The Passing of Dane County Supports for People With Developmental Disabilities Into Managed Care
Accounts of organizational change are more often written from the perspective of those initiating change than from the point of view of those who are the objects being changed by those with greater power. This paper reflects the perceptions and actions of local leaders –people with DD, families, advocates, agency managers, and county administrators– who felt a moral obligation to conserve capacities they value as a process implemented by State Department of Health Services (DHS) officials replaced local government leadership with Family Care (managed long term care) operated by contracted agents of Wisconsin’s State Medicaid agency. This story of change identifies differences in mindset and practice between State officials responsible for long term care administration and local people who, as they see it, have created an effective community response to people with DD. It identifies potential costs of centrally imposed change as local people identified them at the time of transition. Local leaders’ perception of the risks of managed care frames a description of the relationships and structures that shaped a comprehensive local system capable of delivering many of the results that DHS and the Federal Center for Medicare and Medicaid Services (CMS) policy values.