Frequently Asked Questions
Questions Frequently Asked by Consumers and Stakeholders
Q: 1. What is long-term care?
A: Long-term care is any service or support that a person may need
as a result of a disability, getting older or having a chronic
illness that limits their ability to do the things that most people
need to do throughout the course of their day. This includes things
such as bathing, getting dressed, making meals, going to work and
paying bills. Family Care offers a
variety of services and supports that can help eligible people do
these things independently or with the support of someone else.
Q: 2. What service choices do I have in
this new long-term care system?
A. Consumers may choose between three service packages: Family Care,
Partnership, or IRIS--the state’s Self Directed Support option.
Within Family Care there will be a broader network
of providers and a larger service array from which to select the set
of services individuals require to meet their health and safety
needs. Also consumers have the
option to self-direct some of their services.
Individuals who choose not to voluntarily enroll in Family Care may continue to receive services available through their
Medicaid card but this would not include services such as Community
Based Residential Care or Supportive Home Care. Community Based
Waiver services previously provided by Counties will no longer be
available.
Consumers may also choose to self-direct their entire care plan
through an alternative statewide structure of self directed
services. This option is called IRIS (short for Include, Respect, I
Self-Direct). Persons who choose IRIS will not be enrolled in either
Family Care or Family Care Partnership.
Q: 3. What is Family Care?
A: Family Care (FC) is an innovative program that provides the full
range of long-term care services through one flexible benefit
program. Family Care provides assistance through interdisciplinary
care management. Sometimes people don’t know exactly what they need,
what’s available or where to go to get the care and services they
need, and coordinating your own services can be overwhelming. When
you participate in Family Care, a care management team of people
works together to help you identify your outcomes (that is, what you
would like to happen in your life), what sort of assistance you
might need to meet those outcomes, and works with you to arrange
your long-term care services. You are an active participant on your
care management team, which can also include a family member, a
caregiver or other professional
Northeast Wisconsin Family Care (NEW FC), a new regional quazi
governmental organization, will be providing Family Care in
northeastern Wisconsin.
Q: 4. What is a Long Term Care District?
A: A Long Term Care District is a new, regional unit of government
created specifically to administer services to provide Family Care
services. The working title for this effort is the Northeast
Wisconsin Family Care (NEW FC). The counties included in the NEW
FC District are Brown, Door, Kewaunee, Marinette, Menominee, Oconto and
Shawano. In addition, the Oneida, Menominee and Stockbridge-Munsee
Tribes are partners in planning the NEW District.
Q: 5. What is Family Care Partnership?
A. The Partnership Program is an integrated health and long-term
care program for frail elderly and adults with disabilities.
Partnership is a Wisconsin long-term care program as well as a
Medicare Advantage Special Needs Plan. Launched in 1995, Partnership
provides expanded care management and covers all long-term care
services in the basic Family Care benefits package, plus all health
and medical services as well as all prescription drugs.
Unfortunately, the Family Care Partnership Program will not be available to NEW
FC District consumers.
Q: 6. What is IRIS?
A. IRIS is a new Wisconsin long-term care option that began July 1,
2008. Individuals who choose to participate in IRIS have more
choices, control, and freedom to design their own support and
service plans to meet their functional, vocational, medical and
social needs. Persons using IRIS self manage their goods and
services and may use IRIS to remain in their community and avoid
moving into a nursing home or an institution. With IRIS, adult
Wisconsinites who are elderly or those with a physical or a
developmental disability have control over the type of services they
receive in home and community settings.
A key IRIS feature is the participant or their family member or
representative being in charge of his/her long term care and fully
self-directing his/her services, supports or goods and life. IRIS
participants create a support and service plan for their long-term
care supports and services within an individually assigned monthly
budget allocation. Individuals may hire their own service workers
directly or they may purchase goods and services from an agency
provider. In IRIS you choose the services you need, and decide where
and how to spend your monthly IRIS budget allocation. IRIS
participants self manage their chosen goods and services. Your
monthly budget allocation may be adjusted based on your unique
circumstances.
You select your own IRIS Independent Consutant with help from the
IRIS Independent Consultant Agency. The IRIS Financial Services
Agency
pays the bills for services received that you authorize
according to your written IRIS plan. Help from both of these IRIS
agencies is provided at no cost to your plan and monthly budget. You
may enlist the help of a support broker if desired, and support
broker fees are paid out of your individual monthly budget
allocation.
IRIS allows you to choose which services you need, when and where
you receive them and will help you to attain the highest quality of
life possible. IRIS is available to Wisconsinites who are Medicaid
eligible and also eligible for publicly funded long term care
services that live in a county where managed care (family care) is
available. Individuals are offered the choice of IRIS or managed
care when they enter the state publicly funded long-term care system
at their local Aging and Disability Resource Center.
Q. 7. Who is eligible for Family Care?
A. There are three eligibility criteria for Family Care: 1). Eligibility for Medicaid, 2). Otherwise eligible to
receive services in a nursing home 3). At least 65 years old or 18+
years old with a physical or developmental disability.
