Background Information and General Questions
What is changing?
Based on the results of a recent competitive process, Inclusa and Lakeland Care managed care organizations (MCOs) were selected to provide the Family Care program in Brown, Door, Kewaunee, Marinette, Menominee, Oconto, and Shawano counties beginning January 1, 2020.
Care Wisconsin will continue to provide services in these counties through the end of the year.
|MCOs providing services through December 31, 2019||MCOs providing services starting January 1, 2020|
|Lakeland Care||Lakeland Care|
What do I need to do?
Care Wisconsin will no longer provide Family Care services in Brown, Door, Kewaunee, Marinette, Menominee, Oconto, and Shawano counties.
If you are currently a Care Wisconsin member in one of those counties, you will need to make a decision about your future services.
In the months leading up to the January 2020 transition, Care Wisconsin Family Care members will need to meet with an aging and disability resource center (ADRC) or a Tribal Aging and Disability Resource Specialist (ADRS) to make a decision about their future services. Your options to continue your services include:
- Selecting Inclusa to provide your services and supports
- Selecting Lakeland Care to provide your services and supports
- Enrolling in the IRIS (Include, Respect, I Self-Direct) program (if determined eligible)
Your local ADRC or Tribal ADRS will contact you between August and December 15, 2019, to schedule a time to discuss your options. Please respond to any outreach by your local ADRC or Tribal ADRS.
Why is Care Wisconsin changing?
Due to the results of a recent competitive process, DHS is ending its contract with Care Wisconsin at the end of the year in Brown, Door, Kewaunee, Marinette, Menominee, Oconto, and Shawano counties.
Every six years, DHS completes a process to select MCOs to operate the Family Care program in each region in Wisconsin. In order for MCOs to offer Family Care in a region, they must submit a proposal to DHS. This process in competitive, and even current MCOs must score high enough on the proposal to continue in the region.
DHS will contract with Inclusa and Lakeland Care to provide Family Care services in these areas beginning January 1, 2020. Care Wisconsin will continue to operate Family Care in other areas of the state.
When is this program option changing?
Starting January 1, 2020, Inclusa will begin to offer Family Care in Brown, Door, Kewaunee, Marinette, Menominee, Oconto, and Shawano counties. Lakeland Care will continue to provide Family Care services in these areas, and the IRIS program will continue to be available as well through Advocates4U, Connections, and TMG.
If you currently receive long-term care services through Care Wisconsin, you will need to decide either to stay enrolled in Family Care or to participate in IRIS.
If you want to stay with the Family Care program, you will need to pick Inclusa or Lakeland Care to provide your services.
- If you select Inclusa, you will stay with Care Wisconsin through December 31, 2019.
- If you select Lakeland Care, you may choose any date prior to January 1, 2020, to enroll.
If you want to participate in IRIS, you will need to complete your service plan prior to enrollment. It usually takes about 45 days to complete a plan, so it is best to reach out to the ADRC if you would like to participate in IRIS. For example, for a January 1, 2020, IRIS start date, your service plan must be finished and approved by your IRIS consultant no later than December 16, 2019. This would allow you time to complete your plan and onboard your service providers before you move to IRIS.
What will happen to my current program?
Care Wisconsin will no longer provide Family Care in Brown, Door, Kewaunee, Marinette, Menominee, Oconto, and Shawano counties, or to the Menominee, Oneida, and Stockbridge-Munsee Tribes on January 1, 2020.
Care Wisconsin will continue to provide the Family Care program until midnight December 31, 2019. Current Care Wisconsin members will need to transfer to a new program by the end of the year.
As a Care Wisconsin member, I understand my current long-term care program choice will be ending. What choices will I have about continuing to get long-term care services?
You will have a choice of enrolling in Inclusa or Lakeland Care to receive your Family Care services or you can choose to enroll in the IRIS program (if determined eligible for IRIS). This change does not impact your eligibility for services.
Who will provide my Family Care services?
Inclusa and Lakeland Care will offer the Family Care program in Brown, Door, Kewaunee, Marinette, Menominee, Oconto, and Shawano counties.
Will I lose the services that I am getting now if I select another Family Care option?
