UPDATED Thursday, December 29, 2011 --- 12:05 p.m.

MADISON, Wis. (AP) -- Federal officials ordered Gov. Scott Walker's administration to immediately lift an enrollment cap on a state program designed to keep the disabled and elderly out of nursing homes.

Walker held a news conference Wednesday to announce he wanted to lift the cap he imposed on Family Care in the state budget. But he made no mention of the Centers for Medicare and Medicaid Services' order. All he told reporters was that state health officials had identified $80 million in program efficiencies that would enable them to lift the cap.

But the CMS in a Dec. 13 letter ordered Walker's administration to lift the cap and immediately enroll anyone waiting to join Family Care.

Walker's spokesman said Thursday morning the governor had been planning to lift the cap for months.

Copyright 2011. The Associated Press.

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UPDATED Thursday, December 29, 2011 --- 6:05 a.m.

MADISON, Wis. (AP) -- Federal health officials have quietly ordered Gov. Scott Walker to lift an enrollment cap and expand state programs designed to keep elderly and disabled people out of nursing homes.

Walker made no mention of the order at a news conference he called Wednesday morning to announce he wants to lift the cap. He told reporters only that health officials in his administration have been talking with Family Care providers for months. Together, they have identified $80 million in efficiencies over the next two years that will enable his administration to end the enrollment cap and expand the programs to the 15 counties that currently don't offer them.

The move could open the door for thousands of people to join the programs -- but it also represents a stark reversal for Walker. The Republican governor has been pushing to rein in Medicaid costs for months and imposed the cap in Family Care enrollment in the state budget.

The Milwaukee Journal Sentinel reported hours after the announcement that the federal Centers for Medicaid and Medicare ordered him to lift the cap in a Dec. 13 letter. Before the newspaper reported the letter, state Department of Health Services Deputy Secretary Kitty Rhoades was vague and made no mention of the order when asked by The Associated Press whether the federal government had denied the state permission to impose the cap.

Messages left late Wednesday night with a state health department spokeswoman and with the U.S. Department of Health and Human Services were not immediately returned. Walker spokesman Cullen Werwie said he didn't have a copy of the letter.

Democrats pounced on the announcement earlier Wednesday, accusing Walker of trying to remake himself into a defender of health care access as efforts to recall him gather momentum.

"It's hypocrisy and grandstanding," state Democratic Party spokesman Graeme Zielinski said. "People know that his record is not somebody who is seeking to improve access to health care for working families."

The Family Care changes are subject to legislative approval. Walker's fellow Republicans control both the Senate and Assembly. Leaders in both houses were noncommittal, saying they want to review the proposal.

The plan rankled at least one powerful Republican legislator. Rep. Robin Vos, R-Rochester, co-chair of the Legislature's budget committee, issued a statement criticizing the expansion. He pointed to a state audit in April that found it was difficult to gauge how cost-effective Family Care has been.

"Expanding another unsustainable program is irresponsible," Vos said. "Perhaps before expanding, we should figure out how to make it work under sustainable parameters."

The committee's other co-chair, Sen. Alberta Darling, R-River Hills, said she was thrilled to hear the governor had found savings in Family Care and she expects lifting the cap will be a priority for the Legislature next year.

Werwie said in response to Vos' remarks Wednesday afternoon that the expansion is a sound financial move.

"Any claim that this was poorly planned or done rapidly simply doesn't reflect reality," Werwie said. "Careful considerations were taken into account ... and communicated in multiple venues over the course of the year."

Family Care programs provide long-term care for the disabled and elderly to help keep them out of nursing homes. The programs fall under the umbrella of Medicaid, the state-federal partnership that pays health costs for low-income people. Walker has been trying to curtail the state's Medicaid spending since he took office in January, saying exploding enrollment has made the programs too expensive.

In March, the state Department of Health Services froze enrollment in BadgerCare Plus Basic, which provides health insurance coverage for childless adults waiting to join the BadgerCare Plus Core program. And in November, his administration asked the federal government for permission to cut about $554 million from Medicaid, a move that could force as many as 65,000 poor adults and children off state health insurance. The CMS has given the state the preliminary go-ahead.

The two-year state budget Walker signed into law in June capped Family Care enrollment at July 1 levels, which translates to about 43,440 people. As of October, about 6,600 people were on a waiting list to join.

