Wisconsin Department of Health Services

This document compiles presentations delivered to the Wisconsin Long-Term Care Advisory Council, offering insights and recommendations related to the state's long-term care system. Key focus areas include a comprehensive market study by Baker Tilly on long-term care challenges through 2030, proposing both private and public sector recommendations to address client volume, complexity, and workforce constraints. It also provides updates on the Home and Community-Based Services (HCBS) settings rule compliance and corrective action plans, introduces a new Provider Management System for Medicaid waiver services to enhance federal compliance and efficiency, and details health, safety, and abuse/neglect issues and trends within nursing homes and assisted living facilities, alongside Division of Quality Assurance (DQA) initiatives. The overarching vision is to protect and promote the health and safety of Wisconsin residents by addressing systemic challenges and improving care quality.

This document presents recommendations from Ad Hoc Groups to the Long Term Care Advisory Council concerning the future of long-term care in Wisconsin. It outlines strategies across three key areas: developing a multi-sectoral plan on aging and disability, strengthening Medicaid long-term care programs for equitable and high-quality services, and enhancing the direct care workforce. The recommendations aim to promote consumer choice, healthy aging, independent living, and sustainable, person-centered care for the people of Wisconsin over short-term (2025), mid-term (1-2 years), and long-term (5-10 years) horizons.

This document outlines the State of Wisconsin's strategic priorities and fiscal plan as presented in Governor Evers' 2023-2025 Biennial Budget. It details key investments in Medicaid expansion, long-term care, aging and disability programs, and behavioral health initiatives aimed at enhancing health services and quality of life for residents. The plan also addresses critical workforce challenges in healthcare, informed by a 2021 workforce survey, and outlines the Department of Health Services' (DHS) approach to managing Managed Care Organization (MCO) acquisitions, including stakeholder engagement and proposed contract amendments to safeguard service quality and access.

The meeting included general updates concerning the Competitive Integrated Employment (CIE) 2024 data trends and planned presentation of the 2025 CIE Report in early 2026. Updates were provided on Managed Care Organizations (MCOs) and two initiatives led by Helen Sampson: ARPA projects, which awarded 37 grants resulting in substantial growth in service delivery, and the National Center to Re-frame Aging, encouraging participation in upcoming sessions. Council feedback was provided regarding MCO engagement. A Payment Integrity Review (PIR) update detailed its focus on proactively reviewing Medicaid claims prior to payment to safeguard program integrity, with council members raising concerns about claim documentation burden and authorization disparities. Discussions on the Long Path Charge centered on building an age-friendly ecosystem using existing initiatives and addressing the intersection of aging and disability. The Workforce Charge noted that the program remains intact while incentive payments shift, and council members were tasked with researching and reporting on key recommendations from the Governor's Task Force on Caregiving. For the Medicaid Long-Term Care Charge, updates covered proposed MCO contract language, the IRIS waiver submission, and establishing a connection with the new Medicaid Advisory Committee (MAC). A Federal Budget/Medicaid Update covered the state budget signing and significant federal changes impacting Wisconsin as a non-expansion state, specifically mandatory work requirements for certain Medicaid populations starting January 1, 2027, and drastic changes to FoodShare/SNAP administration funding and work requirements. Council business included scheduling topics for the next meeting, and public comments addressed concerns regarding PIR audits and the IRIS provider management system implementation.

The meeting included a review and approval of the January meeting minutes, followed by general updates. Key discussions centered on the IRIS Waiver Renewal process, including targeted outreach, an aggregated survey revealing concerns regarding access and transportation barriers, and the upcoming 30-day public and tribal comment period before the October 1, 2025 submission deadline to CMS. The Federal Landscape update addressed new call center scripts and the lack of state role in federal budgeting, leading to council feedback encouraging members to contact federal representatives. The Governor's Budget Update presentation covered the budget cycle, mental health supports, and confirmation that the minimum fee schedule continuation is included in funding. The council established a process for moving forward with ad hoc gatherings (Long Path, Medicaid Long Term Care, and Workforce groups), requesting these groups meet before the next session to develop priority lists. A significant portion of the meeting involved a presentation and discussion on the Long Path charge, specifically reviewing Minnesota's multisector plan for aging to inform their own approach, focusing on areas like affordable housing, integrated care, and equitable opportunities. Council business included requests for updates on the PIR claims review, the status of unregulated independent living situations, the overall Medicaid situation, and updates concerning the IRIS program and EVV mandates.