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Key Consumer Features of Family Care

Eligibility:

  • Anyone can receive an eligibility screen, advice, information and referral services from an Aging and Disability Resource Center.
  • Individuals must meet both financial and functional eligibility tests to receive LTC services through Family Care.
    • Who is financially eligible for services? – any person who:
      • Is financially eligible for Medical Assistance, or
      • Needs LTC services that cost more than the income and assets available to them (after certain deductions and allowances), or
      • People with too much income and assets to be eligible for public subsidy can pay for their own services and buy case management, service coordination and provider oversight from the CMO
    • Who is functionally eligible for services? – any person who:
      • Is either over age 65, or over age 18 and has a physical or developmental disability, and
      • Has a condition expected to last at least 90 days or result in death within a year, and
      • Needs assistance at:
        • The Comprehensive Level – requires ongoing care, assistance or supervision, or
        • The Intermediate Level – is at risk of losing independence or functional capacity unless he or she receives assistance from others
      • In the immediate future, the new Family Care benefit is available only to people who live in one of the counties that is piloting the new program.

Guaranteed Access to Services:

  • Individuals eligible at the Comprehensive Level are guaranteed services.
  • Individuals eligible at the Intermediate Level are guaranteed services if they are Medicaid-eligible or if they need adult protective services.
  • There may be a waiting list for other individuals eligible at the intermediate level if there is not sufficient funding available for everyone eligible at that level.

Funding for Services Follows the Person:

  • Services are available regardless of the setting the person chooses:
    • Community Options – home or apartment, owned or rented by the enrollee or a relative / friend of the enrollee with services provided or contracted by the CMO brought in
    • Residential Options – Adult Family Home, Community Based Residential Facility (CBRF) or Assisted Living (RCAC) provided or contracted by the CMO
    • Institutional Options – Nursing facility (including Intermediate Care Facilities for the Mentally Retarded) provided or contracted by the CMO

More Choices:

  • Everyone:
    • Receives information about the service system so they can make informed choices; special efforts are made to discover the choices of people with cognitive impairment
    • If eligible, chooses whether to enroll in a CMO or to receive traditional Medicaid services
  • People who enroll in a CMO:
    • Will have funding for services available in all living arrangements – home, residential facility or nursing home
    • Can choose from among available services to help design their own care plan
    • Can  choose from among providers, even outside the CMO network for intimate care
    • Can choose to manage and control their own service and will be supported to do so
    • Can choose to work without ending up with less income or losing access to services

Last Revised:  July 12, 2010