Publicly Funded Long Term Care Programs
Many people need help accomplishing activities of daily living and caring for their health due to frailties of aging or an intellectual developmental or physical disability. This help, referred to as longterm care, includes many different services, such as personal care, housekeeping or nursing. Long-term care is provided in people’s homes, in small and large residential care facilities or group homes, in nursing facilities, and in the workplace.
Publicly funded long-term care programs are designed to provide cost-effective, comprehensive, and flexible long-term care that will foster consumers’ independence and quality of life, while recognizing the need for interdependence and support. These programs were developed to improve the cost-effective coordination of long-term care services by creating flexible benefits that include a large number of health and long-term care services that otherwise would be available through separate programs. In order to assure access to services, the State of Wisconsin contracts with Managed Care Organizations (MCOs) which develop and manage a comprehensive network of long-term care services and support, either through contracts with providers, or by direct service provision by MCO employees. MCOs are responsible for assuring and continually improving the quality of care and services consumers receive. IRIS is another one of Wisconsin’s Medicaid long-term support programs. In IRIS, you direct your own services and supports rather than being managed by an MCO. The State contracts with an IRIS Consultant Agency (ICA) and a Fiscal Employment Agent (FEA) that are available to assist you in managing your care plan. Individuals participating in any of the publicly funded long term care programs may be required to pay a cost share as part of their eligibility requirements
Publicly funded long-term care programs serve adults with physical disabilities, adults with developmental disabilities and frail elders, with the specific goals of:
- Giving people better choices about where they live and what kinds of services and supports they may receive to meet their needs
- Improving access to services
- Improving quality through a focus on health and social outcomes
- Creating a cost-effective system for the future
Family Care
The Family Care benefit is available through Managed Care Organizations (MCOs). Waukesha County offers a choice of three MCOs: Community Care, Inclusa and My Choice Wisconsin. The MCOs serve adults in three primary target groups who have a long-term care condition expected to last for more than 90 days. The three Family Care target groups are:
- Frail Older Adults (65 years or older)
- Adults with Physical Disabilities (18 years or older)
- Adults with Intellectual/Developmental Disabilities (18 years or older*)
*ADRCs and MCOs can begin planning for children with physical or intellectual/developmental disabilities prior to their 18th birthday.
To be eligible for Family Care an individual must fit in one of the three target groups, live in a Family Care county, and meet the financial and functional eligibility requirements. The Long Term Care Functional Screen determines functional eligibility. The screen assesses an individual’s medical status and level of independence in activities of daily living. Medicaid-eligible individuals automatically meet the financial eligibility criteria for Family Care.
Once enrolled in Family Care, you will be assigned a care team consisting of a care manager and registered nurse. You and your team will develop an individual service plan that will focus on your long term care needs. This plan will then be coordinated by your Family Care team. For more information about Family Care go to: www.dhs.wisconsin.gov/ltcare/INDEX.HTM
If an individual is eligible for managed long-term care and chooses to enroll in Family Care, the ADRC will enroll the person in an MCO serving Waukesha County residents.
MCOs serving Waukesha County include:
Family Care Partnership
Family Care Partnership serves the same target groups described under Family Care. The Family Care Partnership option in Waukesha is offered by Community Care and My Choice Wisconsin. This option provides a full range of long-term care, primary, acute, and preventive care delivered through interdisciplinary teams that include a registered nurse, licensed social worker, nurse practitioner, rehabilitation and recreation therapists, dietitian and doctor who work together to ensure your complete social, personal and medical care needs are met. Eligibility requirements for Family Care Partnership are the same as those under Family Care. For more information about Family Care Partnership go to: www.dhs.wisconsin.gov/wipartnership/index.htm
PACE (Program of All-Inclusive Care for the Elderly)
The option of the PACE program through Community Care, is for individuals age 55 and up who also meet the eligibility requirements described under Family Care and Family Care Partnership. PACE is a nationally recognized model which provides a comprehensive program that fully integrates all Medicare and Medicaid covered institutional and community based services, including a full range of long term care and medical care. The interdisciplinary team is the same as listed under Family Care Partnership. PACE is an adult day centered model and includes coverage of many services including but not limited to dental, vision, hearing and foot care, home health services, transportation, caregiver respite, physical and occupational therapy, home delivered meals and end of life/palliative care. For more information about PACE go to: www.dhs.wisconsin.gov/publications/p0/p00088h.pdf
IRIS (Include, Respect, I Self Direct)
IRIS is Wisconsin’s Medicaid long-term support Self-Directed Waiver Program. It is available in counties where Family Care operates with the same eligibility requirements as Family Care and Family Care Partnership. In IRIS, you direct your own services and supports rather than being managed by an MCO. The State contracts with an Independent Consultant Agency (ICA) and a Fiscal Employment Agent (FEA) that are available to assist you in managing your care plan. The ICA oversees a group of IRIS Consultants (IC) who help you to plan for the support and services you need within the cost of your allocated budget (which is determined by the Long Term Care Functional Screen). Everyone in IRIS will receive help from a Fiscal Employer Agent (FEA). The ADRC will offer you options and you will choose which fiscal employer agent you want to work with. The fiscal employer agent does background checks on workers you hire, processes payroll, manages the amount of federal and state taxes to take out of your workers’ checks, and helps with other employer tasks. For more information about IRIS: http://www.dhs.wisconsin.gov/iris/index.htm
ICAs serving Waukesha County include:
FEAs serving Waukesha County include:
Long Term Care Eligibility
The Aging and Disability Resource Center of Waukesha County (ADRC) will work with Waukesha County Department of Health and Human Services Economic Support staff to assist individuals in determining eligibility for long-term care support programs by assessing financial and functional needs. The Long Term Care screen includes assessment of :
- Income and assets;
- Activities of daily living (bathing, dressing, mobility, transfers, eating and toileting);
- Instrumental activities of daily living (meal preparation, money and medication management, telephone use, transportation, and employment);
- Health related risks (skilled nursing);
- Diagnoses;
- Behavioral symptoms;
- Cognition.
The assessment also includes information on risk factors, mental health and substance abuse. The functional screen is used to help determine eligibility and is required in order to enroll in a publicly funded long-term care program.
Long Term Care Option's Counseling
Options counseling is available to all Aging and Disability Resource Center of Waukesha County (ADRC) clients, whether or not they are interested in participating in Family Care.
After assessment of individual needs, the Aging and Disability Resource Center of Waukesha County (ADRC) will provide advice about available options to meet those needs. Long term care options counseling will help individuals make informed, cost effective decisions about their long term care and includes pre-admission consultation for individuals entering nursing homes, adult family homes, and assisted living facilities.
Long Term Care Options counseling will:
- Review available services and benefits.
- Explain managed long-term care options, Self Directed Support Waiver option, and services available through a Medicaid card.
- Explore which long-term care option is best for a person.
Long Term Care options may include:
- Enrollment in a Managed Care Organization
- Enrollment with an IRIS Consultant Agency
- Remaining in Medicaid fee for service system
- Self Directed Support
- Private paid services
- Community services
- Other available options