This change does not impact your right to receive long-term care services or your eligibility for services. If you choose Family Care, the same service providers and services will initially continue as you transition into the new MCO. The new MCO will then work with you to develop a care plan and arrange for service providers. As the new care plan is implemented, it may mean a change in services and/or providers.
Will I lose the services I am getting now if I select IRIS?
It depends. IRIS does not cover all of the same services that Family Care offers. For example, IRIS doesn't cover nursing home services or community-based residential facilities. In addition, IRIS works differently from Family Care.
If you enroll in IRIS, you will be responsible for coordinating your home and community-based services waiver plan, which includes hiring, scheduling, and budgeting for your service providers. You will work with an IRIS consultant agency and fiscal employer agent to meet program requirements and to assist you with these tasks.
Will my family or guardian still be able to help me?
Your family, guardian, or others will still be able to help develop your care plan when you choose a new Family Care MCO or the IRIS program.
Once I pick my program, will a care manager or IRIS consultant help me with the transition?
Care managers (Family Care) or consultants (IRIS) will work with you to help make a successful transition.
If I stay in Family Care and choose Inclusa, can I enroll before January 1, 2020?
Inclusa may make a courtesy call to you as soon as the ADRC or Tribal ADRS communicates your program selection to them and they will begin providing services on January 1, 2020. Care Wisconsin will continue as your Family Care provider until midnight, December 31, 2019.
If I pick Lakeland Care or IRIS, can I enroll before January 1, 2020?
You can enroll in and receive services from Lakeland Care or IRIS prior to January 1, 2020.
If you pick IRIS, you will meet with an IRIS consultant to develop a service plan prior to your start date. It usually takes about 45 days to complete a plan, so if you want to enroll in IRIS, you should contact your ADRC as soon as possible (by November 15th) to allow for plan development.
Who should I call if I have questions or concerns about the upcoming changes?
You can call your ADRC or Tribal ADRS. You can find out more about the change on the transition webpage.
Who should I call if I have questions or concerns about Family Care or IRIS programs?
Please contact your ADRC or Tribal ADRS:
|Aging and Disability Resource Center Serving||Phone Number|
|Tribal Aging and Disability Resource Specialist Serving||Phone Number|
|Menominee Indian Tribe of Wisconsin||715-799-5137|
How can I talk to an Ombudsman?
If you are age 60 or older, call the Wisconsin Board on Aging and Long Term Care at 800-815-0015.
If you are between 18 and 59 years old, contact Disability Rights Wisconsin at 800-928-8778.
Aging and Disability Resource Center and Enrollment Counseling
Who chooses my program and my services if I have a guardian?
Your preference is important, and you should make your program selection known to your guardian. Your guardian is required to sign the program enrollment form on your behalf. Similarly, you and your guardian will take part in developing your service plan, and the guardian will sign it.
Can I meet with the ADRC or Tribal ADRS more than once?
Yes. You can meet with the ADRC or Tribal ADRS as many times as you want to get the information you need to make a decision. If you make a decision and later decide it is not the right fit, you can contact the ADRC or Tribal ADRS to consider another program or provider.
If I need time to think about my decision after my ADRC or Tribal ADRS enrollment counseling, do I need to make another appointment to enroll?
You would need to contact the ADRC or Tribal ADRS to discuss your enrollment choice and complete the correct enrollment form. If you have met with the ADRC or Tribal ADRS and have enough information to make a choice, you can sign the enrollment form and mail it to the ADRC. If you have a legal guardian, he or she would sign on your behalf.
Is it hard to switch between Family Care and IRIS? How many times can I switch, and how long does a switch take?
You can switch programs whenever you would like if you decide your program is not the right fit for you. The ADRC or Tribal ADRS can help. The time it takes to change varies. It could take less than a week if you do not need more information to make a choice and you are not enrolled in a program or not yet referred to IRIS. On the other hand, it could take longer if you would like more information or need time to decide on your program, or if you are developing a service plan with an IRIS consultant agency.
I met with the ADRC or Tribal ADRS, picked the IRIS program, and picked my IRIS consultant agency. Am I finished?
Everyone who picks IRIS must have an IRIS service plan in place prior to their IRIS start date.
