Program Expansions

Family Care and Family Care Partnership will be expanding to additional counties in 2008. Family Care will expand to Sheboygan County on February 1, 2008, and to Columbia and Ozaukee Counties on March 1, 2008. Family Care Partnership, formerly Wisconsin Partnership Program, will expand to Columbia County on March 1, 2008.

Family Care and Family Care Partnership expansion dates for 2008 in other counties will be detailed in future BadgerCare Plus Updates.

BadgerCare Plus Benchmark Plan members are not eligible to be enrolled in Family Care or Family Care Partnership.

Program Information and Covered Services

Family Care and Family Care Partnership are Wisconsin’s flexible health and long term care programs. Both programs are voluntary and offer increased consumer choice, improved access to services, and improved quality through a focus on health and social outcomes.

Individuals must qualify for Medicaid or BadgerCare Plus Standard Plan in order to enroll in Family Care or Family Care Partnership. The following individuals with long term care needs may be eligible to enroll:

• Elderly persons.
• Individuals with physical disabilities, age 18 to 64.
• Individuals with developmental disabilities, age 18 to 64.
• Individuals eligible under the Long Term Functional Screen as outlined in this Update.

Refer to Attachment 1 of this Update for a list of services that are included and not included in each benefit package and to Attachment 2 for home and community-based waiver services included in Family Care and Family Care Partnership.

Family Care

Family Care includes long term care services provided under the home and community-based waiver and the Standard Plan. In general, long term care services such as home health services are included in the Family Care benefit package.

Acute and primary care services are reimbursed by fee-for-service for members who are enrolled in Medicaid or the Standard Plan.

For more information about Family Care, refer to the Family Care Guide on the Wisconsin Medicaid Web site at dhs.wisconsin.gov/medicaid/ or the Family Care Web site at dhs.wisconsin.gov/medicaid4/familycare.htm. Further information on statewide Family Care program expansion may be obtained at dhs.wisconsin.gov/managedltc/.

Family Care Partnership

Formerly known as Wisconsin Partnership Program, Family Care Partnership integrates health and long term support services. Family Care Partnership is a Medicare advantage special needs plan and a Medicare Part D plan. The Family Care Partnership benefit package includes all Medicare and Medicaid home and community-based waiver services, including prescription drugs.

Acute and primary care services such as physician services, hospital services, and prescription medications, are part of the Family Care Partnership benefit plan.

For more information about Family Care Partnership, refer to the Family Care Partnership Web site at dhs.wisconsin.gov/WIpartnership/.

Managed Care Organizations

The Department of Health and Family Services contracts with managed care organizations (MCOs) to provide or manage Family Care and Family Care Partnership services. In turn, each MCO develops a network of providers under contract with or employed by the MCO to provide and manage care for its members.

The primary functions of a MCO include the following:

• Deliver health and long term services, either by contracting for services or directly providing them.
• Ensure and continually improve the quality of services.
• Involve the member (and the member’s family or representative) in decision making.

Refer to Attachment 3 for designated MCOs for Sheboygan, Columbia, and Ozaukee Counties, contact information, and anticipated expansion dates.

Enrollment Verification

Individuals must qualify for Medicaid or the Standard Plan in order to enroll in Family Care or Family Care Partnership. Members may voluntarily enroll in or disenroll from a MCO at any time during the month. Providers are encouraged to verify a member’s enrollment before providing services. Refer to the Member Information chapter of the Family Care Guide at dhs.wisconsin.gov/medicaid/ for more information on program eligibility and enrollment.

The Role of Aging and Disability Resource Centers

Local Aging and Disability Resource Centers are a "one-stop shop" for long term care information. Resource Center services are not limited to Medicaid and Standard Plan-eligible individuals; anyone may receive services from the Resource Centers. The primary functions of the Resource Centers include the following:

• Provide reliable and objective information about a broad range of programs and services.
• Offer counseling on all available options for meeting long term care needs.
• Assist individuals applying for government program benefits, including Medicaid.
• Provide benefits counseling for public long term care programs.
• Provide a connection to prevention and early intervention activities to help people maintain their independence.
• Offer pre-admission consultations with information and counseling to individuals before they enter a nursing home or assisted living facility.
• Determine functional eligibility for Family Care and Family Care Partnership. (After the Resource Center has administered a Long Term Care Functional Screen to determine functional eligibility criteria, the county income maintenance unit determines financial eligibility for Family Care or Family Care Partnership).
• Provide enrollment counseling to help individuals through the process of enrolling in Family Care or Family Care Partnership.

Resource Centers offering services for Columbia, Ozaukee, and Sheboygan counties may be contacted via the following:

• Columbia County Aging and Disability Resource Center by calling (608) 742-9233.
• Columbia County Aging and Disability Resource Center Web site at www.co.columbia.wi.us/ColumbiaCounty/hhs/DepartmentServices/
  AgingandDisabilityResourceCenter/tabid/1085/ Default.aspx/.
• Ozaukee County Aging and Disability Resource Center by calling (262) 284-8120.
• Ozaukee County Aging and Disability Resource Center Web site at www.co.ozaukee.wi.us/aging/index.htm.
• Sheboygan County Aging and Disability Resource Center by calling (800) 596-1919, ext. 3095 (toll free) or (920) 459-3095.
• Sheboygan County Aging and Disability Resource Center Web site at www.co.sheboygan.wi.us/html/ d_hhs_AgeDisResc_Cntr.html.

Attachment 1 — Services Included and Not Included in Family Care and Family Care Partnership Benefit Packages
Attachment 2 — Home and Community-Based Waiver Services Included in Family Care and Family Care Partnership
Attachment 3 — Family Care and Family Care Partnership Expansion Schedule and Contact Information