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Click here
to view a printable version of the frequently asked questions (FAQs) on this page.
Milwaukee County held five Long-Term Care Reform Information
Forums from September of 2007 through January 2008 at various
Milwaukee County locations. These Forums provided an opportunity
for people to hear about proposed changes in the long-term care
service system for persons with disabilities between the ages of
18-59 and to ask questions about these changes.
Click here
for an English version of the PowerPoint that was presented at the Forums.
Click here for the
Spanish version of the PowerPoint presentation. This
presentation covers the following topics:
- What is Long-Term Care Today.
- The Milwaukee County Long-Term Care Reform Project.
- Proposed Expansion of Family Care.
- Family Care Goals / Expected Outcomes.
- How Family Care Works / What Services Are Included.
Below are some of the more frequently asked questions (FAQs)
raised at the Forums, along with answers.
Click on the heading or the individual questions that you would like to see
answers for.
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Question: What is actually going to change for persons with
disabilities between the ages of 18-59 in Milwaukee County,
if Family Care is expanded?
- Question: Is Family Care a Health Maintenance Organization (HMO)?
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Question: I am very satisfied with my current services. Would I be
able to keep these services if Family Care is expanded?
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Question: What services can be provided under Family Care?
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Question: Is Transit Plus going to stay the same if Family Care is
expanded?
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Question: Does Family Care provide or pay for housing?
-
Question:
Would the Care Management Organization (CMO) help me locate
the services I need?
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Question: Is self-directed care an option under Family Care?
- Question: Would services for kids change?
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Question: Would Family Care keep me from going to a nursing home?
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Question: Would Family Care take the place of Title 19 / Medicaid?
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Question: What is the maximum amount of dollars available for a
Family Care member’s service plan?
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Question: Where would the dollars come from to support the 2,500
people on the Disabilities Services Division (DSD) wait
list? Would funding increase? If not, would quality
decrease?
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Question: If Family Care is expanded and I choose to enroll, would
I be able to keep my same providers?
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Question: What happens if Family Care is expanded, but my current
provider does not contract with the expanded Care Management
Organization (CMO)? Would the expanded Family Care CMO pay
providers that are outside of the established provider
network?
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Question: Would I be able to keep my care manager under Family
Care?
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Question: Would I be able to choose my own personal care nurse?
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Question: How can I be sure that the people who would care for me
are qualified?
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Question: Would providers have the capacity to handle all the new
clients if Family Care is expanded? Would new providers be
needed?
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Question: Would I need to be eligible for Title 19 / Medicaid to
qualify for the Family Care benefit?
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Question: What if I am already on a Waiver program? Would I have
to re-apply and be re-evaluated for Family Care?
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Question: If I have Managed Care SSI and Medicare, does this
automatically make me eligible for Family Care?
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Question: Could you own your own home and still be eligible for
Family Care?
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Question: How long would I be entitled to services after I’ve been
enrolled in Family Care?
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Question: Can I still receive my Medicaid Waiver services until I
turn age 60 or until Family Care is available?
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Question: If Family Care is expanded, would I have the choice not
to join?
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Question: I never seem to be eligible for services, but I need
help. Where can I go?
- Question: How can I contact the Aging and Disabilities Resource
Center (ADRC)?
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Question: When will Family Care become operational for adults with
disabilities between the ages of 18 to 59 in Milwaukee
County?
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Question: What is the timetable for enrollment?
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Question: How can I find out if I am on the Disabilities Services
Division (DSD) wait list?
FREQUENTLY ASKED QUESTIONS
Answer: The following are some changes that you
might notice if Family Care is expanded to adults with
disabilities under age 60 in Milwaukee County:
- Under Family Care, the Disability Services Division (DSD)
wait list would be eliminated.
- People who are eligible for long-term care services
would not have to wait for necessary services.
- People who are currently receiving services through DSD
may notice improved choice about where to live and the kinds
of services available to them.
- Every Family Care member would be part of an
Interdisciplinary Care Management Team (IDT), which would
include at least three people – a social worker, a nurse,
and the member. Having a nurse on the team may not be
something consumers are used to under the current Waiver
system. Family Care, however, tries to ensure that consumers
have the best health possible by coordinating health care
with long-term supports. With the help of the IDT, each
member would create an individual service plan.
