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An Overview of Wisconsin's Family Care Program
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In the mid-1990s, a broad consensus developed on the need to redesign
Wisconsin’s long-term care system, prompted by concerns with the cost
and complexity of the long-term care system, inequities in availability,
and by projections of an aging population’s growing demand for long-term
care. Over the next few years, consumers, advocates, providers, state and
local officials, and others collaborated to design a new approach to the
provision of long-term care in Wisconsin. This new approach, named
"Family Care," was designed to provide cost-effective,
comprehensive and flexible long-term care that will foster consumers’
independence and quality of life, while recognizing the need for
interdependence and support. Family Care was partially based on experience
in developing the Wisconsin
Partnership Program, which integrates all health and long-term care
services into one inclusive benefit.
Family Care, authorized
by the Governor and Legislature in 1998, serves people with
physical disabilities, people with developmental disabilities and frail
elders, with the specific goals of:
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What is Family Care?
Who does Family Care
serve?
Aging and Disability
Resource Centers
Care Management
Organizations
Where in Wisconsin
can you find Family
Care?
How do you apply?
Real life stories
Why Family Care?
Being a Full Partner
in Family Care
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Giving people better choices about where they live and
what kinds of services and supports they get to meet their needs.
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Improving access to services.
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Improving quality through a focus on health and social
outcomes.
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Creating a cost-effective
system for the future.
Family Care has two major organizational components:
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Aging and disability resource centers (ADRCs), designed to be
a single entry point where older people and people with
disabilities and their families can get information and advice about a
wide range of resources available to them in their local communities.
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Managed care organizations (MCOs), which manage and
deliver the new Family Care benefit, which combines funding and
services from a variety of existing programs into one flexible
long-term care benefit, tailored to each individual’s needs,
circumstances and preferences.
Family Care ADRCs and MCOs are located in the following
counties (Map):
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Chippewa
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Columbia
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Dodge
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Dunn
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Fond du Lac
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Green Lake
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Jefferson
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Kenosha
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La Crosse
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Marquette
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Milwaukee (serves the elderly population only)
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Ozaukee
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Pierce
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Portage
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Racine
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Richland
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Sauk
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Sheboygan
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St. Croix
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Washington
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Waukesha
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Waushara
In
addition, several other counties provide resource-center only
services. ADRC map (PDF,
43 KB).
Using the resource center model developed by Family Care,
Wisconsin is moving to create additional aging and disability resource
centers accessible to everyone in the state. For more information about
Wisconsin's initiative to expand aging and disability resource centers,
e-mail Janice Smith at Janice.Smith@dhfs.wisconsin.gov.
Overview of Aging and Disability Resource Centers
Aging and disability resource centers (ADRCs) offer the general public
a single entry point for information and assistance on issues affecting
older people, people with disabilities, or their families. These centers
are welcoming and convenient places to get information, advice and access
to a wide variety of services. As a clearinghouse of information about
long-term care, they will also be available to physicians, hospital
discharge planners, or other professionals who work with older people or
people with disabilities. Services will be provided through the telephone
or in visits to an individual’s home. Detailed descriptions of the
services the resource centers provide are contained in the ADRC
Contract and Exhibits. A more general description of the
services they provide follows:
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Information and Assistance. Provide information
to the general public about services, resources and programs in areas
such as: disability and long-term care related services and living
arrangements, health and behavioral health, adult protective services,
employment and training for people with disabilities, home
maintenance, nutrition and Family Care. Resource center staff will
provide help to connect people with those services and to also apply
for SSI, Food Stamps and Medicaid as needed.
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Long-Term Care Options Counseling. Offer
consultation and advice about the options available to meet an
individual’s long-term care needs. This consultation will include
discussion of the factors to consider when making long-term care
decisions. Resource centers will offer pre-admission consultation to
all individuals with long-term care needs entering nursing facilities,
community-based residential facilities, adult family homes and
residential care apartment complexes to provide objective information
about the cost-effective options available to them. This service is
also available to other people with long-term care needs who request
it.
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Benefits Counseling. Provide accurate and
current information on private and government benefits and programs.
This includes assisting individuals when they run into problems with
Medicare, Social Security, or other benefits.
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Emergency Response. The resource center will
assure that people are connected with someone who will respond to
urgent situations that might put someone at risk, such as a sudden
loss of a caregiver.
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Prevention and Early Intervention. Promote
effective prevention efforts to keep people healthy and independent.
In collaboration with public and private health and social service
partners in the community, the resource center will offer both
information and intervention activities that focus on reducing the
risk of disabilities. This may include a program to review medications
or nutrition, home safety review to prevent falls, or appropriate
fitness programs for older people or people with disabilities.
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Access to the Family Care Benefit. For people
who request it, resource centers will administer the Long-Term Care
Functional Screen to assess the individual’s level of need for
services and eligibility for the Family Care benefit. Once the
individual’s level of need is determined, the resource center will
provide advice about the options available to him or her – to
enroll in Family Care or a different case management system, if
available, to stay in the Medicaid fee-for-service system (if
eligible), or to privately pay for services. If the individual chooses
Family Care, the resource center will enroll that person in a MCO. The
level of need determined by the Long-Term Care Functional Screen also
triggers the monthly payment amount to the MCO for that person.
Findings from the Aging and Disability Resource Centers:
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During calendar year 2004, resource centers handled
nearly 66,500 contacts. The number of contacts is only an
approximation of the number of individuals who received information
and assistance from the resource centers; one person may have made
more than one contact during this period, while other single contacts
assisted more than one person. A contact is defined as an exchange
between a person seeking assistance or information and a resource
center staff person trained to provide that assistance.
