Navigating the landscape of long-term care can be complex, especially when it comes to understanding specific programs designed to support individuals and families. In Wisconsin, the Family Care program stands as a cornerstone of long-term care services for frail elderly individuals and adults with disabilities. To help you better understand this crucial program, we’ve compiled a list of key definitions. This guide aims to clarify the terminology associated with Family Care, ensuring you have a solid foundation for accessing and utilizing these vital services in Wisconsin.
Core Concepts of Family Care
Family Care (FC): At its heart, Family Care is a Wisconsin state program dedicated to delivering comprehensive long-term care services to eligible residents. These services are designed for frail elderly individuals and adults living with physical and developmental disabilities. Eligibility for Family Care hinges on meeting both functional and financial criteria, as defined by state and federal guidelines.
Long Term Care (LTC): This encompasses a range of services for individuals facing chronic, long-term illnesses, injuries, or disabilities that necessitate ongoing support. The need for long-term care often arises from conditions associated with aging or significant physical or developmental disabilities.
Choice: A fundamental principle of Family Care is choice. This means that the care, support, and services provided to members are tailored to their individual needs, while also considering effectiveness and cost-efficiency. The program strives to empower members to make informed decisions about their care.
Cost Effective: In the context of Family Care, “cost-effective” signifies the balance between achieving positive outcomes for members, meeting their needs, and managing the overall cost of services. This principle ensures the sustainability of the program for all eligible individuals.
Entitlement: Family Care operates on the principle of entitlement. This guarantees services to individuals who meet the functional and financial eligibility requirements established by state and federal agencies. If you qualify, you are entitled to receive the necessary support.
Program Administration and Structure
Managed Care: Family Care employs a managed care approach. This model balances the demand for long-term care services with the available resources. The aim is to ensure the program’s long-term viability and accessibility for all eligible individuals by effectively managing and coordinating care.
Managed Care Organization (MCO): The Managed Care Organization (MCO) is a private entity that contracts with the Wisconsin Department of Health Services (DHS) to administer the Family Care program at the local level. MCOs are responsible for employing or contracting with Care Managers and RN Care Managers who directly assist Family Care members. They also establish provider networks to offer a diverse range of service options.
Lakeland Care: As an example of an MCO, Lakeland Care is a private, non-profit organization authorized by the Wisconsin DHS to operate the Family Care program in specific northeastern Wisconsin counties. It serves as a local point of contact and service delivery for the program.
Capitated Rate: The financial structure of Family Care involves a capitated rate. This is a fixed monthly payment made by the state to each MCO for every individual they serve. This predetermined rate allows MCOs to manage their budgets and provide services within a predictable financial framework.
Eligibility and Assessment
Financial Eligibility: Meeting financial eligibility is one of the two primary requirements for enrolling in Family Care. This is determined by state economic support workers based on established Medicaid program guidelines. It ensures that the program serves those with genuine financial need.
Functional Eligibility (Screen): The second key eligibility requirement is functional eligibility. This is assessed through a standardized screening process conducted by certified functional screen staff. The screening tool evaluates an individual’s needs and abilities to determine if they require the level of care provided by Family Care.
Aging and Disability Resource Centers (ADRC): For individuals with questions about aging or disability services, Aging and Disability Resource Centers (ADRCs) are invaluable resources. These service centers, present in most Wisconsin counties, offer public information on all aspects of aging and living with a disability. They serve as the initial point of contact for many seeking support.
Care Planning and Service Delivery
Inter-Disciplinary Team (IDT): Care planning within Family Care is a collaborative effort involving an Inter-Disciplinary Team (IDT). At a minimum, the IDT includes the Family Care member, a Care Manager, and an RN Care Manager from the MCO. Members can also choose to include family, guardians, advocates, friends, providers, and physicians in their IDT to create a comprehensive support network.
Care Manager & RN Care Manager: These professionals are employed or contracted by the MCO and are central to the Family Care experience. Care Managers and RN Care Managers work directly with members to understand their needs, develop care plans, and coordinate services.
Family Care Benefits: Family Care Benefits refer to the array of services and supports that an MCO can provide based on a member’s individual needs and desired outcomes. These benefits are personalized and designed to promote independence and well-being.
Provider: A provider in Family Care is an individual, agency, vendor, or company that delivers services under contract with the MCO. Providers form the network of resources available to Family Care members.
Provider Network: The provider network is the group of contracted providers who have agreed to deliver services to Family Care members through the local MCO. This network offers members a range of choices and options for their long-term care needs.
RAD (Resource Allocation Decision Method): The Resource Allocation Decision Method (RAD) is the process used to make decisions about a member’s care plan. It focuses on the member’s identified personal experience outcomes and explores various options to develop a tailored plan of care and services.
Self-Directed Support (SDS): Self-Directed Support (SDS) is an option within Family Care that provides members with greater autonomy over their long-term care. SDS empowers members to arrange, purchase, and direct their services, offering increased flexibility and control over their care budget and provider choices, including hiring and managing their own direct care workers.
Other Relevant Terms
Acute Care: This refers to health care services provided in a hospital setting, typically for short-term illnesses or injuries.
Economic Support (ES): Economic Support (ES) is a term used in Wisconsin to refer to public assistance programs, including Aid to Families with Dependent Children (AFDC), Medical Assistance (MA), and FoodShare (FS).
Economic Support Worker/Specialist (ESS): An Economic Support Worker/Specialist (ESS) is a professional employed by a county, tribal governing body, or Wisconsin Works agency. Their responsibilities include determining and redetermining eligibility for public assistance programs.
Primary Care: Primary care is the fundamental health care you receive from your primary doctor for routine health needs and preventative care.
By understanding these key definitions, you can gain a clearer picture of the Wisconsin Family Care program and how it works to support individuals needing long-term care services. This knowledge is the first step towards accessing the resources and assistance available to you or your loved ones.