- In Family Care, there are no across-the-board decisions
about who gets what services. The focus is on individualized
planning to meet each individual’s desired outcomes. i.e.
what is important to that person. Some examples of Family
Care outcomes are:
- I decide where and with whom I live.
- I make decisions regarding my supports and services.
- I decide how I spend my day.
- I have the best possible health.
- I feel safe.
Answer: Family Care is not a HMO. It is a “managed”
long-term care program, which means that there are Care
Management Organizations (CMOs) that manage and deliver each
member’s Family Care “package.” Funding and services from a
variety of existing programs would no longer be available.
Instead, funds from these programs would be pooled into one
flexible long-term care benefit.
Although Family Care is not a HMO, it is classified by the
Center for Medicare and Medicaid Services (CMS) as a Pre-paid
Inpatient Health Plan (PIHP). What that means, is that in many
respects it is treated similarly to a HMO. Family Care is
classified as a PIHP because nursing homes and ICF-MRs
(Intermediate Care Facility for Mental Retardation) are included
in the benefit package. As a PIHP, Family Care is subject to
many of the same regulatory requirements that apply to HMOs and
other managed care programs. Some of these requirements are very
beneficial to members, such as: an Appeal and Grievance process,
choice of providers and a self-directed supports option.
Answer: The Family Care benefit package includes all
the services in the current Medicaid Waiver programs (Community
Integration Program [CIP], Community Options Program [COP] and
Brain Injury Waiver [BIW]). Care Management Organizations (CMOs)
may also provide additional services not in the Medicaid benefit
package if they meet the member’s individual outcomes and are
cost-effective. You would get the services you need at the level
you need them to cost effectively meet your personal outcomes.
They may or may not be the exact same services at the exact same
level that you currently receive.
Answer: The services that Family Care provides would
depend upon the needs of the individual as determined by the
Long-Term Care Functional Screen (LTCFS) and the Member-Centered
Plan. The LTCFS is used to determine the level of care. For most
members, the LTCFS assessment would find a nursing home level of
care. That does not mean the person needs to be in a nursing
home to receive services. It means that the person is eligible
for Waiver services. The Family Care benefit for members at the
nursing home level of care can provide the following long-term
support services:
- adaptive aids
- adult day care
- adult family home
- certified Residential Care Apartment Complex (RCAC)
- children’s foster care and treatment foster care (for
people between the ages of 17 years nine months and 22)
- communication aids/interpreter services
- Community-Based Residential Facility (CBRF)
- consumer education and training
- counseling and therapeutic resources
- daily living skills training; day services
- financial management services
- home delivered meals
- home modifications
- housing counseling
- personal emergency response system services
- prevocational services
- relocation services
- respite care
- Self-Directed Services (SDS) support broker
- skilled nursing services
- specialized medical equipment and supplies
- supported employment
- supportive home care
- transportation
- vocational futures planning.
The following “card” services can also be provided in the
Family Care benefit:
- disposable medical supplies
- durable medical equipment
- home health
- mental health and substance abuse services
- occupational, physical and speech therapy
- personal care
- skilled nursing services
- nursing facility services
Answer: Transit Plus is a County service that may or
may not change. If changes do occur, they would not be the
result of the current Family Care expansion planning.
Transportation is a covered Family Care benefit.
Answer: In Family Care, housing costs, including
room and board or rent, continue to be paid by an individual’s
own funds including SSI (Supplemental Security Income) or SSDI
(Social Security Disability Insurance). Family Care is a
Medicaid Waiver program and is limited to paying for services to
support individuals in the community.
Answer: Yes. The State requires that the social
worker and nurse care managers (part of your Interdisciplinary
Care Management Team or IDT) have knowledge of long-term support
resources. With the help of your IDT, you would come up with an
individual service plan that contains the services that are
appropriate to meet your needs and personal outcomes. The plan
must be clear about what services and supports you would receive
to achieve your personal outcomes, who would provide you with
each service or support and when each service or support would
be provided. The plan would describe things you are going to do
yourself or with help from family or friends.
The CMO must have a provider network with enough providers to
meet the long-term care needs of the members. On enrollment, you
would receive a directory of all of the service providers within
the provider network. Once you and the rest of your IDT decide
what services are necessary, you may select a provider from the
network. If you’re not sure which provider you would like to
select, your case manager can help you make that selection.
