accessible to families.

  • Aging and disability resource centers will be required to designate a caregiver coordinator, create a marketing plan about their programs, and measure impact.
  • By providing more funding to Tribal specialists, funding for tribes will better match county funding.

Dementia Care Specialist Expansion

Currently, residents of 56 of Wisconsin’s counties have access to a dementia care specialist through aging and disability resource centers, supporting caregivers and people with dementia while they live at home.

Increased funding will expand this access to all counties and tribes. 18 more specialists at county aging and disability resource centers and seven additional tribal specialists will ensure access statewide.

Alzheimer's Family Caregiver Support Program

Supporting caregivers of family members with irreversible dementia, the Alzheimer’s Family Caregiver Support Program provides up to $4,000 for relevant services and supplies.

The Alzheimer’s Family Caregiver Support Program currently serves around 1,200 families each year.

  • This program helps with things like respite care, in-home help, adult day care, transportation, nutritional supplements, home delivered meals, and chair lifts.
  • By raising the income eligibility limit from $48,000 to $55,000 per year, the Alzheimer’s Family Caregiver Support Program will be able to serve even more families.

Hearing Aids Assistance

Through the Telecommunications Assistance Program, this funding will provide access to hearing aids to individuals in need.

Current funding provides for the launch of a pilot Telecommunications Assistance Program, and this funding increase will make it possible to continue that program.

Family and Guardian Training

Funding this training will inform families and guardians on the duties and responsibilities of serving as a guardian.

Caregiver Assessment Tool

Caring for a loved one can be stressful and affect a family caregiver’s mental and physical health. By assessing their health, stress levels, skills, and support systems in a tailored assessment, we can better understand the challenges facing family caregivers.

The subsequent pilot program will provide evidence-based care management support for family caregivers.

Last Revised: March 4, 2021