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People calling on their own behalf as well as staff
from long-term care facilities and community agencies are the most
frequent callers, followed by friends and relatives.
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People most often call the resource center seeking
information and assistance related to basic needs and financial
related services such as health insurance, money problems, or paying
for food and utilities. However, people have called their resource
center about a wide variety of topics from in-home care to hospice
services, from legal issues to Alzheimer's care, from job help to
education.
Overview of Managed Care Organizations (MCOs) and the
Flexible Family Care
Benefit
Family Care improves the cost-effective coordination of long-term care
services by creating a single flexible benefit that includes a large
number of health and long-term care services that otherwise would be
available through separate programs. A member of a MCO has access to a
large number of specific health services offered by Medicaid, as well as
the long-term care services in the Home and Community-Based Waivers and
the very flexible state-funded Community Options Program. In order to assure access to
services, MCOs develop and manage a comprehensive network of long-term
care services and support, either through contracts with providers, or by
direct service provision by MCO employees. MCOs are responsible for
assuring and continually improving the quality of care and services
consumers receive. MCOs receive a monthly per person payment to manage and
purchase care for their members, who may be living in their own homes,
group living situations, or nursing facilities. Some highlights of the
Family Care benefit package are:
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People Receive Services Where They Live. MCO members receive Family Care services where they live, which may be in
their own home or supported apartment, or in alternative residential
settings such as Residential Care Apartment Complexes, Community-Based
Residential Facilities, Adult Family Homes, Nursing Homes, or
Intermediate Care Facilities for people with developmental
disabilities.
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People Receive Interdisciplinary Case Management.
Each member has support from an interdisciplinary team that consists
of, at a minimum, a social worker/care manager and a Registered Nurse.
Other professionals, as appropriate, also participate as members of
the interdisciplinary team. The interdisciplinary team conducts a
comprehensive assessment of the member’s needs, abilities,
preferences and values with the consumer and his or her
representative, if any. The assessment looks at areas such as:
activities of daily living, physical health, nutrition, autonomy and
self-determination, communication, and mental health and cognition.
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People Participate in Determining the Services They Receive.
Members or their authorized representatives take an active role with
the interdisciplinary team in developing their care plans. MCOs
provide support and information to assure members are making informed
decisions about their needs and the services they receive. Members may
also participate in the Self-Directed Supports component of Family
Care, in which they have increased control over their long-term care
budgets and providers.
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People Receive Family Care Services that Include:
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Long-Term Care Services that have
traditionally been part of the Medicaid Waiver programs or the
Community Options Program. These include services such as adult
day care, home modifications, home delivered meals and supportive
home care.
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Health Care Services that help people
achieve their long-term care outcomes. These services include home
health, skilled nursing, mental health services, and occupational,
physical and speech therapy. For Medicaid recipients, health care
services not included in Family Care are available through the
Medicaid fee-for-service program.
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People Receive Help Coordinating Their Primary Health Care.
In addition to assuring that people get the health and long-term
care services in the Family Care benefit package, the MCO interdisciplinary teams also help members coordinate all their
health care, including, if needed, helping members get to and
communicate with their physicians and helping them manage their
treatments and medications.
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People Receive Services to Help Achieve Their Employment
Objectives. Services such as daily living skills training, day
treatment, pre-vocational services and supported employment are
included in the Family Care benefit package. Other Family Care
services such as transportation and personal care also help people
meet their employment goals.
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People Receive the Services that Best Achieve Their Outcomes.
The MCO is not restricted to providing only the specific services
listed in the Family Care benefit package. The MCO interdisciplinary care management team and the member may decide
that other services, treatments or supports are more likely to
help the member achieve his or her outcomes, and the MCO would
then authorize those services in the member’s care plan.
For a complete list of the services that must be offered by
MCOs, refer
to the description of the long-term care benefit package in the Health
and Community Supports Contract.
MCO
Enrollment by Target Group
Refer to the monthly
snapshot of MCO enrollment data by target group for current
information.
Quality and Cost-Effectiveness of MCO Services
An independent
assessment (completed in late 2005) found that Family Care produced
substantial savings for Wisconsin's Medicaid program. The study
compared Medicaid-funded long-term care costs in 2003 and 2004 for
people in Family Care to costs for similar people who received
long-term care in other programs. Average monthly costs for the Family
Care members were $452 lower per person. Spending was $55 lower per
person for Milwaukee County.
Analyses of the reasons for the cost savings found that, among
other reasons, Family Care favorably affects its members' health and
abilities to function, so that over time they have less need for
services than their counterparts in the comparison group. While Family
Care members had more frequent physician office visits for primary
care, expenditures for non-primary care office visits decreased among
Family Care members. It appears that more-frequent primary care
physician visits provide opportunities to increase prevention and
early intervention health care services, which in turn reduce the need
for more acute and costly services among members of Family Care.
Implementing Statewide Reform
In his February 2006 State of the State speech, Governor Doyle
announced plans to expand Family Care statewide and eliminate waiting
lists for community-based long-term care programs during the next five
years. While Wisconsin has been a national leader in offering
community-based alternatives to nursing home care, about 11,500 people
are on waitlists for community care statewide.
Starting January 2007, the Family Care program expanded to Kenosha
and Racine Counties as the first step in this statewide expansion. (The
Partnership Program is also available in both of these
counties.) Family Care continues to expand in 2008 -- Fifteen counties
began offering Family Care this year, and approximately five more
counties anticipate starting by the end of 2008. Anticipated
implementation of Family Care, by county (PDF,
16 KB).
For more information about expanding Family Care statewide, refer
to the Managed
Long-Term Care Expansion website.
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Last Revised: September 08, 2008 |
