DHS Fiscal Update May 3, 2017 Julie Anstett DHS Director of Area Administration DHS Fiscal Update May 3, 2017

DHS 2017 Field Goals

Wisconsin Medicaid: Current Program

Wisconsin Medicaid – Projected All Funds Costs under Current Law, by Eligibility Category (in $ Billions) This projections assumes 5.4% growth in costs annually (3.4% PMPM and 2.3% Caseload) Elderly, Blind, and Disabled members account for 66% of program costs and 21% of program enrollment Children account for 12% of program costs and 43% of program enrollment

Long-Term Care Investments in the 2017-2019 Biennial Budget Eliminates home and community-based services waiting lists for children. DHS will work with counties on a funding allocation and county contribution methodology. Governor Walker will conclude the long-term care reforms that Governor Thompson began when Family Care is expanded to the final county (Dane County) in January 2018. Eliminating all home and community-based services waiting lists for adults and children will make Wisconsin a national leader.

Long-Term Care Workforce Challenges By 2040, Wisconsin’s population of people ages 65 and older will increase 72%. This means more and more people will need some type of individualized care, either in a nursing home, assisted living facility, or in their own home. Current challenges: In Wisconsin, 1 in 7 caregiving staff positions are unfilled. Nearly 50% of providers had no applicants for vacant caregiver positions.

Wisconsin Caregiver Career Program In March 2017, Wisconsin received more than $2.3 million to implement this new program. Program designed to encourage 3,000 Wisconsinites to enter caregiver careers by providing training and testing. Program developed in partnership with nursing homes, LeadingAge Wisconsin, Wisconsin Health Care Association, and Wisconsin Technical College System.

Wisconsin Caregiver Career Program Includes $250,000 for a marketing and recruitment plan to highlight the program and rewarding aspects of working as a nurse aide caring for Wisconsin’s elders. Includes resources for DHS to work with nursing homes to explore ways to make working in their facility a desirable location. Flexible hours Accommodations for child care

Personal Care Independent Assessment Goal is to ensure the right amount of care is being provided to members at the right time in the right settings. Starting June 1, 2017, Liberty Healthcare Corporation, will conduct in-person assessments using DHS’ personal care screening tool to determine a member’s medical needs for services. Includes Wisconsin Medicaid and BadgerCare Plus members who receive personal care services through: Fee-for-service (card services) IRIS (Include, Respect, I Self-Direct) program; those who do not self-direct their personal care services

CLTS Waiver Renewal Three waivers reduced to one waiver. Reduced reporting for the counties. Wisconsin Provider Management (WPM) state directory. State rate setting methodology in development for waiver services. CMS Corrective Action Plan. DHS is committed to continuation of services. CLTS meeting May 10th in Madison.

Children’s COP Draft guidelines and memo issued to counties 4/4/17. CCOP Procedure Guide Informational Memo All counties submitted their C COP Plans. Plans were all reviewed and approved.

IMD Rebalancing Initiative (RI) Background: Launched July 1, 2016. To assess future collaborative planning and policies. Pilot ends December 31, 2017. Goals: To provide some financial relief to counties. To better understand and further promote collaboration with counties. To gather data.

IMD Rebalancing Initiative (RI) In Q3 and Q4 of 2016 fewer Counties participated than DHS anticipated. 71 IMD stays were reported. IMD RI paid out $223,769 to counties to date. $1.8 million funding available to counties for CY 17. DHS is amending the contract to move the county due date from January 31, 2018 to March 31, 2018. DHS will have more data from the MCO’s later in 2017 and will do further analysis.

Questions For questions about this DMS - LTC information please contact: Deb Rathermel Deborah.Rathermel@dhs.wisconsin.gov CLTS Waiver Renewal Children’s COP Vaughn Brandt Vaughn.Brandt@dhs.wisconsin.gov IMD Rebalancing Initiative General Questions Grant Cummings Grant.Cummings@dhs.wisconsin.gov IMD Rebalancing Initiative Contract/Fiscal

Electronic Health Records (EHR) DHS received approval in the 2013-2015 biennial budget to procure an EHR system to support its seven care facilities. Benefits to having an EHR: Increases continuity of care. Reduces medical errors. Standardizes care and facilitates best practices. Provides the ability to analyze trends and long term changes in patients. Improves medical practice management. Enhances physician recruitment.

Treatment to Competency The 2017-2019 biennial budget increases forensic patient capacity to help DHS reduce waiting time for forensic patients on the admissions list and reduce population pressures in county jails. Provides funding to staff two additional treatment units for forensic patients at Mendota Mental Health Institute, totaling 40 beds, which will be operational 2020. Adds 73 FTE and $7.2 million All Funds per year.

Comprehensive Community Services Available in 64 counties, two tribes. DHS is committed to working with county and tribal partners to ensure all CCS clients are receiving high-quality services. Meetings are being held in each DHS region to address the concerns raised by counties and tribes regarding programming, recent audits, and technical assistance provided by DHS.

Mental Health and Substance Use Initiatives in the 2017-2019 Biennial Budget Invests $1.2 million to develop an eight bed Crisis Treatment and Stabilization Facility for children to improve outcomes for children in crisis. Intended for short-term (non-emergency detention) placements. Will be community-based and will provide mental health services to children in the least restrictive setting. Develops a peer-run respite center for veterans in the Milwaukee area to improve outcomes of veterans in crisis and those having difficulty coping with mental illness.

Governor’s Task Force on Opioid Abuse In 2016, Governor Walker responded to the epidemic and formed the Governor’s Task Force on Opioid Abuse, naming Representative Nygren as a co-chair Special Session on Opioid Abuse: Keep track of prescription drugs. Enable first response. Invest in treatment. Wisconsin has earned its reputation as a national leader in the response to this public health crisis.

21st Century Cures Act Grant Wisconsin was awarded $7.6 million of year one funding from the Substance Abuse and Mental Health Services Administration. 21st Century Cures Act Grant year one is May 1, 2017 through April 30, 2018. Grant purpose: Expand access to evidence-based treatment and recovery supports for opioid use disorders. Increase retention in opioid treatment services. Improve quality of life and advancing effective opioid misuse prevention strategies.

Wisconsin 21st Century Cures Act Grant Activity Highlights Allow up to 25 hospitals with high rates of drug overdose care to hire contract recovery coaches. Expand the state medically assisted treatment centers to provide assessment, counseling, treatment, and intensive case management services to many individuals looking for support. Create an addiction hotline. Support community coalitions focused on reducing the nonmedical use of opioids among people age 12 to 25.

Questions