Family Care is a Wisconsin Medicaid program designed to provide long-term care for older adults and adults living with disabilities. The primary goal of Family Care is to ensure individuals receive the necessary services and support to live in a home setting whenever possible, promoting independence and quality of life within their communities.
Understanding Family Care and Long-Term Care Needs
Long-term care addresses the diverse needs of individuals who require ongoing assistance due to a disability, the effects of aging, or a chronic illness that significantly impacts their daily lives. These conditions can create challenges in performing essential daily tasks that many people take for granted. Activities such as bathing, dressing, preparing meals, managing finances, or even maintaining employment can become difficult or impossible to manage independently. Family Care steps in to bridge this gap, offering a coordinated system of support.
Key Partners in Delivering Family Care Services
The Family Care program operates through a network of partnerships to deliver comprehensive care. Two primary groups are central to the program’s functionality:
- Wisconsin Department of Health Services (DHS): DHS oversees the Family Care program, setting guidelines, and ensuring program integrity and quality of care.
- Managed Care Organizations (MCOs): These organizations contract with DHS and are responsible for the direct delivery of services to Family Care members. Members choose an MCO to coordinate their care. MCOs build networks of long-term care providers and manage the funds allocated by DHS to arrange and oversee the services each member receives.
Services Covered Under Family Care
Family Care offers a wide spectrum of long-term care services tailored to the individual needs of its members. These services are designed to provide support across various aspects of daily living and well-being. The range of services can include assistance with personal care at home, skilled nursing care, therapies, adaptive equipment, counseling, and mental health services. For a detailed list of benefits, you can Learn more about Family Care benefits.
To access Family Care services, the process begins with determining eligibility:
- Contacting the ADRC: Potential members should first contact their local Aging and Disability Resource Center (ADRC). ADRCs serve as the initial point of contact, providing information about Family Care and assessing preliminary eligibility. They will explain what it means to be part of the program and guide individuals through the application process.
- MCO Enrollment: Once eligibility is confirmed, individuals can choose a Managed Care Organization (MCO) and enroll. Enrollment with an MCO is essential to begin receiving Family Care services.
Determining Eligibility for Family Care
Specific criteria must be met to be eligible for enrollment in Family Care. These criteria ensure that the program serves those who genuinely require long-term care services. Eligibility requirements include:
- Age Requirement: Applicants must be at least 18 years of age.
- Condition: Individuals must be classified as a frail elder or an adult with a disability.
- Medicaid Eligibility: Applicants must be eligible for Wisconsin Medicaid.
- Functional Eligibility: Functional eligibility is assessed using the Long Term Care Functional Screen. This assessment helps determine the level of care needed.
- Long-Term Care Need: The applicant must have a long-term care condition expected to last for more than 90 days.
It is important to note that individuals with dementia or a terminal condition may also qualify for Family Care, highlighting the program’s adaptability to various complex health needs.
How Family Care Operates and Delivers Support
The operational framework of Family Care is designed for efficiency and quality assurance. The Wisconsin Department of Health Services (DHS) plays a pivotal role by providing monthly payments to MCOs for each enrolled member. These funds are then strategically utilized by the MCOs to locate, arrange, and coordinate necessary services for their members. MCOs maintain comprehensive networks of long-term care providers, ensuring that members have access to a range of quality service options. A core responsibility of MCOs is to continuously monitor and maintain the quality of services provided to Family Care members, ensuring they receive the best possible care and support.
Contact Information for Family Care Assistance
For individuals seeking further information or assistance with Family Care, resources are readily available. For any questions or inquiries, you can reach out through the following contact methods:
- Phone: Call Medicaid Member Services at 800-362-3002.
- Email: Send your inquiries via email to [email protected].
A Look at the Program’s History and Growth
Family Care has a rich history of serving the Wisconsin community, dating back to its inception in 1999. It was launched as a pioneering initiative to transform Wisconsin’s long-term care system, aiming to create a more integrated and effective approach. Since its beginning, Family Care has marked significant milestones:
- 1999: The Family Care program was established, laying the foundation for a new era in long-term care in Wisconsin.
- 2000: Initial implementation began in five Wisconsin counties: Fond du Lac, La Crosse, Milwaukee, Portage, and Richland, marking the program’s first steps in service delivery.
- 2007: The program expanded its reach to additional counties, demonstrating its growing success and demand.
- 2010: Family Care reached a significant milestone, serving over 30,000 members across 56 counties, illustrating its widespread impact.
- 2013: Research conducted by DHS highlighted the program’s financial efficiency, revealing $34.7 million in savings statewide while enhancing service delivery to older adults and individuals with disabilities.
- 2015: A pivotal year when Governor Walker and the state government expanded Family Care to cover the entire state, eliminating the waitlist and solidifying its position as a cost-effective, high-quality care solution.
- 2018: Statewide coverage was completed as the last county in Wisconsin incorporated Family Care into its service offerings.
- Present Day: Family Care now supports over 55,000 members throughout Wisconsin, demonstrating its vital role in the state’s long-term care landscape. View Family Care enrollment numbers for more details.
This historical progression underscores Family Care’s commitment to evolving and meeting the long-term care needs of Wisconsin residents, continually striving for improved access, quality, and efficiency.
