Two national for-profit health insurance corporations have announced proposals to acquire local Wisconsin Family Care Managed Care Organizations (MCOs).
Information provided by the Wisconsin Board for People with Developmental Disabilities: WI BPDD
DHS oversees Family Care MCOs and has requirements through its contracts to ensure quality care. DHS cannot stop the acquisitions. DHS’s Managed Care Contract is the state’s primary tool to direct how Family Care operates after the acquisitions occur.
Molina intends to acquire MyChoice Wisconsin. MyChoice Wisconsin has more than 16,800 Family Care members in 39 counties. Molina already owns TMG, Wisconsin’s largest IRIS consulting agency with more than 17,600 participants (73% of the entire IRIS membership).
Humana intends to acquire Inclusa. Inclusa has more than 15,500 Family Care members in 68 counties.
Both Molina and Humana are large scale, for profit, corporations operating in multiple states, and their primary business is health care insurance.
DHS is hosting two public forums to gather public input (registration links next to event):
- Wednesday, December 14th from 9:00-11:00 AM (Register)
- Thursday, December 15th from 6:00 – 8:00 PM (Register)
We encourage people with disabilities, family members, and providers to attend these sessions to share their experiences with how Family Care is currently operating and concerns about the future of Family Care.
If you cannot attend the online forums or would prefer to provide written comment, you can: Email your comments to:
dhsltccomments@dhs.wisconsin.gov
What Action Steps should you take?
Advocates are concerned Family Care relies too much on natural supports in care plans, unpaid family members filling in shifts when no paid caregivers are available to hire or do not show up for shifts, and there are not enough quality providers and workforce to serve people where they live.
A strong MCO contract is needed to improve Family Care quality and direct how for-profit insurers must do business in our state.
Topics that the public may want to comment on at the public forums:
- Placing limits on total profit and administrative costs.
- Requiring that MCOs invest excess profits to increase provider ability to serve more people, and in outcomes that improve participant’s independence including community integrated employment, community supported living, use of remote support technology, and increased access to non-driver transportation options.
- Requiring MCOs to measure how much time and services are being provided by natural supports in care plans and unpaid family caregivers who are covering authorized hours. Survival Coalition’s recent Family Caregiver survey found family caregivers pick up the pieces when paid help falls through.
- Including pay for performance criteria that pays for community integrated outcomes (hours worked in community jobs, people living in community supported living, etc.).
Requiring MCOs to have pay scale increases that reward direct support workers with specialized skills, who serve geographically underserved areas, or high acuity participants, and who stay in the field so MCOs can sustainably increase worker wages.
A TEAM USA 