Publicly Funded Long Term Care Programs
Long-term care is any service or support that a person may need as a result of getting older or having a disability that limits their ability to do the things that are part of their daily routine. Long-term care services include things such as assistance with bathing, dressing, making meals, going to work, and paying bills. Long-term care services may be provided in people’s homes, in small and large residential care facilities, in group homes, in nursing facilities, or in the workplace, in addition to other settings.
Publicly funded long-term care programs are Medicaid programs designed to provide cost-effective, comprehensive, and flexible long-term care services 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.
Publicly funded long-term care programs serve adults with physical disabilities, adults with intellectual/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
What are the eligibility criteria for long-term care programs?
To be eligible for the publicly funded long term care programs, you must:
- Be aged 65 or older, or an adult with a disability
- Meet applicable requirements for Wisconsin residency
- Have long-term care service needs that meet program functional eligibility requirements. Functional eligibility is determined by the Long Term Care Functional Screen
- Meet financial eligibility requirements
People receiving a long-term care benefit may be required to pay a cost share to the long-term care program they choose to enroll in.
Once your eligibility for long-term care has been determined, the ADRC will provide information about the options available to you. Options may include enrollment in Family Care, Partnership, PACE, or IRIS. You may also be able to choose to receive services through the Medicaid fee-for service system or to privately pay for services.
If you decide to enroll in a publicly funded long-term care program, the ADRC will complete enrollment or referral paperwork, finish the enrollment or referral process, and notify the managed care organization (MCO) or IRIS consultant agency (ICA) of the enrollment or referral date. Within three days after your enrollment date or referral, the MCO or ICA will contact you to begin working on your plan for services and supports.
What publicly funded long-term care programs are available in Waukesha County?
Family Care
Family Care is a Medicaid long-term care program for frail elders and adults with physical, developmental, or intellectual disabilities. In Family Care, you will receive long-term care services to help you live in your own home whenever possible. Family Care is an innovative program that provides a full range of long-term care services, all through one flexible benefit program. When a person enrolls in Family Care, they join a managed care organization (MCO). Wisconsin Department of Health Services (DHS) pays MCOs monthly for each member they serve. The MCO uses the funds to find and schedule services for its members based on need, situation, and preference. If you enroll in Family Care, your MCO will give you a full list of benefits. Additionally, MCOs have a full list of long-term care providers. They make sure services for members are top quality.
If you are found functionally eligible at the non-nursing home level of care, you may only be eligible for a limited set of services.
Once enrolled in Family Care with an MCO, 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 you and your Family Care team.
MCOs offering Family Care in Waukesha County include:
For more information about Family Care go to the WI Dept. of Health Services Family Care Page.
Family Care Partnership
Partnership (also called Family Care Partnership) is a Medicaid long-term care program for frail elders and adults with physical, developmental, or intellectual disabilities who meet a nursing home level of care. The Partnership program offers an integrated model of care that includes home and community-based long-term care services, as well as nursing home and other institutional care, physician services, hospital stays, medications, dental services, and other medical care. These services are delivered through interdisciplinary teams that may 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.
MCOs offering Partnership in Waukesha County include:
For more information about Partnership go to the WI Dept. of Health Services Partnership Page.
Program of All-Inclusive Care for the Elderly (PACE)
PACE, like Partnership, integrates your long-term care services, health and medical care services (primary and acute care), and prescription medications. PACE is available to individuals who are 55 or older and meet a nursing home level of care. PACE services are primarily delivered at a PACE center and supplemented with care in your home or a setting of your choice. PACE 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. The interdisciplinary team is the same as Partnership.
MCOs offering PACE in Waukesha County include:
For more information about PACE go to this WI Dept. of Health Services PACE document.
Include, Respect, I Self-Direct (IRIS)
IRIS is a self-directed program for Wisconsin’s frail elders and adults with disabilities who meet a nursing home level of care. IRIS is built on the principles of self-determination and self-direction. In IRIS, a budget is established for you based on your long-term care needs. You get to decide what goods, support, and services will help you achieve your goals and, using your budget, you will help create a support and service plan to meet your needs. Your IRIS services will be there to help you live a meaningful life. In IRIS, instead of contracting with 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.
ICAs serving Waukesha County include:
FEAs serving Waukesha County include:
For more information about IRIS go to the WI Dept. of Health Services IRIS Page.
