Demographics in the U.S. are changing, as 10,000 baby boomers turn 65 each day through the year 2030, says the Pew Research Center. According to the 2015 National Council on Aging’s United States of Aging Survey, 75% of older adults prefer to continue living in their own home as they age.

Long-term care services are thus vital to assisting these individuals live in their home for as long as possible. Family Care, a Medicaid long-term care program in Wisconsin, was created in 1999 to offer services to eligible individuals, including older adults, to support independence and quality of life.

Now available statewide, enrollment in the Family Care program in Wisconsin has doubled in the last 10 years, from 23,824 as of Jan. 1, 2009, to 48,936 on Feb. 1, 2019. As our population ages, it is imperative that attorneys specializing in health care, elder law, disability law, and estate planning are aware of Family Care as one of the many resources that may be available to their clients.

Eligibility for Family Care

Eligibility for Wisconsin’s Family Care program under Wis. Stat. section 46.286(1) is for residents who have a long-term care condition expected to last for more than 90 days who are:

• frail elders (over 65 years of age and have a physical disability or irreversible dementia);

• individuals with physical disabilities (18 years of age and older); or

• individuals with developmental disabilities (18 years of age and older).

Each individual must also have both:

• functional eligibility, as defined in Wis. Stat. section 46.286(1)(a), with a level of care need at either the nursing home level or non-nursing home level; and

• financial eligibility, as defined in Wis. Stat. section 46.286(1)(b).

How to Enroll

The Family Care program is available to eligible residents in all Wisconsin counties. Individuals and their families can obtain information about all the community resources available to them, including the Family Care program, through their local Aging and Disability Resource Centers. Each ADRC helps the general public understand the many different programs and benefits that may be available to individuals and their families. ADRCs serve as the starting point for enrollment in many services.

Individuals enrolled in the Family Care program become a member of a Managed Care Organization (MCO). Each MCO provides or coordinates services tailored to each member’s needs and preferences, which may include the preference to continue living at home. Most Wisconsin residents have a choice of MCO in each county based on the Family Care Geographic Service Regions Map.

Benefits and Services

Once an individual is enrolled in the Family Care program through an MCO, the MCO is required – under Article V of the Family Care Contract between the Wisconsin Department of Health Services and each MCO – to ensure that each member has a “meaningful opportunity to participate in the initial development of, and updating of, his/her member-centered plan.” Member-centered planning is an ongoing process which reflects changes in the member’s life and is updated through reassessments every six months.

Each member is provided member-centered care management through a designated interdisciplinary team (IDT) staff, which includes the member, a social service coordinator, a Wisconsin-licensed registered nurse, and anyone else the member chooses. Each IDT determines which services the member may receive under the Family Care Benefit Package and other available resources, and authorizes for the services to be delivered.

Services include adaptive aids, durable medical equipment and supplies, home delivered meals, home modifications, nursing services, residential services, and supportive home care.

MCOs manage delivery of high-quality services to each member through a network of long-term care providers. Each MCO is responsible for maintaining an adequate network of long-term care providers under Wis. Stat. section 46.284(3)(b), which includes:

• providers with expertise and ability to provide services that are responsive to the disabilities or conditions of the individuals enrolled in the Family Care Program;

• providers that can meet preferences and needs for services at various times;

• availability of residential and day services;

• supported living arrangements of different types and sizes; and

• coverage for specific geographic areas.

A Member-centered Care Option

Family Care is a flexible, member-centered option for eligible Wisconsin residents that provides individuals the opportunity to reside in their own homes while receiving high quality support and care management.

Enrollment in the Family Care program is likely continue to grow as Wisconsin’s population ages. Knowledge and support of this important long-term care program will benefit Wisconsin’s legal community and residents in many enriching ways.

This article was originally published on the State Bar of Wisconsin’s Health Law Blog. Visit the State Bar sections or the Health Law Section web pages to learn more about the benefits of section membership.