A coming change to a Wisconsin long-term care program is raising concerns among enrolled people with disabilities, who worry it will make it harder to hire and pay their care workers.
The state is switching to a single company to help people in the IRIS program process payroll and conduct background checks on their caregivers. Adults enrolled in IRIS hire their own care workers and rely on them for basic needs, such as showering and getting out of bed. That help allows them to stay in their own homes and out of more expensive nursing homes or institutions that isolate people with disabilities.
The switch to a single company, called a fiscal agent, has raised concerns that people enrolled in IRIS may go weeks or months without care workers if payment delays cause existing workers to quit or if lagging background checks stymie new hires. Already under the current system, with three fiscal agents, people in IRIS report delays in processing background checks and paying workers.
“My concern is those delays will be compounded when we only have one entity providing the service,” said Jason Glozier, executive director of the Wisconsin Coalition of Independent Living Centers.
Even more troubling, Glozier and other advocates say, is the company selected as the new IRIS fiscal agent.
Late last month, the state announced plans to award a multi-year contract to Public Partnerships LLC, a New York-based company that has come under fire in New York and other states over missing or late payments, technical glitches and unresponsive customer service, leading to lawsuits. The company does not have a presence in Wisconsin.
“As we outsource these services, we get further and further away from real accountability when issues arise,” Glozier said.
Losing bidders all file protests of Public Partnerships’ selection
Public Partnerships, which works with people with disabilities in 20 states, scored the highest of any bidder under the state’s competitive bidding process.
The three other bidders all have submitted formal protests of Public Partnerships’ selection, a state purchasing agent confirmed, alleging failures in the bidding and evaluation process. One is Milwaukee-based iLIFE Financial Management Services, which has been a fiscal agent for the IRIS program since the beginning. The others are GT Independence, another IRIS fiscal agent, and Palco, Inc., which works with Wisconsin adults with disabilities in an alternative program to IRIS.
Officials with the Wisconsin Department of Health Services, which oversees the IRIS program, declined to give an interview, saying it would be premature before the award is final. A DHS spokesperson said the department works closely with contractors to ensure programs run effectively, and failures may result in sanctions.
State officials said the move to a single fiscal agent will streamline processes for IRIS members and care providers, with uniform timesheets and hiring paperwork. Officials also predict better customer service, with faster response times, and more direct oversight of the fiscal agent.
Public Partnerships declined to discuss specifics about the Wisconsin contract, but said its involvement in a New York program was the “largest Medicaid transition in the nation’s history.”
“We have processed more than $2.8 billion in payroll for over 240,000 personal assistants while modernizing oversight and strengthening program integrity,” the company said in a statement.
Members worried about lack of choice, payment lapses
People involved with IRIS from the beginning recall long payment delays when, at its inception, the program had only one fiscal agent.
“It was just a total mess,” said Jason Endres, who is enrolled in IRIS. “We’re going back to the original IRIS program where you didn’t get paid.”
Those payment lapses can be insupportable for care workers who, on average, make less than $17 an hour and may live paycheck to paycheck. Endres reported losing “countless” care workers because of issues getting them paid or lags in processing new hires’ background checks.
Without those workers, people with disabilities might go without needed care, potentially resulting in skipped meals, missed showers, bed sores or other health issues.
Members also worry about growing restrictions on choice, when the IRIS program was meant to provide more autonomy and control to people with disabilities. IRIS members will no longer have the option of switching companies if they run into payment issues.
“They’re going backwards. They’re taking the choices away from us,” said Julie Endres, Jason’s wife who also is an IRIS member.
The IRIS program, which stands for “Include, Respect, I Self-Direct,” began in Wisconsin in 2008. It is funded by state and federal Medicaid dollars and provides long-term care to adults with physical or developmental disabilities and older people who struggle with everyday tasks like going to the bathroom and dressing. Unlike other long-term care programs, IRIS was designed to give its members more decision-making and control over their long-term care budgets, which pay for everything from caregivers and adult day care to transportation and home modifications.
With enrollment near 29,000 people, the program costs more than $1 billion in state and federal funds to run each year.
Low satisfaction with fiscal agents a ‘perennial concern’
The state has struggled for years with low satisfaction with IRIS fiscal agents. Since the beginning, IRIS members have complained about payment delays and inaccuracies resulting in lapses in care and long wait times for customer service. A report stemming from a 2023 summit on IRIS described the fiscal agents as a “perennial concern” and their performance as “one of the weakest parts of the IRIS program.”
Currently, iLIFE is the largest of the fiscal agents for IRIS, with more than 15,000 clients. In 2024, state regulators issued sanctions and put iLIFE on a plan to correct a “significant” payroll issue, according to minutes from an IRIS Advisory Committee meeting. For a time, the company was not allowed to take on new clients.
The contract with the new fiscal agent is set to begin April 1 and will be for a five-year period, followed by the option of five one-year renewals, according to procurement records.
The state will begin moving IRIS members to the new fiscal agent in 2027, in phases.
Some advocates are skeptical a smooth transition will occur and wonder if a single company will be able to gear up to serve the nearly 29,000 IRIS members and counting.
“There is going to be potential for all kinds of havoc, changing all these people over,” said Julie Burish, vice president of InControl Wisconsin, a group that advocates for people with disabilities.
Cindy Pichler, with the Milwaukee-based nonprofit Independence First, worries about further delays in paying contractors who install wheelchair ramps and other home modifications for IRIS members.
Over the years, the number of contractors willing to work with IRIS members for home modifications in the Milwaukee area has dwindled, Pichler said, primarily because of missed payments by fiscal agents.
“We’ve lost some really good contractors,” said Pichler, a senior assistive technology specialist at Independence First. “It’s just been a gradual erosion of resources related to nonpayment.”
Adding to concerns is Public Partnerships’ reputation.
Public Partnerships faces a federal lawsuit over unpaid overtime in Pennsylvania, a case now before an appeals court. In New York, another case filed by care workers alleges wage theft and blames technical glitches and other issues for making it difficult for workers to report hours and get them approved.
Last year, New York lawmakers clashed with a Public Partnerships official in a hearing over a troubled transition to the company in one of the state’s Medicaid long-term care programs. Workers reiterated complaints of missed paychecks and patients of missed care.
Unlike Wisconsin, New York was switching to Public Partnerships from a system of hundreds of fiscal intermediaries – not a mere few – over a short period of time.
Public Partnerships also has drawn scrutiny over its ties to private equity. In 2022, Axios reported that DW Healthcare and Linden Capital Partners, both private equity firms, had made investments in Public Partnerships. Its CEO is now a Linden operating partner and its chief strategy officer is a principal at DW Healthcare.
“Anytime there’s one entity controlling all of the resources, it starts to raise a concern because there’s no way to hold folks accountable,” Glozier said.
Reporter Sarah Volpenhein can be reached at svolpenhei@usatodayco.com or at 414-607-2159.
This article originally appeared on Milwaukee Journal Sentinel: Wisconsin’s IRIS program changes contractor. Will care workers face payment delays?
Reporting by Sarah Volpenhein, Milwaukee Journal Sentinel / Milwaukee Journal Sentinel
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