Answer: Yes. Self-directed support (SDS) is
available to all Family Care members. SDS gives consumers the
option of buying their services directly with their Care
Management Organization (CMO) dollars instead of having the CMO
buy them. Self-directing one’s services may offer consumers more
control over their services and supports.
Answer: If Family Care is expanded, all minor
children, under 18, would continue to receive services through
the children’s long-term support system, as long as they
continue to remain eligible.
At age 18, young adults who are eligible for Family Care
would no longer be eligible for children’s long-term support
services because they would have the option to enroll in the
Family Care program without delay. However, children who have a
diagnosis of Severe Emotional Disturbance may continue to be
served by the children’s Waiver until age 22.
At age 17 years 9 months, anyone may be screened for Family
Care eligibility at the Aging and Disability Resource Center (ADRC).
If eligible, they would be told what options are available to
them and given the option to enroll.
Answer: Family Care is designed to meet an
individual’s long-term care needs, wherever they need them;
therefore, a person could receive services in the community or
in a nursing home. Family Care may prevent nursing home
admissions to the extent that your needed services can be
provided in an alternative living arrangement or in your own
house or apartment and are cost effective.
The main purpose of Family Care is to help people receive
services in the community whenever possible. Sometimes nursing
home admission may be a good idea for a short time. Some people
may need rehabilitation in a nursing home after an accident or
an injury. The nice part about Family Care is that even if you
do need this type of rehabilitation, you still have the IDT
(Interdisciplinary Care Management Team). You and the rest of
your IDT can work with the nursing home right from the start to
get you back in the community as soon as possible.
Answer: Family Care would take the place of part of
Title 19 / Medicaid. Some services that Title 19 covered would
be a part of your Family Care benefit. Some examples of this are
home health services and therapy services. Some services, like
your doctor, would still be covered by Title 19. Family Care
combines or “pools” all the funding currently in the system for
long-term care. This includes money that funds the current
Medicaid Waiver programs: Community Integration Program (CIP),
Community Options Program (COP), Brain Injury Waiver (BIW), and
some Title 19 / Medicaid “card” services.
Answer: There is no pre-established maximum dollar
amount available for each member. Family Care - Care Management
Organizations (CMOs) receive a monthly rate for each enrolled
member. The CMO then pools all the funding received for its
members and utilizes those dollars in the most cost effective
manner to provide services to its members. Some people’s care
plans may cost more than the rate and some may cost less. The
goal is always to meet the individual care needs of each member
while being mindful of overall program funding.
Answer: The State Legislature has approved a
budgetary increase to support Family Care expansion in the
current State biennial budget with approximately $80 million in
newly appropriated funds. These funds are coming from several
new revenue sources.
In addition, the State believes, and we agree, that by
providing more community services and managing the care for more
people, fewer people would need to use more costly services,
like nursing homes or hospital emergency rooms. By helping
people remain as healthy as possible, fewer people would rely on
high cost services; therefore, more people could receive
services. For Family Care to succeed, it will be important to
make sure quality does not decrease. If quality decreases in the
community services, we would not be able to decrease the use of
high cost services, because people would not maintain the best
possible health. It is expected that Family Care expansion would
help improve the quality of services provided, by requiring CMOs
to develop more sophisticated means of measuring quality and a
more cost effective service delivery system.
Answer: This would depend on whether your current
providers are currently in or able to join the Care Management
Organization’s (CMO’s) provider network and could meet your
individual outcomes in a cost-effective manner.
In practice, the Family Care CMOs have contracted with most
of the providers that that were previously in Waiver programs.
The number of providers available to members has actually grown
in Family Care because the CMOs are required to have providers
for all the covered services and offer a choice of providers.
The Milwaukee County Department on Aging, which currently
operates a CMO in Milwaukee County for adults age 60 and older,
has over 700 providers in its network for their members to
choose from. Many of these providers already provide services to
persons age 18-59.
Answer: Family Care members can request a provider
who is not in the provider network and the CMO must consider the
request. A member’s request for a provider outside the network
should be honored by the CMO when current network providers:
- do not have the capacity or specialized expertise to
meet the need;
- cannot meet the need on a timely basis;
- or are located in geographic locations or buildings that
make transportation or physical access an undue hardship to
the member.
Answer: Continuity of services is very important;
however, there are no guarantees that you would have the same
care manager under Family Care. Some staff changes may always be
possible as care managers retire, move on, or transfer teams.
