Need for a Medicaid Home and Community-Based Services Waiver for Persons with Mental Illness

Existing waiver programs do not serve individuals who have only a mental illness. Wisconsin has developed a series of Medicaid waiver programs for persons with developmental disabilities, traumatic brain injuries, physical disabilities, or who are elderly to divert or relocate them from nursing facilities. These programs are known as the COP waiver and the Community Integration Program (CIP) waivers. However, none of these waiver programs serve persons who have only a mental illness.

Large numbers of individuals with mental illness currently reside in nursing facilities. Persons with mental illness have traditionally been served in nursing homes in Wisconsin. In part this dates to the time when there were county asylums, which were converted to nursing facilities in the mid-1970's. In spite of state efforts to reduce the number of persons with mental illness in nursing homes, there are currently 1472 persons residing in nursing homes who have been screened and found to have a serious mental illness. 396 of these individuals are under the age of 65.

The lack of a waiver to serve persons with mental illness in the community has meant that persons are inappropriately placed into Medicaid funded nursing homes when resources are not available for community placement and they may stay in these facilities for long periods of time.

• Of the 1472 persons with mental illness noted above, 1026 have been there for over 30 months: 237 of these individuals are under age 65.
• Also when nursing homes close, an increasingly frequent event, residents with mental illness are often moved to another Medicaid funded nursing home bed instead of being relocated. People can be placed into the community only if the county has the resources to do so, if they have another concurrent disability, or if they are elderly which would enable them to receive a CIP slot.

It is now time for Wisconsin to develop a waiver so these individuals can be diverted from nursing homes or relocated to the community when their needs can be met there. The Department of Health and Family Services needs to be directed to develop and submit such a waiver to the federal Department of Health and Human Services by a date certain and language to authorize the implementation of such a waiver needs to be written and incorporated into the state budget.

A Legislative Fiscal Bureau paper on this topic has been developed and indicates that such a waiver would be feasible. DHFS staff also is working on development of a waiver.