Questions about Family Care
Additional information about our proposed rate methodology can be found here.
I saw in the news that you are lowering rates. What does that mean?
Lakeland has historically paid a residential facility the same rate for every member served. Based on how LCI is paid, we need to make sure we are adjusting rates based on individual member needs. Our new rate model serves to support this by paying for care and supervision at the right amount, based on member’s needs, and if needs go up, it adjusts accordingly.
Why are you lowering rates?
Firstly, Lakeland is not universally lowering rates. The cost of care for each member varies based on their needs and desired outcomes and managed care organizations must manage their resources to provide the right amount of care, in the right place and at the right time. The model we are transitioning to provides durable, consistent rate setting that is responsive to reimbursement and member service changes at a foundational level. Lakeland Care’s previous model did not align closely enough with how the members needs matched with the type of setting that could best serve those needs. This meant Lakeland Care was overpaying in several situations. Our new model does create rate increases for providers as members’ needs grow over time and/or when reimbursement rates from DHS to our organization increase.
Will some members be forced out of their long-term care facilities as a result of the rate changes?
Lakeland Care will work with providers to help provide the best option for our members moving forward. To that end, it is our hope that providers will sign the new contract, indicating that they will accept the rates effective April 1, 2021. LCI will be following up with each provider to address any questions about the rates, how we can partner together, and next steps in the process.
What is long-term care?
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.
What is Family Care?
Family Care (FC) is an innovative program that provides assistance through interdisciplinary care management plus the full range of long-term care services, through one flexible benefit program. 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 supports 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 supports. You are an active participant on your care management team, which can also include a family member, a caregiver or other professional if you choose. Family Care members receive the services that best achieve the results they desire, based on their identified outcomes. “Personal Experience Outcomes” are statements that the FC program strives to achieve, and FC members themselves define what these statements mean to them and their life.
What does ‘managed care’ mean, and how does it work?
The idea behind managed care is to make available an entitlement to services in the community in a planned, member-centered, high quality, and cost effective manner. The way Family Care works is the state pays a Managed Care Organization (MCO) like Lakeland Care a monthly ‘capitated,’ or per-person rate, for each person enrolled in the program. The MCO 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.
Is Family Care run by a Health Maintenance Organization (HMO)?
Family Care is not a HMO and does not provide health care services. It is a “managed” long-term care program, which means that it provides 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, in many respects, the program is treated similarly to a HMO. For example, Family Care is subject to similar regulatory requirements that are very beneficial to members including Appeals and Grievance procedures, choice of providers and the option to self-direct supports.
What are Aging and Disability Resource Centers (ADRCs) and how do they fit in the system?
ADRCs are one-stop, county 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 they are also a resource for information on all types of programs for the elderly and people with disabilities.
How do I sign up for Family Care?
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. Regardless of your eligibility for Family Care, visiting the ADRC is your first step to obtaining assistance.
What’s the difference between Medical Assistance, Medicaid, Title 19 and Medicare?
Medical Assistance (MA) is Wisconsin’s name for the federal Medicaid program, created in 1965 under Title 19 of the federal Social Security Act. 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.
Will Family Care keep me from going to a nursing home?
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 members’ 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 after an 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, which works with the member and the nursing home to get the member back into the community as soon as possible.
Are people with mental health needs included in Family Care?
Care plans for Family Care-eligible elders and adults with disabilities who also have mental health needs, will incorporate supports to meet 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 receive assistance through other programs.
Is enrollment in Family Care voluntary?
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.
Does Family Care provide or pay for housing?
In Family Care, housing costs such as 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.
What if I want to self-direct my services?
Self-directed supports (SDS) are a part of the Family Care program and are offered through Lakeland Care. If you choose, your care management team can help you determine which supports to self-direct and get you started in this effort. SDS is a way for members to arrange, purchase and direct their long-term care services. Members have greater responsibility, flexibility and control over service delivery. With SDS, members can choose to control their own budget for services, and may have control over their providers including hiring, training, supervising and firing their own direct care workers. Members can choose to self-direct all or some of their services. With Self-Directed Supports:
- You decide what services you want to self-direct and how much you want to participate in directing those services.
- You decide how much responsibility you want in managing your own budget and what type of supports you would like.
- You can receive assistance and resources to fully participate in SDS the way you would like.
- You decide who you want to provide your services and supports.
- You can choose to have your family, friends and others help you with participating in SDS.
