Lakeland Care District
(920) 906-5100
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Lakeland Care District
Questions Frequently Asked at Consumer Forums
We will be adding additional forum questions as soon as possible! If you have a question that is not listed here, please call 920-906-5100 for more information.
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The
- The District receives Medicaid funding from the state and federal governments. Districts receive a capitated, or per-person, amount for every member they serve, and the rate is set annually each year by the state’s Department of Health Services.
- The capitated rate includes administrative expenses. The Lakeland Care District is committed to maintaining low administrative costs so that most of our funding is used for services to members.
- The Lakeland Care District establishes and monitors standards for providing quality services to its members, both from the organization itself and through the providers with which it contracts. The standards include such things as timely response to service requests, timely review of all Member Centered Plans (MCPs) and in-depth member satisfaction surveys. . Every year, the District participates in a thorough evaluation conducted by a disinterested outside organization that monitors quality standards and efforts of all of the state’s Managed Care Organizations (MCOs).
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Family Care services may be provided through a public Long Term
Care District or a private nonprofit organization; regardless
which entity provides the services, both must enter into the
same contract with the state’s Department of Health Services.
Local policymakers in
Q. 6 How
does Family Care work with people who have assets?
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In order to be eligible for Family Care, members must meet
functional and financial requirements as determined by the
state. Some assets are
allowed, but those with additional assets may be required to
‘spend down’ to become eligible.
These rules will be explained to you by staff at the
- The staff-to-member ratio varies based on the target group served, but the average ratio for Care Managers is 1:40 and 1:55 for Registered Nurse Care Managers.
- At a minimum the team consists of the member receiving services, a Care Manager and a Registered Nurse Care Manager. The member is encouraged to invite others to participate if they wish, which could include family, friends, providers and caretakers.
- Both the Care Manager and RN Care Manager are members of the Interdisciplinary Team (IDT) in Family Care. The RN Care Manager does not provide direct nursing services, but is an important member of the team for addressing issues related to members’ overall health. The RN Care Manager brings an additional prevention focus to the Family Care program by helping members stay healthier, longer. This in turn results in more cost-effective care.
- Family Care is available to serve members at all levels of need who are eligible for the program. In fact, our care management teams are very effective in addressing ‘low need’ members and preventing their needs from escalating prematurely.
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Family Care is funded through a per-capita method, so the
District receives a set amount of funding for each member it
serves. Since members’ cost of care varies based on their needs
and outcomes, Districts must manage their resources to provide
the right amount of care, in the right place and at the right
time.
- The capitated rate is the amount of funding the state provides for each member enrolled in Family Care. The amount is set by actuaries hired by the state, who calculate the rate based on members’ needs in each District. Because individuals’ needs vary, each District’s capitation rate is different.
- Prevocational services are included in the Family Care benefit package, so yes, they are included in the benefit package.
- We understand the importance of consistency and will do our best to make the transition as smooth as possible. However we are unable to guarantee your Care Manager will remain the same.
Q. 15
Can I maintain my private insurance with Family Care?
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Staff at the
- Your Care Manager and RN Care Manager will walk you through the required paperwork and assist you with any questions you may have.
- Your Care Manager and RN Care Manager will work with you to review and discuss options so you are involved throughout the process. Timeframes will vary depending upon your desired outcomes and the complexity of your needs.
- Family Care is a new program that is focused on your needs and outcomes. It’s individually based, meaning you will work as a member of a team to determine your outcomes and how those will be met. This is a more individualized approach than the former waiver program.
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State guidelines determine how Family Care can be implemented in
every county. If you’re
already receiving county long term care services you will be
contacted to discuss your options for long term care services. If you are
already on your county’s waiting list to receive long term
support you will be
notified by staff from the ADRC when your turn comes up on the
list. If you are
requesting benefits for the first time you need to contact your
Either your Care Manager or RN Care Manager is required to have a face-to-face meeting with you on a quarterly basis. In addition, within the quarter they must also have two additional contacts with you (or with someone whom you have given the IDT staff permission to speak to) about your well-being.
- Both oxygen and in-home nursing are benefits covered under Family Care. Your team will work with you to develop a care plan that meets all of your needs.
- Yes, respite services are covered under the Family Care benefit package.
- The Lakeland Care District will hire and train enough staff to serve its members, so a Care Manager and RN Care Manager will be assigned to work with you.
- The Lakeland Care District will attempt to contract with all providers currently providing services in its member counties. We also expect that additional providers will wish to contract with us. Plus, existing providers may also expand their service offerings, so that members may have additional choices available to them.
- Family Care is a program that empowers its members to determine their outcomes so that together, teams can work to meet those goals. The Inter-Disciplinary Team staff (IDT) is available to help and support the member. In addition, the District will have a Member Rights Specialist in every office who may be contacted for assistance. Members’ parents may choose their level of involvement, and may also be part of the IDT if requested by the member.
Q. 26 Do
you help us find a group home?
- Your team will work with you to determine living arrangements that best fit your personal outcomes.
- IRIS is another program option for meeting long term care needs. The Lakeland Care District encourages you to contact your local ADRC for more information on IRIS.
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In order to meet eligibility requirements you must provide proof
of
- When you become a member of the Lakeland Care District, staff will contact you to provide basic information about Family Care and answer your questions. You will receive your member handbook at that time, and receive annual updates yearly after that.
- We are working with each county to ensure that Care Managers affected by Family Care implementation are provided employment opportunities within the Lakeland Care District.
- A full listing of the Family Care benefit package is available by clicking http://dhs.wisconsin.gov/publications/P0/p00088p.pdf
- Individuals are able to enroll in Family Care at any time, as long as they meet the eligibility requirements.
- The Family Care benefit covers many residential living arrangements, including Assisted Living.
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