The Governor has proposed terminating the IRIS long term care option for the elderly and people with disabilities. The IRIS program is an important alternative to managed long term care in Family Care as it allows people to manage their own budgets and self-direct their long term supports. IRIS works effectively for more than 11,000 people. If IRIS is eliminated in the budget, people currently enrolled in the program would be required to join a managed care organization in Family Care. The Governor is also proposing major changes to the Family Care program that may reduce the number of managed care organizations operating in the state and open the door to large, for-profit, managed care/insurance companies. (Existing regional long-term care districts are eliminated in this budget and DHS will now solicit statewide managed care proposals that will have additional oversight by the Office of the Commissioner of Insurance.) Like other states that have adopted this service delivery, the Family Care long-term care program would begin to operate more like a medical model in an insurance program. DRW believes these changes will decrease choice and competition in long term care and have the potential to severely limit community integration. DHS may also include primary and acute medical services in the long term care program. This may restrict people’s choice of physicians and other health professionals, in some cases forcing people to change doctors if they want to receive any long term care services. The budget proposal does not demonstrate any significant cost savings from this major overhaul of Wisconsin’s long-term care system that is being proposed without input from anyone receiving or delivering long-term care.