Lakeland Care District

General questions about Long Term Care Services and Family Care:

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 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 that 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 FC, a care management team of people works together to help you identify what sort of assistance you might need, 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.
Family Care members receive the services that best achieve the results they desire, based on their identified outcomes. “Quality of Life Outcomes” are statements that the FC program strives to achieve, and FC members themselves define what these statements mean to them and their life.

Q: 3. 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 eligible frail elderly people and people with physical and developmental disabilities. Services can include supportive long-term care services, health care services, or both.
In our region, several committees are meeting to develop a structure for a long term care district proposed to serve eligible people in Fond du Lac, Manitowoc and Winnebago counties. The working title for this effort is the Lakeland Care District, which would initially provide long-term care services for eligible residents in these three counties. The ‘Phase 2’ plan for this District is to integrate health care into the list of services it provides.

Q: 4. What does ‘managed care’ mean, and how does it work?
A: The idea behind the current reform effort is to make available an entitlement to services in the community that currently exists only in institutionalized settings and to do so in a planned, member-centered, quality, and cost effective way. The way Family Care works is the state pays each district’s Care Management Organization (CMO) a monthly ‘capitated,’ or per-person rate, for each person enrolled in the program. The CMO 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 goals.

Q: 5. 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, which oversees the program, has projected that savings 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 clients 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: 6. Are “consumer choice” and “cost effective” compatible goals?
A: In developing the Lakeland Care District, we will create a broader network of providers from which consumers can select services. However, in order to provide more services in a cost neutral manner, there must be some attention made to coordinating care. In order to eliminate waiting lists and subsequently reduce costs, we will work hard to provide the highest-quality services to all eligible people in a cost effective manner.

Q: 7. Wisconsin has been viewed as a leader among states with regard to community-based care as a long-term care option.  Why do we need reform?
A: Currently, our system guarantees funding for services provided in nursing homes. However, a lack of funds for community-based services has created waiting lists across the state. Wisconsin’s Family Care pilots have shown that more non-institutional services can be purchased for more people in a managed care environment, eliminating waiting lists and allowing people to remain in the community rather than in more restrictive settings that do not meet their needs.

Q: 8. Is Family Care a Health Maintenance Organization (HMO)?
A: Family Care is not a HMO and will not provide health care services. It is a “managed” long-term care program, which means that it provides for coordination and delivery of services to members related to activities necessary for daily living functions, such as eating and bathing.
While Family Care is not a HMO, it is classified by the federal Center for Medicare and Medicaid Services (CMS) as a Pre-paid Inpatient Health Plan (PIHP) which means that, in many respects, the program is treated similarly to a HMO. It is classified this way because nursing homes and other institutions that provide long-term care services are included in Family Care’s benefit package. Because it’s considered a PIHP by the federal government, this subjects the program to additional regulatory requirements. Some of these requirements are very beneficial to members including Appeals and Grievance procedures, choice of providers and the option to self-direct supports.

Q: 9. 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 within the community.
For those who aren’t already served through Creative Care Options, the ADRCs in Fond du Lac (go to website) and Manitowoc (go to website) will be the first stop for residents who want to enroll in Family Care once the Lakeland Long Term Care District is created and services are available. An ADRC is being developed to serve District residents living in Winnebago County.

Q: 10. How do I sign up for Family Care?
A: If you are interested in Family Care you should contact your local Aging and Disability Resource Center (ADRC). Staff there will assess your circumstances and advise you as to your options and eligibility for a variety of programs, including Family Care. In Fond du Lac County, call: 920-929-3466 or toll-free: 1-888-435-7335. In Manitowoc County, call: (920) 683-4180. Winnebago County does not yet have an ADRC but one is being planned and will be implemented in conjunction with Family Care. A lot depends upon state funding, but at this time it appears that the Family Care benefit will not be available to Manitowoc and Winnebago county residents until 2010 or later.
Regardless of your eligibility for Family Care, visiting the ADRC is your first step to obtaining assistance.

Q: 11. What’s the difference between Medical Assistance, Medicaid, Title 19 and Medicare?
A: Medical Assistance (MA) is Wisconsin’s name for the federal Medicaid program, created under Title 19 of the federal Social Security Act in 1965. MA is an entitlement program that funds a wide range of health and care services for certain low-income individuals, and is commonly also referred to as "Medicaid" or "Title 19." Family Care is a program funded through the state’s MA system.
Medicare is the federally-funded program that provides health care coverage for nearly all people over the age of 65 regardless of income, for some people under age 65 who have disabilities, and for people with end-stage renal disease.

Q: 12. What’s the difference between Waiver services and Family Care services?
A: Family Care benefits are more expansive, and include all Waiver services or long-term support services such as residential services, employment services, work and day services, etc. The Family Care benefit also includes several services that are not currently provided by MA Waiver programs including Medical Assistance Personal Care, nursing home and others.

Q: 13. Of those who are on the ‘waiting list’, what services are people waiting for?
A: Primarily, people are waiting for long-term care services such as home care and personal care, and some mental health services that could be provided in the community.

Q: 14. Will Family Care keep me from going to a nursing home?
A: Family Care is designed to meet an individual’s long-term care needs wherever they need them, so a person could receive services in the community or in a nursing home. Family Care may prevent or delay nursing home admissions to the extent that member’s needed services can be provided cost-effectively through an alternative living arrangement or in their own home or apartment.
Family Care is designed to help people receive services in the community whenever possible. Sometimes nursing home admission may be a good idea for a short time, for example, for rehabilitation when injury has occurred. Family Care benefits its members because their stay in a facility due to short-term needs is monitored by the care management team, who works with the member and the nursing home to get the member back into the community as soon as possible.

Q: 15. Are people with mental health problems 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 diagnosis of mental illness who are not otherwise eligible for Family Care based on a disability or frail elderly need, could continue to receive services through their existing service providers.

Q: 16. Is enrollment in Family Care voluntary?
A: Enrollment in Family Care is voluntary. The State’s goal is to provide long-term care services through a managed care system that is effective and cost efficient. Other options for people who don’t wish to enroll in FC include institutions or using Medicaid card services, which does not cover all of the long term care services such as assisted living, supportive home care, etc.

Q: 17. 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]). The Lakeland Long Term Care district may also provide additional services that are not currently available, if they meet the members’ individual outcomes and are cost effective. 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: 18. Does Family Care provide or pay for housing?
A: In Family Care, housing costs including room and board or rent, continue to be paid by an individual through their own funds including Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Family Care is a Medicaid Waiver program and is limited to paying for services to support individuals in the community.

Q: 19. What if my current care plan and services are self-directed?
A: Self-directed supports are a part of the Family Care program and will be offered through the Lakeland Care District. In addition, a program of self-directed services called IRIS (short for “Include, Respect, I Self-Direct”) is available to people who do not enroll in Family Care. More information about IRIS is available through your ADRC.