CCCW: FAQ

Frequently Asked Questions

What is long-term care?

What is long-term care reform?

What is Family Care?

Who is Eligible for Family Care

How do I apply for Family Care?

What if I don't qualify for Family Care?

Will I be put on a waiting list?

What is Community Care of Central Wisconsin(CCCW)?

Why are Marathon, Portage and Wood Counties creating a regional organization to deliver Family Care to area residents?

Why is Family Care already available in Portage County?

When will Family Care be available in Marathon and Wood Counties?

What is included in the Family Care benefit package?

What will happen to the services I am already getting through community waivers?

How will county tax payers be affected by Family Care expansion?

How can I learn more?

How can I become involved?

Because of frailties of aging or a developmental or physical disability, many people need help accomplishing activities of daily living and caring for their health. This help, referred to as long-term care, includes many different services, such as personal care, pre-vocational and vocational, housekeeping or nursing. Long-term care is provided where needed, in peopleÎs homes, in small and large residential care facilities or group homes, in nursing facilities and in the workplace.

Most long-term care is actually provided by family members, and many people pay directly for the care they receive. Yet the government in Wisconsin still spends more than a billion dollars a year paying for care that Wisconsin residents themselves cannot afford

State of Wisconsin Department of Health and Family Services (DHFS):http://www.dhfs.state.wi.us/LTCare/Generalinfo/Index.htm

What is long-term care reform?

Many things about our current long-term care system are right and are working just fine. Our Community Options Program (COP) is a national model for flexible home and community supports and services. Supplemented by our federal Medicaid waivers for home and community-based care, we have built a strong program that is popular and cost-effective. Our nursing homes are among the best in the nation, and we have high quality providers of all kinds throughout the system. We have a network of skilled county case managers with long experience in working with elderly people and people with disabilities to build individualized plans of support.

However, several years of intensive study have pointed out some serious flaws with the way we organize and deliver long-term care in Wisconsin. People with disabilities and, in particular, older people and their families tell us that the system often doesnÎt make good sense and doesnÎt work for them. And analysis shows that we could be far more efficient with our resources, serving more people for the same amount of money.

To help determine how to improve long-term care, the Wisconsin Department of Health and Family Services spent more than two years during the mid-1990s gathering information not only from people who need long-term care, but also their relatives and service providers, as well as experts and taxpayers.

A new plan called Family Care was proposed in 1998 for consideration by citizens and their elected representatives. In his February 2006 State of the State speech, Governor Doyle announced plans to expand Family Care statewide and eliminate waiting lists for community-based long-term care programs during the next five years.

DHFS: http://www.dhfs.state.wi.us/LTCare/History/whatwrong.htm

What is Family Care?

Family Care is the name given by Governor Thompson to the State of WisconsinÎs reform of Long Term Care Services provided to seniors and to adults who are physically and/or developmentally disabled. Family Care strives to:

Give people better choices about where they live and what kinds of services and supports they get to meet their needs.
Improve access to services.
Improve quality through a focus on health and social outcomes.
Create a cost-effective system for the future.

Family Care has two major organizational components:

Aging and disability resource centers (ADRCs), designed to be a single entry point where older people and people with disabilities and their families can get information and advice about a wide range of resources available to them in their local communities.
Managed Care Organizations (MCOs), which manage and deliver the new Family Care benefit, which combines funding and services from a variety of existing programs into one flexible long-term care benefit, tailored to each individualÎs needs, circumstances and preferences.

DHFS: http://www.dhfs.state.wi.us/LTCare/Generalinfo/WhatisFC.htm

Who is Eligible for Family Care?

Individuals are required to meet both functional and financial eligibility criteria to qualify for Family Care.

Functional Eligibility Criteria:Functional eligibility is based on the degree to which an individual can independently manage the activities of daily living, such as mobility and eating, and/or instrumental activities of daily living, such as money management or arranging transportation. The Long Term Care Functional Screen, administered by Resource Center staff, determines functional eligibility.

Financial Eligibility Criteria: Besides functional eligibility criteria, individuals must also meet certain financial thresholds to be eligible for Family Care. Medicaid-eligible individuals automatically meet the financial criteria for Family Care. Individuals who are not financially eligible for Medicaid may still qualify for Family Care based on their cost of care.

Individuals receiving the Family Care benefit may be required to pay a cost share to the care management organization (CMO). Except for the functional eligibility determination made at the Resource Center, all other eligibility determinations, and cost-share, are determined at the county Economic Support Unit.

DHFS: http://www.dhfs.state.wi.us/Medicaid2/handbooks/familycare/member.htm

How do I apply for Family Care?

Anyone interested in learning more about his/her options for long-term care, including applying for the Family Care benefit, should contact the county's Aging and Disability Resource Center. Resource center services are available to everyone, whether or not they are eligible for Family Care or other Medicaid programs.

Aging and Disability Resource Center staff offer counseling on available long term care options, including the Family Care benefit. If you are eligible for Family Care and choose to participate in Family Care, you will enroll in an MCO. Resource Center staff and/or Family Care enrollment brokers will help you complete the necessary paperwork for enrolling in an MCO.

DHFS: http://www.dhfs.state.wi.us/LTCare/Generalinfo/Apply.htm

DHFS: http://www.dhfs.state.wi.us/Medicaid2/handbooks/familycare/member.htm

What if I don't qualify for Family Care?

Aging and Disability Resource Centers assist individuals to access long term care services regardless of the level of disability, the level of income, or the amount of assets available to pay for services. For those who are not interested or do not qualify for Family Care, Aging and Disability Resource Center staff are knowledgeable and able to provide unbiased information about a variety of other options available to meet their care needs, the costs associated with various options, and other sources of funding that may be available.

