When a person decides to enroll in Family Care, they become a member of a managed care organization (MCO). MCOs operate the Family Care program and provide or coordinate services in the Family Care benefit. The Family Care benefit 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.
View a list of items covered in the Family Care benefit package.
In order to assure access to services, MCOs develop and manage a comprehensive network of long-term care services and support, either through purchase of service 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 per person per month payment to manage 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 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 Disabilities.
- 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 home care.
- 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 MCOs, refer to the description of the long-term care benefit package in the Health and Community Supports Contract.
MCO Enrollment by Target Group – Refer to the monthly snapshot of MCO enrollment data for current information.