Family Care History: Why People with Physical Disabilities Need
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 states
long-term care system. COP provides care in peoples 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?
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.
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.
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.
Barriers to work.
Many people with disabilities want to work, but find many barriers in the current system.
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
In the new system, funding is tied to individual
eligibility, not to target group proportions.
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 COPs), 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.
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.
1997 Spending (in millions)
$58 (40%) - nursing homes
$57 (39%) - MA fee-for-service non-inst.1
$31 (21%) - COP/Waivers/Comm. Aids2
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.
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
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 disabilities9
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 dont follow the person. COP funding is an
allocation to counties. Money doesnt follow the person and access varies from county
to county. A persons 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
April 23, 2014