One of the jobs of your IRIS consultant is to help you build your IRIS service plan. It usually takes about 45 days to complete a plan, so you should contact the ADRC or your Tribal ADRS to get started. To start in IRIS on January 1, 2020, your service plan must be finished and approved by your IRIS consultant no later than December 16, 2019. This would allow you time to complete your plan and onboard your service providers before you move to IRIS.
When must my IRIS service plan be finished in order for me to start in IRIS on January 1, 2020?
To start in IRIS on January 1, 2020, your IRIS service plan must be finished and approved by your IRIS consultant agency no later than December 16, 2019. You should start putting together your plan right away because it can take several weeks to complete.
What happens if I cannot finish my IRIS service plan by December 16, 2019?
If your IRIS service plan is not finished by December 16, 2019, you will be referred back to the ADRC or Tribal ADRS to talk with you about the options that are available.
If you have not finished the plan, you should call your IRIS consultant as soon as possible. Your IRIS consultant will help you finish your plan. If you don't have the phone number, call the IRIS call center at 888-515-4747, and ask for the name and phone number of your IRIS consultant.
Information about Family Care MCOs
How soon after I pick an MCO will I hear from my care team?
If you select Lakeland Care, they will contact you within three calendar days of the enrollment. Inclusa may make a courtesy call to you as soon as the ADRC or Tribal ADRS communicates your program selection to them.
Where can I find a list of service providers for each MCO?
You can find a list of service providers on each MCO's website.
The MCOs also share their provider lists with the ADRC and Tribal ADRS.
How will I transition from Care Wisconsin to a different Family Care option?
You first need to meet with the ADRC to tell them that you are interested in remaining enrolled in Family Care. When you choose Family Care with Lakeland Care or Inclusa, all of your current services covered by Family Care will be immediately authorized, so no lapse will occur in these services.
You will get a welcome call from your MCO within three calendar days of your enrollment, and you will meet with your care team within ten calendar days of your enrollment date.
Information about IRIS Consultant Agencies and Fiscal Employer Agents
How soon after I pick a program will I hear from my IRIS consultant?
The IRIS consultant agency that you picked will call to welcome you to the program within three business days of the referral date.
What is the role of a fiscal employer agent (FEA) in IRIS?
In IRIS, an FEA does the paperwork, tax reporting, and caregiver background checks that are needed when you hire a caregiver. The FEA also pays for the services you get from an agency. If you have a cost share, you would send your monthly payment to your FEA.
How will I transition from Family Care to IRIS?
In the IRIS program, your IRIS consultant agency will call to welcome you to the program within three days of making your ICA selection. You and your consultant will build an IRIS plan that will include a start date. Your current Family Care services will continue until your IRIS plan is approved. You will be able to decide which of your current services you want to continue for your IRIS plan.
Can I be in IRIS if I live with a parent?
Yes. You may live with a family member and be in the IRIS program.
If I currently self-direct my services with Care Wisconsin, can I continue to do so with a different Family Care option? What about IRIS?
Your opportunity to self-direct your services will continue if you select Inclusa or Lakeland Care.
IRIS is a self-directed program.
Is there a difference between IRIS and Family Care self-directed services?
In IRIS, you are in charge of self-directing all of your long-term care services. In other words, you have full budget authority.
In Family Care, you can choose to self-direct many of your services and supports, and the MCO will continue to manage any of the services you choose not to self-direct.
Which services can I self-direct in IRIS or Family Care?
IRIS provides full budget authority so you are in charge or self-directing all of your long-term care services.
In Family Care, you may self-direct any home and community-based services except care management and community residential care services.
What parts of care management and case management are not covered by IRIS because they fall within my responsibility to self-direct? What is not covered by Family Care?
IRIS is a self-directed program, so it is largely your responsibility, together with your guardian or your family and friends, to direct your services. The IRIS program does not include care management. Care management is included in Family Care and is coordinated by the care team.
Your IRIS consultant provides assistance to maximize self-direction in the IRIS program, and your fiscal employer agent (FEA) will help you with paperwork and bill paying. When you need more help than what your IRIS consultant and FEA provide, friends and family can often help. When this is not possible, the support broker service may be used to help you plan, get, or direct services.