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Publicly Funded Long Term Care

Aging and Disability Resource Center

Aging and Disability Resource Centers (ADRCs) offer the general public a single entry point for information and assistance on issues affecting older adults, adults with disabilities, or their families. These centers are welcoming and convenient places to get information, advice and access to a wide variety of services. As a clearinghouse of information about long-term care, they will also be available to physicians, hospital discharge planners, or other professionals who work with older adults or adults with disabilities.

Resource center services are available to everyone, whether or not they are eligible for a publicly funded long-term care program or other Medicaid programs.

General information:

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, housekeeping or nursing. Long-term care is provided in people’s homes, in small and large residential care facilities or group homes, in nursing facilities and in the workplace.

Publicly funded long-term care programs are designed to provide cost-effective, comprehensive and flexible long-term care that will foster consumers’ independence and quality of life, while recognizing the need for interdependence and support. These programs were developed to improve the cost-effective coordination of long-term care services by creating flexible benefits that include a large number of health and long-term care services that otherwise would be available through separate programs. In order to assure access to services, The State of Wisconsin contracts with Managed Care Organizations (MCOs) which develop and manage a comprehensive network of long-term care services and support, either through contracts with providers, or by direct service provision by MCO employees. MCOs are responsible for assuring and continually improving the quality of care and services consumers receive. Individuals participating in any of the publicly funded long term care programs may be required to pay a cost share as part of their eligibility requirements.

These programs began in Waukesha County on July 1st of 2008 replacing what had been the Community Options Program (COP) and the Community Integration Program (CIP).

Anyone interested in learning more about options for their long-term care needs should contact the Aging and Disability Resource Center of Waukesha County at (262) 548-7848 or (866) 677-2372

ADRC

Publicly funded long-term care programs serve adults with physical disabilities, adults with developmental disabilities and frail elders, with the specific goals of:

  • Giving people better choices about where they live and what kinds of services and supports they may receive to meet their needs
  • Improving access to services
  • Improving quality through a focus on health and social outcomes
  • Creating a cost-effective system for the future.

Individuals with concerns or complaints about Publicly Funded Long Term Care programs can contact:

Participants age 60 and up:

Wisconsin Board on Aging and Long Term Care
1 (800) 815-0015(262) 785-7166

Regional Ombudsman, Joan Schmitz
1402 Pankratz Street, Suite 111,
Madison 53704-4001
Email: joan.schmitz@wisconsin.gov

More information regarding the Wisconsin Board on Aging and Long Term Care can be found in the Advocacy section of this book.

Participants age 18 - 59:

Disability Rights Wisconsin
(414) 773-4646
TTY 1 (888) 758-6049 (800) 708-3034

6737 West Washington Street #3230,
Milwaukee 53214

Disability Rights

 

There are several program options for Waukesha County residents to choose from and they are as follows:

Family Care

The Family Care benefit is available through Managed Care Organizations (MCOs).

Waukesha County offers a choice of two MCOs. They are Care Wisconsin and Community Care. The MCOs serve adults in three primary target groups who have a long-term care condition expected to last for more than 90 days. The three Family Care target groups are:

  1. Frail Older Adults (65 years or older, except in Milwaukee County)
  2. Adults with Physical Disabilities (17 years, 9 months or older)
  3. Adults with Developmental Disabilities (17 years, 9 months or older)

To be eligible for Family Care an individual must fit in one of the three target groups, live in a Family Care county, and meet the financial and functional eligibility requirements. The Long Term Care Functional Screen determines functional eligibility. The screen assesses an individual’s medical status and level of independence in activities of daily living. Medicaid-eligible individuals automatically meet the financial eligibility criteria for Family Care.

Once enrolled in Family Care, you will be assigned a care team consisting of a care manager and registered nurse. You and your team will develop an individual service plan that will focus on your long term care needs. This plan will then be coordinated by your Family Care team.

More information about Family Care can be found at: 


Family Care


Family Care Partnership

Family Care Partnership serves the same target groups described under Family Care. However, the Family Care Partnership option is only offered through the MCO Community Care. This option provides a full range of long-term care, primary, acute and preventive care delivered through interdisciplinary teams that include a registered nurse, licensed social worker, nurse practitioner, rehabilitation and recreation therapists, dietitian and doctor who work together to ensure your complete social, personal and medical care needs are met. Eligibility requirements for Family Care Partnership are the same as those under Family Care.

More information about Family Care Partnership can be found at: 

Partnership


PACE (Program of All-Inclusive Care for the Elderly)

The option of the PACE program through MCO, Community Care, is for individuals age 55 and up who also meet the eligibility requirements described under Family Care and Family Care Partnership. PACE is a nationally recognized model which provides a comprehensive program that fully integrates all Medicare and Medicaid covered institutional and community based services, including a full range of long term care and medical care. The interdisciplinary team is the same as listed under Family Care Partnership. PACE is an adult day centered model and includes coverage of many services including but not limited to dental, vision, hearing and foot care, home health services, transportation, caregiver respite, physical and occupational therapy, home delivered meals and end of life/palliative care.

More information about PACE can be found at:

PACE


IRIS (Include, Respect, I, Self Direct)

IRIS is Wisconsin’s Medicaid long-term support Self-Directed Waiver Program. It is available in counties where Family Care operates with the same eligibility requirements as Family Care and Family Care Partnership . In IRIS, you direct your own services and supports rather then being managed by an MCO. The State contracts with an Independent Consultant Agency (ICA) and a Financial Services Agency (FSA) that are available to assist you in managing your care plan. The ICA oversees a group of Independent Consultants (IC) who help you to plan for the support and services you need within the cost of your allocated budget (which is determined by the Long Term Care Functional Screen).

For more information about IRIS: Call 888-515-IRIS (4747) Toll-free or Email: info@wisconsin-iris.com; or visit the following websites:

IRIS


Managed Care Organizations

Care Wisconsin

(262) 523-1600(866) 530-2295

N19 W24075 Riverwood Drive,
Waukesha 53188

CARE WI

 

Community Care

(262) 953-8500

1801 Dolphin Drive,
Waukesha 53186

Community Care