Walker wants to lift cap on Family Care programs

MADISON, Wis. (AP) — Federal health officials have quietly ordered Gov. Scott Walker to lift an enrollment cap and expand state programs designed to keep elderly and disabled people out of nursing homes.

Walker made no mention of the order at a news conference he called Wednesday morning to announce he wants to lift the cap. He told reporters only that health officials in his administration have been talking with Family Care providers for months. Together, they have identified $80 million in efficiencies over the next two years that will enable his administration to end the enrollment cap and expand the programs to the 15 counties that currently don’t offer them.

The move could open the door for thousands of people to join the programs — but it also represents a stark reversal for Walker. The Republican governor has been pushing to rein in Medicaid costs for months and imposed the cap in Family Care enrollment in the state budget.

The Milwaukee Journal Sentinel reported hours after the announcement that the federal Centers for Medicaid and Medicare ordered him to lift the cap in a Dec. 13 letter. Before the newspaper reported the letter, state Department of Health Services Deputy Secretary Kitty Rhoades was vague and made no mention of the order when asked by The Associated Press whether the federal government had denied the state permission to impose the cap.


Messages left late Wednesday night with a state health department spokeswoman and with the U.S. Department of Health and Human Services were not immediately returned. Walker spokesman Cullen Werwie said he didn’t have a copy of the letter.

Democrats pounced on the announcement earlier Wednesday, accusing Walker of trying to remake himself into a defender of health care access as efforts to recall him gather momentum.

“It’s hypocrisy and grandstanding,” state Democratic Party spokesman Graeme Zielinski said. “People know that his record is not somebody who is seeking to improve access to health care for working families.”

The Family Care changes are subject to legislative approval. Walker’s fellow Republicans control both the Senate and Assembly. Leaders in both houses were noncommittal, saying they want to review the proposal.

The plan rankled at least one powerful Republican legislator. Rep. Robin Vos, R-Rochester, co-chair of the Legislature’s budget committee, issued a statement criticizing the expansion. He pointed to a state audit in April that found it was difficult to gauge how cost-effective Family Care has been.

“Expanding another unsustainable program is irresponsible,” Vos said. “Perhaps before expanding, we should figure out how to make it work under sustainable parameters.”

The committee’s other co-chair, Sen. Alberta Darling, R-River Hills, said she was thrilled to hear the governor had found savings in Family Care and she expects lifting the cap will be a priority for the Legislature next year.

Werwie said in response to Vos’ remarks Wednesday afternoon that the expansion is a sound financial move.

“Any claim that this was poorly planned or done rapidly simply doesn’t reflect reality,” Werwie said. “Careful considerations were taken into account … and communicated in multiple venues over the course of the year.”

Family Care programs provide long-term care for the disabled and elderly to help keep them out of nursing homes. The programs fall under the umbrella of Medicaid, the state-federal partnership that pays health costs for low-income people. Walker has been trying to curtail the state’s Medicaid spending since he took office in January, saying exploding enrollment has made the programs too expensive.

In March, the state Department of Health Services froze enrollment in BadgerCare Plus Basic, which provides health insurance coverage for childless adults waiting to join the BadgerCare Plus Core program. And in November, his administration asked the federal government for permission to cut about $554 million from Medicaid, a move that could force as many as 65,000 poor adults and children off state health insurance. The CMS has given the state the preliminary go-ahead.

The two-year state budget Walker signed into law in June capped Family Care enrollment at July 1 levels, which translates to about 43,440 people. As of October, about 6,600 people were on a waiting list to join.

Walker explained his about-face at his news conference by saying the enrollment cap was always meant as a “time out” to reassess the programs, not a permanent freeze. Still, the governor offered no details on the efficiencies he said were driving his decision.

Rhoades said the details were still being fleshed out, but the biggest savings will be counseling potential participants about other, cheaper ways to solve their problems, such as installing handlebars in their bathtubs or having family members shovel their driveways, rather than enrolling in full-blown Family Care. Pressed by the AP about whether federal Medicaid officials had refused to allow the cap, Rhoades said the state and the federal governments are always negotiating over Medicaid programs. She said federal officials told the state it would need permission to make the cap permanent, but said that point was moot because Walker planned to lift the caps before the end of the year.

She made no mention of the Dec. 13 order. A CMS spokesman said in an email to the AP on Wednesday the agency was reviewing proposed unspecified changes to Family Care and he would have to find out more about the situation.

Democrats and their allies are pushing to recall Walker over his plan to strip most public workers of nearly all their union rights. Recall organizers announced on Dec. 15 they had gathered 507,533 of the 540,208 signatures they need by Jan. 17 to force an election.