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 Partnership Program, which integrates all health and long-term care
services into one inclusive benefit. (Description of key
differences between Family Care and Family Care Partnership.)
Family Care, authorized
by the Governor and Legislature in 1998, serves people with
physical disabilities, people with intellectual/developmental disabilities and frail
elders, with the specific goals of:
What is Family Care?
Who does Family Care
Aging and Disability
Where in Wisconsin
can you find Family
How do you apply?
Why Family Care?
Being a Full Partner
in Family Care
Giving people better choices about where they live and
what kinds of services and supports they get to meet their needs.
Improving access to services.
Improving quality through a focus on health and social
Creating a cost-effective
system for the future.
Family Care has two major organizational components:
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. For more information about aging and disability resource centers,
visit the ADRC
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.
As of July 1, 2013, Family Care was available in 57 counties in Wisconsin (Map).
Overview of Managed Care Organizations (MCOs) and the
Flexible Family Care
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:
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 Individuals with Intellectual
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.
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.
People Receive Family Care Services that Include:
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
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.
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.
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.
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
to the description of the long-term care benefit package in the Health
and Community Supports Contract.
Enrollment by Target Group
Refer to the monthly
snapshot of MCO enrollment data by target group for current
Quality and Cost-Effectiveness of MCO Services
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.
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January 30, 2014