Navigating long-term care options can be challenging, especially when you or a loved one requires ongoing support due to aging, disability, or chronic health conditions. In Wisconsin, the Wisconsin Family Care Program stands as a crucial initiative designed to provide comprehensive long-term care services to eligible individuals. This guide will delve into the key aspects of Family Care, explaining essential terms and concepts to help you better understand this vital program.
What is the Wisconsin Family Care Program?
The Wisconsin Family Care Program (FC) is a state-run initiative dedicated to delivering long-term care services to Wisconsin residents who are frail elderly individuals or adults with physical and developmental disabilities. To participate in Family Care, individuals must meet specific functional and financial eligibility criteria as determined by state and federal guidelines.
Family Care operates under a Managed Care approach, balancing the need for long-term care services with the responsible allocation of resources. This ensures the sustainability of services for all eligible individuals who require them. The program is delivered through Managed Care Organizations (MCOs), private entities that contract with the Wisconsin Department of Health Services (WI DHS). Lakeland Care, for instance, is an example of an MCO operating in northeast Wisconsin, authorized by the WI DHS.
Key Components of Family Care
To understand Family Care fully, it’s important to grasp several core concepts:
Eligibility: Functional and Financial
Eligibility for Family Care is determined by two main factors:
- Functional Eligibility (Screen): This assesses an individual’s needs and abilities using a standardized screening tool. Certified functional screen staff conduct this assessment to determine if an individual requires the level of care provided by Family Care.
- Financial Eligibility: This aspect is determined by the State’s economic support workers based on Medicaid program guidelines. It evaluates an individual’s financial situation to ensure they meet the income and asset requirements for the program.
Service Delivery and Care Planning
Once enrolled in Family Care and becoming a Member, individuals receive services coordinated by an Inter-Disciplinary Team (IDT). This team is central to the Family Care approach and includes:
- The Family Care Member
- A Care Manager from the MCO
- An RN Care Manager from the MCO
Members can also choose to include other individuals in their IDT, such as family members, guardians, advocates, friends, providers, and physicians, ensuring a person-centered approach to care planning.
The IDT works collaboratively using a Resource Allocation Decision Method (RAD). This process focuses on the member’s identified personal experience outcomes to explore various care and support options. The goal is to develop a personalized care and services plan that aligns with the member’s needs, preferences, and available resources.
Range of Family Care Benefits
Family Care Benefits encompass a wide array of services and supports that can be provided based on a member’s assessed needs and desired outcomes. These benefits are tailored to each individual and are delivered through a Provider Network. This network consists of contracted Providers – individuals, agencies, vendors, or companies – that agree to deliver services to Family Care members through the local MCO. This network ensures members have Choice in selecting services and providers that best meet their needs.
Self-Directed Support (SDS) Option
For individuals seeking greater control over their care, Family Care offers a Self-Directed Support (SDS) option. SDS empowers members to arrange, purchase, and direct their own long-term care services. This option provides increased responsibility, flexibility, and control over service delivery, allowing members to manage their service budget and even hire, train, supervise, and, if necessary, dismiss their direct care workers. Members can choose to self-direct all or a portion of their services, offering a highly personalized approach to care management.
Understanding the Financial Aspects: Capitated Rate and Cost Effectiveness
Family Care’s financial model involves a Capitated Rate. This refers to a fixed dollar amount that the state pays each MCO monthly for every individual served under the program. This fixed rate helps to manage and predict healthcare costs.
The program emphasizes Cost Effective service delivery, aiming to balance member outcomes and needs with the cost of services. This ensures responsible resource allocation and program sustainability while prioritizing quality care.
Navigating the System: ADRCs and Economic Support
For individuals with initial questions about aging or disability services, Aging and Disability Resource Centers (ADRCs) are invaluable resources. ADRCs serve as the first point of contact for information on all aspects of life related to aging or living with a disability. They can provide guidance on programs like Family Care and connect individuals with local resources. Wisconsin has ADRCs in most counties, and resources to find ADRCs in specific regions are readily available, such as through Lakeland Care’s Helpful Links page.
In the context of financial eligibility, understanding Economic Support (ES) is important. ES is a term referring to public assistance programs like Medical Assistance (MA) and FoodShare (FS), which are relevant to determining financial eligibility for Family Care. Economic Support Worker/Specialist (ESS) are county or tribal employees who determine or redetermine program eligibility for these programs.
Family Care and the Broader Healthcare Context
It’s also helpful to understand how Family Care relates to other healthcare terms:
- Acute Care: Refers to short-term health care services typically provided in a hospital setting for sudden or severe illnesses or injuries. Family Care focuses on Long Term Care (LTC), which addresses ongoing needs arising from chronic conditions, disabilities, or aging.
- Primary Care: This is the routine health care you receive from your primary doctor, focusing on preventative care and managing general health concerns. Family Care complements primary care by addressing specialized long-term care needs.
Conclusion: Accessing Long-Term Care through Wisconsin Family Care Program
The Wisconsin Family Care Program is an Entitlement program, meaning that services are guaranteed to individuals who meet the functional and financial guidelines established by state and federal agencies. It represents a commitment to providing essential long-term care services to Wisconsin’s frail elderly and adults with disabilities. By understanding the definitions and key components of Family Care, individuals and their families can more effectively navigate the process of accessing needed support and services. For further information and a more extensive glossary of terms, you can refer to the Wisconsin Department of Health Services website.
Image: Logo of ADRC (Aging and Disability Resource Center) representing local access points for information and assistance regarding aging and disability services.
Image: Lakeland Care logo in color, representing a Managed Care Organization providing Family Care services in northeast Wisconsin.
