Wyoming health officials are exploring ways to make a Medicaid program for the developmentally disabled less prone to conflicts of interest.

But the effort is causing concern among nonprofit groups that care for people with disabilities. They worry the changes, however well intended, will lead to a system that’s slower to respond to the needs of a vulnerable population.

The changes focus on case managers who help nearly 2,300 people navigate the state’s Home and Community-Based Waivers Program. Officials want them to operate more independently of the organizations that provide services to people with intellectual disabilities and brain injuries.

Under the state’s existing rules, case managers can work for the same organizations that provide services such as adult day care and job training. They can also provide the services themselves.

Case managers are not supposed to recommend a specific service provider. But some might be guiding clients to their employer’s programs, even when another organization might be a better option, said Chris Newman, who oversees the state’s waiver program.

Officials also worry that some case managers hesitate to raise concerns about a client’s care when it involves a service provide by their employer. Making case managers more independent would result in a more responsive system, Newman said.

“I think people will see concerns and frustrations will be addressed more quickly and appropriately,” she said.

Others aren’t as sure. Laura McKinney is president of Magic City Enterprises, a Cheyenne-based organization that serves people with developmental disabilities. She’s found her case managers interact with clients more often than independent ones. It’s also easier for them to address a concern.

“Our case managers know if there is an issue, they can come to me … if they don’t feel it is addressed, they can go to the state,” she said.

Larger overhaul

Wyoming is in the midst of an overhaul of its waiver program, spurred by a desire to reduce wait times for services without spending more money. Wringing conflicts of interest from the system is one part of that effort.

Health officials believe they can reduce the number of conflicts by making case managers more independent. Those managers play a key role in the waiver program. They work with clients to develop plans for care and then help connect them to services in the community.

Case managers are also responsible for ensuring their clients are properly cared for. If a client is staying at a group home without enough nurses, it would be the case manager’s job to approach management about the situation, Newman said.

But what happens when a case manager’s employer runs the group home?

“What we have seen consistently from across the state, it is very difficult for a case manager who is working for the organization to go to the organization and say, ‘You need more staffing there. My person is not being served appropriately,’ ” Newman said.

It’s possible such a scenario has played out somewhere in Wyoming, said Chris Boston, executive director of NOWCAP Services, a Casper-based disability service provider. But in his view, it’s far from a given.

“I will tell you flat out: That doesn’t happen in our organization,” he said. “We have weekly staff meetings where we work out issues and concerns.”

Other conflicts might not be so overt. Reform advocates worry that case managers might direct clients to their own employer’s services — even if their motivations aren’t financial.

“They are familiar with their own program,” said Rep. Elaine Harvey, R-Lovell, who chaired the legislative committee that sponsored the overhaul. “They feel their program is valuable.”

Case managers who work for larger disability providers insist they can still give fair counsel to clients. Tony Scoville, a case manager with Magic City, said he doesn’t have any difficulty giving his clients options beyond his own organization.

Case managers are taught to avoid potential conflicts of interest in the system, he said.

“There are choices,” he said. “I tell my folks that.”

Questions remain

Health officials expect to complete a draft plan for the conflict-free system sometime next month. They haven’t determined the details of the plan, or when it might actually go into effect.

That ambiguity has sparked some anxiety among people who rely on services, said McKinney, the Magic City president. Some of her clients are worried they might lose their case manager in the transition to a new system. Case managers themselves are also concerned they might have to leave their employer, either for a new agency or to go independent.

Even after the transition is over, McKinney doubts people in the waiver program will be better off. She says in states with other systems, clients only interact with case managers a few times each year.

“I understand the idea behind [the conflict-free system], but I think some of the problems that have been brought up are not as big as some people say they are,” she said.

There are options besides making case managers more independent. Heavier monitoring is one. But Newman argues that such an approach isn’t feasible in Wyoming.

There are 239 case managers in the system, and it’s difficult to catch one who is not providing appropriate services based on a conflict of interest, Newman said. She believes it’s better to craft a system that minimizes the chances a conflict could develop.

“It would give the case manager the authority and the power to be independent and work independently,” she said. “They aren’t being pulled in three different directions.”

Contact Joshua Wolfson at 307-266-0582 or at josh.wolfson@trib.com. Visit http://trib.com/news/opinion/blogs/wolfjammies to read his blog. Follow him on Twitter @joshwolfson.