Q: 8. What is the difference between
Family Care and Partnership?
A. Family Care arranges and manages all long-term care services and
coordinates with acute and primary care providers. Partnership, in
addition to arranging and managing all long term care services, also
provides all the health services for people with disabilities and
the elderly--unfortunately, the Partnership Program is not available to residents in the
NEW FC District.
Q: 9. Wisconsin has been a leader among
states in providing long term care service options. Why is there a
need to change the long-term support system?
A. There are waiting lists for community based services in most
counties due to lack of funding yet there is an entitlement
(guaranteed funding) for more expensive services provided in
institutions such as nursing homes. Based on the experience of
Family Care, more non-institutional services can be
purchased for more people in a managed care environment. This
eliminates wait lists and allows people to remain in the community
rather than more restrictive services, like nursing homes.
Q: 10. Isn’t this going to cost extra
money, and where will the money come from?
A: Based on an independent analysis of Family Care, the State of
Wisconsin has projected that savings in the State Medicaid budget
generated under the new system, through the integrated management of
long-term care services and a focus on prevention, will allow for
‘cost neutral’ expansion, allowing more consumers to be served.
Existing funds will be reallocated from other long-term care
programs including Medical Assistance (MA) Waiver programs like
Community Options Program (COP), Community Integration Program (CIP)
and the Brain Injury Waiver (BIW) Program, and some MA ‘card’
services like institutional and personal care. Family Care combines
most of the federal, state and county funds associated with these
programs.
Q: 11. If there are savings, where are
they going to come from?
A. Savings will be achieved through enhanced coordination and
management of existing plans and services plus the integration of
traditional long term care services with Medicaid card services. One
of the goals of this long-term care initiative is to integrate the
two into one health care system that focuses on proactive care that
prevents or reduces costs. In the five pilot programs, the majority
of the savings were in the State Medicaid budget for services such
as hospitals and nursing homes.
In Family Care, the state pays each Managed Care
Organization (MCO)a monthly “capitated” or averaged per person rate.
The MCO is responsible for providing all Family Care
benefits and services to members to help them meet their desired
outcomes. Because those outcomes are member-determined and
member-specific, each care plan is designed to deliver the unique
mix of services that will meet an individual’s needs.
Q: 12. What will be different in the new
system?
A. No matter what changes, we are committed to the goal of local
access to a variety of high quality, consumer-focused services
targeted to assist eligible individuals to remain in a setting of
their choice and achieve the highest level of self-sufficiency and
quality of life.
Q: 13. When will Family Care start and when will consumers get off the waiting list?
A. At this time, the state is projecting expansion in Northeast
Wisconsin in 2011. Waiting lists are expected to be eliminated
within 36 months of implementation in each county.
Q: 14. How is this going to affect
family members?
A. Families will remain actively involved in care planning when
managed care starts. The individual enrolled in the program or the
client’s legal guardian must approve care plans and can provide
feedback on the effectiveness’ of the care plan.
Q: 15. What are Aging and Disability
Resource Centers (ADRCs) and how do they fit in the system?
A: ADRCs are one-stop, local agencies where consumers can get
information and counseling related to their long-term care needs.
ADRCs are the first step for enrolling in Family Care and are also a
resource for information on all types of programs for the elderly
and people with disabilities regardless of income and assets.
The Brown County Aging and Disability Resource Center, currently
exists to serve Brown County. A new Wolf River ADRC is in the
planning stage and would serve Menominee, Shawano and Oconto
Counties, and the Menominee and Stockbridge-Munsee Tribes.
Marinette, Kewaunee and Door County are in the process of
considering their options but will be developing ADRCs concurrent
with Family Care development.
Q: 16 Will this initiative address
services for children?
A. Not at this time.
Q: 17. Are people with mental illness
included in Family Care?
A: Care plans for Family Care-eligible elders and adults with
disabilities, who also have mental health issues, will incorporate
meeting their mental health needs. Individuals with a primary
diagnosis of mental illness who are not otherwise eligible for
Family Care based on a disability or frail elderly need, will not be
included in this initiative.
Q: 18. Under Family Care, will my
services be reduced?
A: Family Care includes all of the services currently available in
the Medicaid Waiver programs (Community Integration Program [CIP],
Community Options Program [COP] and Brain Injury Waiver [BIW]) as
well as some services provided under the Medicaid card. Members
receive the services they need at the level they need them, to cost
effectively meet their personal outcomes.
Family Care takes a fresh approach by targeting services based on
individual member’s expressed goals and desired outcomes. A team
that includes the member, a case manager, a nurse, and possibly
others will work together to identify member’s goals and desired
outcomes. Together, the team decides how those goals can best be
met, which may or may not be the exact same services at the exact
same level that is currently received.
Q: 19. If I have more questions, how do
I have them answered?
A: There will be on-going opportunities for communicating and asking
questions. A web site, www.northeastwisconsinfamilycare.com
has been developed and is updated regularly. The web site
will provide notice of upcoming meetings, stakeholder forums and
updates regarding the planning process.