Is Family Care just for “high medical-need” people?
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 working with ‘low need’ members and preventing their needs from escalating prematurely.
How and when can I sign up for Family Care?
If you are requesting benefits for the first time, you need to contact your county Aging and Disability Resource Center (ADRC). Staff there will assist you to determine eligibility and enroll you into the program you choose. Your ADRC will provide you with more specific information.
Is respite a Family Care benefit?
Yes, respite services are covered under the Family Care benefit package.
If you are an undocumented immigrant can you still receive the Family Care benefit?
Undocumented immigrants are not eligible for the program. In order to meet eligibility requirements you must provide proof of United States citizenship.
What services are covered? Which services are excluded?
A full listing of the Family Care benefit package is available by clicking: http://dhs.wisconsin.gov/publications/P0/p00088p.pdf
Does Family Care pay for Assisted Living?
The Family Care benefit covers many residential living arrangements, including Assisted Living.
How many options and choices will consumers have to choose from?
Lakeland Care offers a broad network of local providers, so that members have options to select the services they require to meet their health and safety needs. You, along with the care manager and the nurse care manager on your Inter-Disciplinary Team (IDT), will work together to determine your providers.
How will Family Care affect family members?
Lakeland Care members are part of their IDT. At the member’s request, family members, guardians and/or other advisors can also be actively involved in developing care plans. Family members also participate by providing feedback on the effectiveness of the care plan.
Does Lakeland Care include medical care?
Medical services such as physician visits would still be covered under Medicaid’s Title 19 program and not by Lakeland Care.
Does Lakeland Care serve children?
No, the Family Care program is only for adults age 18 and older.
How is Lakeland Care funded?
Lakeland Care receives Medicaid funding from the state and federal governments. MCOs receive a capitated, or per-person, amount for every member they serve, and the rate is set annually by the state’s Department of Health Services.
Do you have a set level of care rate for members?
Family Care is funded on a per-capita basis, so Lakeland Care receives a set amount of funding for each member it serves. Since members’ cost of care varies based on their needs and desired outcomes, managed care organizations must manage their resources to provide the right amount of care, in the right place and at the right time.
What is the state capitated rate? How is it calculated? Is each MCO’s capitated rate the same?
The capitated rate is the amount of funding the state provides to a Managed Care Organization 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 MCO. Because individuals’ needs vary, each MCO’s capitation rate is different.
Is Administrative staff part of the capitated rate?
The capitated rate covers all costs, including administrative expenses. Lakeland Care administrative costs are very low, typically less than 4%, so that about 96 cents of every dollar of Lakeland Care funding is used for services to members.
How does Family Care work with people who have assets?
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 county Aging and Disability Resource Center (ADRC) and are based on individuals’ circumstances.
What are the quality measures?
Lakeland Care 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 member satisfaction surveys. Each year, the Lakeland Care participates in a thorough evaluation conducted by a disinterested outside organization that monitors the quality standards and efforts of all of the state’s Managed Care Organizations (MCOs).
Who is part of the Inter-Disciplinary Team (IDT)?
At a minimum the team consists of the member receiving services, a Care Manager and a Registered Nurse Care Manager. If they wish, members may invite others to participate including family, friends, providers or caretakers.
What if I don’t need a Registered Nurse?
Both the Care Manager and RN Care Manager are members of the Inter-Disciplinary 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 Family Care program includes an RN Care Manager on the team to focus on preventative efforts aimed at helping members stay healthier, longer. This in turn results in more cost-effective care.
Will there be a lot of paperwork?
Your Care Manager and RN Care Manager will walk you through the required paperwork and assist you with any questions you may have.
What is the timeframe for decisions being made?
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.
What are the minimum contact standards?
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.
I’m a parent providing full-time care to my adult child. Do I need to always advocate?
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, Lakeland Care has a Member Rights Specialist located in each 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.
How will Family Care affect service providers?
Lakeland Care is responsible for developing a network of local providers suitable to serve members in our geographic service region. The network will focus on offering covered services necessary to meet members’ needs. We will contract with providers based on members’ needs and provider’s qualifications, ability, skill and licensure. In Family Care, members are part of the team that is involved in service decisions and choice of providers.
How can I share my views about Lakeland Care or ask questions?
A feedback form available on this website allows you to send us an email. Please visit our contact us tab at the top of the website to submit your feedback.