(6) comments

DDAdvocate
DDAdvocate

In order to fix the problem the state needs to start from the inside out and eliminate the conflicts of interest in their own departments. Chris Newman's spouse use to work for MRSI a huge agency in the state and she single handed made multiple decisions that affected that organization and she was fine doing so and the conflict didn't bother her at all while he was collecting a huge check. Then you have Christine Bates a supervisor at the Office of Healthcare Financing-Medicaid, her mom is one of the head cheese at Cheyenne Medical Specialist in Cheyenne...guess what group I bet never has a Medicaid audit. Then you have Teri Greene the head of Medicaid married to Pat Greene the head of the state's HR dept... but the problem is with the case managers for developmental disabilities. Sure there are case managers that won't do a thing working for an agency but there are plenty of independent case managers with the same issue. The problem is the state wants to eat their cake and have it too. Chris Newman mentions staffing that a case manager can recognize and report understaffing...well Newman already took care of that problem when the state tighted up supervision levels and are allowing 0% flexibility to providers. At the end of the day people like Chris Boston and Laura McKinney are on the name plate at these agencies as the person running them; however, every day Chris Newman gets closer and closer to the state running the agencies, I wouldn't be surprised if Chris Newman wanted to go back to institutional life because it would be easier for her to monitor, she really needs to stop talking out of both sides of her mouth. I bet in a few years she will run for public office because she is perfect to be a politician.

WyomingCowboy82435
WyomingCowboy82435

DD Advocate you are dead on correct.

Moore
Moore

Sadly enough I will be giving resignation of case management services this month. No conflicts with me, ever. I provide only CM services, never for friends or family. I always give provider lists for interviewing. One problem is the lack of providers. The more control the government wants the less providers they will have. People are tired of feeling threatened for caring for others. Changes occur constant and then reprimand is given for "our confusion." Don't misunderstand, there are some fantastic people in the state who are very helpful, but it doesn't outweigh the ones who look for any means to find fault and punish. It is exhausting!

WyomingCowboy82435
WyomingCowboy82435

I have been involved in the Wyoming DD system for nearly 30 years. Not only do Chris Newman and her minions have no clue what the consequences will be for their misadventure, Chris, Joe, Kathy E and others have not even spent a day in direct services. These are power hungry bureaucrats who never spend even a moment in the community programs and really don't know what they are doing. It would be like having a auto mechanic responsible for your brain surgery. Although Chris Newman's spouse is no longer working at MRSI, he still provides services to Waiver recipients and not very good services at that. It is unfortunate that these individuals have been able to win over Rep. Elaine Harvey from Lovell, because for years she was the DD systems number one advocate and was an outspoken supporter of the community providers. It looks like now she is willing to let community providers fold up their tents with out even so much as a support word from Mrs. Harvey. The saddest part of these changes is for the participants who depend on their current case managers every day for support and the new system as it has been discussed will take away that choice from the participants and their guardians. Guardians will no longer be aloud to choose what is in the best interest of this most vulnerable population. Chris Newman and Joe Simpson spout current case management problems with out any data to back up their allegations. Wyoming had independent case management under Governor Geringer, and it was discontinued as a total failure. I guess the current Governor and his Dept of Health do not have the ability to learn from previous mistakes. Taking away choice is against current best practice and will result in participants failing to thrive in the community which they have for the past 50 years. The Dept of Health is out of control and I pray that the legislature takes back control before all the providers are out of business. Thank God the media has finally picked up on this debacle. The Dept of Health is in a big rush to change the system even without a plan B for all of these disenfranchised participants. Senators Barnard, Scott and Craft passed an amendment in SF 60 which would still allow for the current system of case management, but the Dept of Health has interpreted how they wish it was written. As the system fails, watch how these bureaucrats scapegoat the programs for trying to serve the participants at their need level. Wake up Wyoming before it is too late to save the existing system.

oz46
oz46

The biggest problem is that we have people running the same model of programs they have run for the last 30 yrs. We seen the state training school providing inadequate antiquated services and moved to community based waiver programs. Now over 20yrs after the ADA and nearly 40yrs after IDEA we have a different expectation for services. 30yrs ago moving people from institutions and the State training school to group homes in the
community was best practice. The majority of people then had no education, no life skills and very little support. It's different now than it was 30yrs ago. There will always be a need for intensive comprehensive services for some people but the need for specialized individual services is what is needed today. People need independent counsel when choosing services. They should receive services that maximize their autonomy and inclusion in community life. We need a specialized provider network that provides specific services
extremely well instead of cumbersome provider

oz46
oz46

The biggest problem is that we have people running the same model of programs they have run for the last 30 yrs. We seen the state training school providing inadequate antiquated services and moved to community based waiver programs. Now over 20yrs after the Weston Lawsuit and 20yrs after the ADA and nearly 40yrs after IDEA we have a different expectation for services. 30yrs ago moving people from institutions and the State Training School to group homes in the community was best practice. The majority of people then had no education, no life skills and very little support. It's different now than it was 30yrs ago. Don't get me wrong there will always be a need for intensive comprehensive services for some people but the need for specialized individual services is best practices today. People need independent counsel when choosing services. They should receive services that maximize their autonomy and inclusion in community life. We need a specialized provider network that provides specific services extremely well instead of the current cumbersome large provider network we have now. These large provider network has been resistant to change and has fought it every step of the way. We have not been able to have a discussion based on the needs of the people because the needs of these big providers to feed an unsustainable antiquated service delivery model has been so strong.

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