Answer: For providers who come into the home or
provide hands-on care, such as personal care and supportive home
care, the Care Management Organization (CMO) must purchase
services from whomever you choose as long as that person meets
the CMO’s requirements and accepts the CMO’s payment rate.
Answer: Family Care requires an extensive quality
assurance program including a Best Practices Team. This team
ensures that qualified staff provides quality care. The State
Family Care Contract also requires that providers meet certain
credentialing requirements, which are monitored by the CMO.
Answer: The current provider network would expand,
as needed, to meet the needs of an expanded population. The
Milwaukee County Family Care CMO would continue to form
partnerships with community-based agencies to help staff the
program.
Answer: Yes. You would need to be eligible for Title
19 / Medicaid to qualify for Family Care benefits. A financial
and functional screen would be given to determine eligibility.
To be eligible, one must meet both the functional and financial
criteria.
Answer: All those currently receiving Waiver
services would be offered options counseling and would be
evaluated to determine current functional and financial
eligibility.
Answer: Eligibility for Family Care is determined by
both financial and functional eligibility. Every member of
Family Care must meet both a financial eligibility screening as
well as a functional screen to determine appropriateness for
Family Care. Managed Care SSI is not currently available to
Family Care members and it is not possible to enroll in both
programs simultaneously. Medicare eligibility does not affect
Family Care eligibility.
Answer: Yes, you could own a home and still be
eligible for Family Care. An Options Counselor from the Aging
and Disability Resource Center (ADRC) would be able to help you
decide if Family Care is appropriate for your needs. If Family
Care is not appropriate for you, they could help you identify
services that are.
Answer: Once you are enrolled in the Family Care
program, you are entitled to receive benefits as long as you
meet the eligibility requirements. At least annually, a member
must recertify to ensure they meet functional and financial
eligibility requirements.
Answer: Yes. You will continue to receive your
Waiver services as long as you continue to be eligible for them.
However, if Family Care expands to adults with disabilities
under age 60 in Milwaukee County, the Waiver programs would no
longer exist.
Answer: Yes. Individuals could choose not to enroll
in the Family Care program. An individual who opts out of Family
Care may still be able to receive long-term care “card”
services.
Answer: If Family Care is expanded to persons with
disabilities aged 18 – 59 in Milwaukee County, the State will
require the County to operate an Aging and Disabilities Resource
Center (ADRC). ADRCs are places where the public can get
accurate, unbiased information on all aspects of life related to
living with a disability or aging. These centers are friendly,
welcoming places anyone can contact to receive information and
assistance regarding not only the public benefits that may be
available, but all public and private programs available
throughout the area. ADRC services can be provided at the ADRC,
via telephone, or through a home visit - whichever is more
convenient to the person seeking help.
Answer: The ADRC is not currently in operation;
however, if you have question, you should contact the Disability
Resource Center at (414) 289-6660 or the Aging Resource Center
at (414) 289-6874. You can also try calling 2-1-1, which is a
24-hour phone service for Milwaukee County residents who need
assistance with family, health and social services.
Answer: If Family Care is expanded, the target date
to begin enrolling adults under age 60 is the first quarter of
2009. The State mandates that the wait list be eliminated two
years after the program is implemented; therefore, if Family
Care begins enrolling clients in 2009, the wait list should be
eliminated by 2011.
Answer: There are three groups of potential members
for each new Family Care Care Management Organization (CMO). One
group is the people currently receiving Medicaid Waiver services
(CIP, COPW and BIW). This group would be enrolled during the
first year that the new Family Care CMO is in operation, a few
people each month. People on waiting lists are the second group
of new Family Care members. They would be enrolled during the
first two years the new Family Care CMO is in operation. The
third group includes people who ask for long-term support
services for the first time during the first two years the CMO
is in operation. They would also be enrolled during the same two
year period as people on waiting lists. People currently
receiving services or on a waiting list would be personally
notified when Family Care is available.
Answer: You should contact the Disabilities Resource
Center at (414) 289-6660 and ask if your name is on the DSD wait
list. If you are not currently on the wait list, but want to be
added, you should call the Disabilities Resource Center.
Click
here
to view “Questions about Family Care for People with
Developmental Disabilities: Responses to Questions from Consumers,
Guardian and Families.” This information was put together by the
Wisconsin Department of Health and Family Services.
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