Walker explained his about-face at his news conference by saying the enrollment cap was always meant as a "time out" to reassess the programs, not a permanent freeze. Still, the governor offered no details on the efficiencies he said were driving his decision.

Rhoades said the details were still being fleshed out, but the biggest savings will be counseling potential participants about other, cheaper ways to solve their problems, such as installing handlebars in their bathtubs or having family members shovel their driveways, rather than enrolling in full-blown Family Care. Pressed by the AP about whether federal Medicaid officials had refused to allow the cap, Rhoades said the state and the federal governments are always negotiating over Medicaid programs. She said federal officials told the state it would need permission to make the cap permanent, but said that point was moot because Walker planned to lift the caps before the end of the year.

She made no mention of the Dec. 13 order. A CMS spokesman said in an email to the AP on Wednesday the agency was reviewing proposed unspecified changes to Family Care and he would have to find out more about the situation.

Democrats and their allies are pushing to recall Walker over his plan to strip most public workers of nearly all their union rights. Recall organizers announced on Dec. 15 they had gathered 507,533 of the 540,208 signatures they need by Jan. 17 to force an election.

Copyright 2011. The Associated Press.

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UPDATED Wednesday, December 28, 2011 --- 11:00 a.m.

MADISON, Wis. (AP) -- Gov. Scott Walker says he wants to lift the enrollment cap on state programs designed to keep people out of nursing homes and expand them throughout Wisconsin.

About 60 counties offer state Family Care programs, which provide long-term care options for the elderly and disabled to stay out of nursing homes.

Walker, a Republican, capped enrollment at about 43,000 people in the state budget that took effect July 1. Republicans contended during the budget debate that the program was growing too rapidly.

Now Walker says talks with Family Care providers have identified efficiencies that will generate $80 million more for Family Care, enabling him to lift the caps and expand programs to all 72 counties. The moves will require legislative approval.

Copyright 2011. The Associated Press.

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Posted Wednesday, December 28, 2011 --- 10:35 a.m.

Statement from the Governor's Office:

Madison–Earlier this year an enrollment cap was placed on Family Care in response to a Legislative Audit Bureau (LAB) evaluation which found a number of areas the program could be improved and made more efficient. After a briefing on the hard work done by DHS over the past couple of months, today Governor Walker announced a plan to lift the Family Care cap. Governor Walker’s plan also calls for Family Care to be expanded to additional counties.

“I am confident that Family Care can continue to be implemented efficiently and cost effectively,” said Governor Walker. “Lifting the cap will be done in a way that respects taxpayers and is mindful of their investment, while at the same time providing care for those who are truly in need.”

The 2011-2013 state budget and the Legislative Audit Bureau required the Department of Health Services to do a thorough review of the program given its rapid growth. The LAB report released in April 2011 offered recommendations for improving the program. A very critical issue raised in the report was that the cost effectiveness of Family Care was difficult to assess. Because the Department was able to take the time to strengthen the program, Wisconsin now has the detailed data needed to develop solutions to ensure Family Care is on sound financial footing for those in the program now and for future enrollees.

The Governor will continue to work with DHS to ensure that lifting the cap is done in a way that reestablishes the focus on helping seniors and individuals with disabilities live well in the community—using the right amount of care, in the appropriate setting, by the most cost-effective means possible.

The Governor’s plan to lift the Family Care enrollment cap calls for legislative action and DHS implementation by this spring.

Also at the announcement today to support the lifting of the enrollment cap was Lynn Breedlove from Disability Rights Wisconsin, Heather Bruemmer Executive Director of the Board on Aging and Long Term Care, Kim Marheine from the Board on Aging and Long Term Care, Beth Sweeden from the Board for Persons with Developmental Disabilities, Maureen Ryan with the Wisconsin Coalition of Independent Living Centers, Michael Blumenfeld representing several MCOs, Teri Buros from Southwest Wisconsin Family Center, State Senator Terry Moulton, and State Representative Dean Kaufert.

In addition to the Family Care announcement, DHS also stated they believe the federal government has met the statutory requirements necessary for an agreement related to the Medicaid waiver application. The state will continue to negotiate with the federal government on any remaining issues yet to be resolved.