Wisconsin Department of Health Services Family Care in Wisconsin Presented by: Kristen Felten, MSW, APSW Office on Aging June 14 th, 2011

2 What is Family Care?  Home and Community Based Medicaid Waiver Program  Combines Medicaid long term care card services with long term care waiver services  Managed Care

3 Who Is Eligible?  Adults  Meet Medicaid asset limit (~$2000)  At or below 300% of federal poverty line for income AND  Eligible at a nursing home level of care as determined by the long term care functional screen

4 History of Family Care  Pre-Family Care  Before 1980  Nursing home entitlement with Medicaid card  In the 1980’s  Community Options Program  Elders and people with physical disabilities  Community Integration Program  People with developmental disabilities

5 History of Family Care  Pre-Family Care  1990’s  Concerns about access, complexity and institutional bias led to a proposed new Medicaid managed long-term care model  Stakeholder process involving hundreds of consumers, family members, providers, and advocates

6 History of Family Care  Family Care pilot project began in 1999 with the first contract issued in  Five pilot counties  Milwaukee – elders  Richland  Portage  La Crosse  Fond du Lac

7 History of Family Care  Purpose of pilot testing was to demonstrate that Family Care was able to serve all eligible individuals within the service area at the same or lower costs than the COP and CIP waivers.  Pilots lasted for 5 years.  Pilots demonstrated Family Care saved money compared to current programs while serving all eligible individuals.

8 History of Family Care  In comparison to other MA participants, Medicaid spending was:  $452 lower pmpm in 4 pilot counties, and  $55 lower pmpm for each frail elder member in Milwaukee County  How were savings achieved:  Reduced reliance on institutional care  Health and functional status was maintained, rather than declining as in the comparison group

9 History of Family Care  In January of 2006 the Governor announced the expansion of Family Care statewide.  In November 2006 expansion began with the start up of the ADRCs in Racine and Kenosha counties.

10 ADRCs in Family Care  Aging and Disability Resource Centers are the front door to all publicly funded long term care programs in WI.  ADRCs explain all of the long term care program options to potential enrollees  ADRCs determine functional eligibility for those programs

11 ADRCs in Family Care  ADRCs assist the individual in making the Medicaid application and getting an eligibility determination.  ADRCs enroll eligible individuals into the program of their choice.  And more

12 MA Waiver Services Family Care MA LTC Card Services Acute & Primary Medicare or MA Assisted Living Home Care Home Mods Day Services Lifeline Home Health Nursing Home Med Transportation Med Equipment MD Visits Lab Tests Hospital Therapy Rx (Part D)

14 Family Care  Contracts with 10 managed care organizations for long-term care  74% of state population 18+ has access  MCO costs, July June 2010 estimated to be $862 million federal and state funds, not including Medicaid card services

15 Managed Care Organizations  To support elders and people with disabilities to get the care and results they want in a way that manages money wisely  Risk-based, managed care business model with reimbursement based on actuarially sound rates  Public agencies or districts, private organizations, profit or not  Directly provide service or contract for service

16 Interdisciplinary Care Teams  Consist of at least a nurse and a social worker  Help members determine the outcomes they want  Include members in decision-making and creating a plan for services that is focused around the member, not the bureaucracy  Provide services to the member, either with staff from the MCO or staff the MCO hires to help the consumer  Coordinate with other services the member needs, like medical care or hospitalization  Assure that quality services are provided

17 Family Care Outcomes  I decide with whom and where I live  I make decisions about my supports and services  I decide how I spend my day, including work if I want  I have relationships with family and friends I care about  I work or do other things that are important to me  I am involved in my community  My life is stable  I am respected and treated fairly  I have privacy  I have the best possible health  I feel safe  I am free from abuse and neglect

18 Payment in Family Care  The MCO’s are paid a capitated per member, per month rate at the beginning of each month to provide care to their members.  The rate is determined using current and historical data from long term care functional screen results, historical costs and cost projections.  Rates for each MCO are based upon the actuarially determined rate for their membership’s acuity level.

19 Family Care and Dementia  Pay for Performance Project  Additional funding was provided to MCOs that provided the following to their members:  Animal naming screen  Cognistat  Referral to a physician and follow up  Care Coordination Interventions for those with dementia  Results are not yet available

20 Family Care and Dementia  Flexibility in care planning to address special challenges in providing care.  Incentive to help people stay in the least restrictive setting.  Care management follows people through health events to the rehab facility and back home.  Follows members to residential facilities and even nursing home placement to ensure continuity of care management.

21 Satisfaction in Family Care  The people, the excellent care, the ability to live in my own apartment. Knowing I don't have to give up my dog or not be able to care for her and myself. If it was not for Family Care helping me I would not be able to take the medications I need and would not be able to stay in my apartment.  We like that they come to our house. They tell us new things and seem to have our interests at heart. They are looking down the road for what might be needed.  My mom’s quality of life is significantly richer! They treat us like family. The equipment they purchased like alarms and her high-low bed give us the security we needed!

22 More Information  Family Care Website   ADRC Website   Office for Family Care Expansion  Sharon Ryan, Program and Policy Analyst   Speaker info  Kristen Felten, Office on Aging 