The State of Wisconsin has developed a helpful on-line tool (https://access.wisconsin.gov/access) to assist people in finding out if they are likely to be eligible for Wisconsin Medical Assistance or other public benefits. Those who decide to apply can submit an application on-line. The on-line program does not save anyone's personal information unless they actually decide to apply.

Will I be put on a waiting list?

In current Family Care counties there are no waiting lists. Seniors and adults with physical and/or developmental disabilities who meet eligibility requirements are already able to enroll in Family Care. In new counties offering Family Care, existing Community Options Program and waiver participants will be immediately eligible to participate in Family Care.

Individuals currently on waiting lists will be part of a 24-month phase out process that has been set by the State Department of Health and Family Services. Finally, any individuals applying for Family Care once the program starts in new counties, will be added to existing waiting lists.

What is Community Care of Central Wisconsin (CCCW)?

Intensive planning activities for Family Care expansion are taking place in county consortia throughout the state. In Central Wisconsin, Wood, Marathon, and Portage counties have partnered together to plan for regionalization under the proposed name of Community Care of Central Wisconsin (CCCW). This new entity will be the Managed Care Organization (MCO) that will be responsible for delivering Family Care benefits and services to eligible Central Wisconsin residents.

Why are Marathon, Portage and Wood Counties creating a regional organization to deliver Family Care to area residents?

As the State works to expand the Family Care program with the goal of statewide implementation, regionalization is preferred because it has the potential to increase business efficiencies, thereby ensuring a long term care program that will be sustainable into the future. Community Care of Central Wisconsin (CCCW) intends to capitalize on the existing partnerships, strengths and capacities in Marathon, Wood and Portage Counties. Building on Portage County's experience as one of the five pilot sites will ensure that the new regional MCO will become operational as quickly and efficiently as possible.

CCCW's tri-county governance structure allows Marathon, Portage, and Wood County governments the ability to retain a local leadership role in the delivery of long term care services to respective eligible county residents.

Why is Family Care already available in Portage County?

Portage County was fortunate to be one of nine counties chosen in 1997 to begin operation of an Aging and Disability Resource Center. In October of 1998, Portage County was again chosen to pilot the second phase of Family Care, the operation of a Care Management Organization. These decisions by the State Department of Health and Family Services allowed the Family Care benefit to become available to eligible Portage County residents. Community Care of Portage County (CCPC) began operation as the Portage County Care Management Organization on April 1, 2000.

When will Family Care be available in Marathon and Wood Counties?

Community Care of Central Wisconsin is working to bring Family Care to Marathon and Wood Counties as quickly as possible. However, there are many structural and operational decisions that the governing board needs to make and management needs to put in place before the organization is fully functional. We are hoping to have Family Care available in Marathon County by the first quarter of 2008 and to phase in Wood County several months later, but at this time there is no definite timeline available.

If you are not currently receiving long term care services and are not on a waitlist, but think you will qualify for Family Care, it would be a good idea to get in touch with your local Aging and Disability Resource Center to discuss what your current options are.

What is included in the Family Care benefit package?

The services members receive are based on the most effective and cost-effective way to meet needs and achieve desired outcomes. The specific services each member receives are outlined in a Member Centered Plan. Services other than those listed below may also be provided based on necessity for them as decided by the team. When needs, goals or preferences change, services will change right along with them.

Adaptive Aids (general and vehicle)
Adult Day Care
Alcohol and Other Drub Abuse Day Treatment Services (in all settings)
Alcohol and Other Drug Abuse Services, except those provided by a physician or on an inpatient basis
Case Management (including assessment and case planning)
Communication Aids/Interpreter Services
Community Support Program
Counseling and Therapeutic Resources
Daily Living Skills Training
Day Services/Treatment
Durable Medical Equipment, except for hearing aids and prosthetics (in all settings)
Home Health
Home Modifications
Meals: home delivered
Medical Supplies
Mental Health Day Treatment Services (in all settings)
Mental Health Services, except those provided by a physician or on an inpatient basis
**Nursing Facility (all stays including Intermediate Care Facility for people with Mental Retardation [ICF/MR] and Institutions for Mental Disease [MD]
Nursing Services (including respiratory care, intermittent, and private duty nursing
Occupational Therapy (in all settings except for inpatient hospital)
Personal Care
Personal Emergency Response System Services (i.e. Lifeline)
Physical Therapy (in all settings except for inpatient hospital)
Prevocational Services
Protective Payment/Guardianship Services
Residential Services: Community Based Residential Facilities (CBRF), Adult Family

**Homes, Residential Care Apartment Complexes (RCAC)
Respite Care (for caregivers and members in non-institutional and institutional settings)
Specialized Medical Supplies
Speech and Language Pathology Services (in all settings except for inpatient hospital
Supported Employment
Supportive Home Care Transportation: Select Medical Assistance covered (i.e. all Medical Assistance covered (i.e. all Medical Assistance covered Transportation Services except Air and Ground Ambulance Services) and non-Medical Assistance covered Transportation Services

**is not available to members who are eligible at the intermediate level of care unless he/she is residing in one of these facilities at the time of enrollment.

If a member is at the intermediate level of care and needs a nursing facility the Resource Center will complete a new functional screen.

"What will happen to the services I am already getting through community waivers?

A unique feature of Family Care is the Interdisciplinary Care Management Team (IDT). Teams include, at minimum, the member (Family Care participant), a social work service coordinator, and a registered nurse. Teams, including the member, work to coordinate the services that will most cost effectively help the member achieve his/her desired outcomes. Members, or authorized representatives, take an active role in care plan development. The nurse and social work service coordinator assist members in making informed decisions about their needs and the services they receive.

Your assigned Interdisciplinary Care Management Team will review your current care plan with you to determine if your services are based on the most effective and cost-effective way to meet your needs and achieve your desired outcomes.