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Family Care History: Why People with Physical Disabilities Need Family Care

COP is not the LTC system. The Community Options Program (COP) is one of the most effective and popular programs in Wisconsin, but it is only one small part of the state’s long-term care system. COP provides care in people’s own homes and other community settings, responding to the overwhelming preference of people with physical disabilities. And the average public cost for each person served in COP is 29% less than the average public cost of nursing home care ($60.64 vs. $85.85 average daily costs). So why would we want to do anything different with our long-term care policies?

Instead of separate nursing home and COP programs, Family Care will be one flexible benefit for all long-term care services. It will include COP, but will also cover nursing homes, other residential options, therapies and many other services and supports now available only under the Medicaid fee-for-service system.

COP is not an entitlement. Nursing home care is an entitlement for people who qualify, but COP is not. Chapter 51 of the statutes mandates counties to serve people with developmental disabilities, but it does not create an entitlement to services, and people with physical disabilities are not included at all.

Once Family Care is implemented within a county, each person who qualifies will be entitled to a tailor-made package of services designed to meet his or her unique needs and preferences. An entitlement means that if a person qualifies, he or she must be served.

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Current community system not adequate. Of total spending in 1997 for COP, all Waiver programs, Community Aids and county funds on long-term care services for Family Care services, only 9% was for adults with physical disabilities.

In the new system, funding is tied to individual eligibility, not to target group proportions.

Barriers to work. Many people with disabilities want to work, but find many barriers in the current system.

Many barriers to employment will be removed in the new system. Eligibility and cost sharing for Family Care will be on a sliding scale (like COP’s), but will include generous allowances for earned income and savings generated from it. Family Care will provide flexible COP supports in the home and workplace that will make employment a real possibility. Pathways to Independence and the Medicaid Purchase Plan will allow people with severe disabilities to work and still have access to needed health and long-term support coverage by buying into Medicaid through reasonable premiums.

In 1997, after 15 years of COP being in place, only 21% of public long-term care spending for people with physical disabilities is for COP, Waivers and other flexible community programs. Forty percent of spending is still in institutions. Another 39% is in other Medicaid card services.

1997 Spending (in millions)
  $58 (40%) - nursing homes
  $57 (39%) - MA fee-for-service non-inst.1
  $31 (21%) - COP/Waivers/Comm. Aids2
$146 total

In the new system, community care and nursing home care will be on an equal footing. People will have real choices about where and how they get needed care.

Pie Chart: Spending

1 Includes Medicaid fee-for-service spending for all non-institutional services that will be in Family Care benefit for persons with physical disabilities under age 65.
2 Includes services for persons with physical disabilities under age 65 funded by the Community Options Program, Medicaid home and community waivers, Community Aids, and county funds.

Waiting lists are long. As of December 1998, almost as many people (2,069) with physical disabilities were on COP waiting lists as were enrolled in COP (2,769). The total waiting list for COP was 10,879. Because caseloads are stable, waiting times are particularly long for people with physical disabilities—9 years or more in some counties.

When a person is found entitled to Family Care, based on functional and financial criteria, funding will be provided to the local care management organization in which he or she enrolls. Unlike the current system, there is not a fixed allocation, with people waiting for a share of available funds.

Medicaid fee-for-service supports too cumbersome. Personal care, home health and therapy services under Medicaid are hard to manage. The state sets rates, prior-authorizes services and prescribes what specific kinds of services may be provided in each category.

For those who enroll in Family Care, control over Medicaid services like personal care will be moved closer to the consumer. Local agencies will authorize services as part of an overall package of supports for each individual. Opportunities for self-directed care will be available to all enrollees. The current Medicaid fee-for-service system will remain in place; people who prefer it will still be able to get personal care and other Medicaid card services without joining Family Care.

COP funds don’t follow the person. COP funding is an allocation to counties. Money doesn’t follow the person and access varies from county to county. A person’s ability to move from one county to another is limited. If the person is receiving services, they are likely to be lost when the person moves. If on a waiting list, he or she would likely have to start all over at the bottom of the list in the new county of residence.

Family Care money follows the person across setting, time and county lines.

Last Revised:  April 23, 2014