Understanding Wisconsin's Family Care Program
Wisconsin's Family Care is a comprehensive, Medicaid-funded long-term care program designed to help older adults and adults with disabilities live as independently as possible in their homes and communities. Rather than focusing on institutional care, the program provides services and support to manage a range of needs, from help with daily tasks like bathing and cooking to more complex medical needs. Administered through managed care organizations (MCOs), the program coordinates services based on each member's unique situation and preferences.
Core Eligibility Requirements
To determine who is eligible for family care in Wisconsin, applicants must meet three primary criteria: age, functional needs, and financial status. An application process is initiated through a local Aging and Disability Resource Center (ADRC), which helps individuals and families navigate their options.
Age and Residency
To be considered, an applicant must be a Wisconsin resident and fall into one of two age categories:
- An adult (age 18 or older) with a physical, intellectual, or developmental disability.
- A frail elder, age 65 or older.
Functional Eligibility
This requirement assesses an individual's need for long-term care support. The determination is made through the Wisconsin Adult Long-Term Care Functional Screen. The screen measures a person's ability to perform routine daily activities such as bathing, dressing, and preparing meals. An individual must have a long-term care condition expected to last more than 90 days.
Financial Eligibility
Family Care is a Medicaid-funded program, so financial eligibility is a key component. Applicants must meet specific income and asset limits set by the state. For individuals who are not already on Medicaid, the ADRC can assist with the financial application. The financial limits often change annually, and certain assets like the primary residence may be exempt under specific conditions.
The Role of the Aging and Disability Resource Center (ADRC)
Your local ADRC is the first point of contact for anyone interested in Wisconsin's long-term care programs. This service is free and provides comprehensive information and assistance. An ADRC will help you:
- Understand the different long-term care programs available, including Family Care and IRIS (Include, Respect, I Self-Direct).
- Conduct the initial screening to see if you meet the functional requirements.
- Begin the financial application process for Medicaid if you are not already enrolled.
- Receive enrollment counseling to make an informed choice about the program that best fits your needs.
Family Care vs. Family Care Partnership
While both are Medicaid long-term care programs in Wisconsin, there are important distinctions to understand. The right program for an individual depends on their specific needs and location.
| Feature | Family Care | Family Care Partnership |
|---|---|---|
| Services Covered | Long-term care services only (e.g., personal care, meal prep, transportation). Members use their regular Medicaid for medical services. | Combines long-term care services with full medical care, including doctor visits, hospital stays, and prescription drugs. |
| Availability | Available statewide to all eligible individuals. | Available only in certain counties. Waitlists can exist depending on enrollment capacity. |
| Target Audience | Frail elders and adults with disabilities who need long-term care assistance. | Frail elders and adults with disabilities who need a more integrated, comprehensive care package. |
Navigating the Application Process
The path to enrollment involves several steps to ensure all requirements are met. It's a structured process designed to be thorough and fair.
Step 1: Contact Your Local ADRC
Initiate the process by contacting your local Aging and Disability Resource Center. They will provide information and begin the initial assessment.
Step 2: Complete the Long-Term Care Functional Screen
An ADRC professional will perform an assessment to determine functional eligibility. This involves reviewing medical information and discussing your need for daily living assistance.
Step 3: Verify Financial Eligibility
If you are not already on Medicaid, the ADRC will connect you with an income maintenance agency to review your financial situation, including income and assets.
Step 4: Enrollment Counseling
Once financially and functionally eligible, the ADRC will provide counseling to help you understand your options and select a managed care organization (MCO).
Step 5: Begin Services with an MCO
After enrolling in an MCO, a care team will work with you to develop a personalized care plan and connect you with approved services.
Supporting Unpaid Family Caregivers
An important aspect of Wisconsin's long-term care system is the ability for eligible individuals to hire relatives, including adult children, as paid caregivers under certain programs. This recognizes and supports the valuable role families play in providing care. The Family Care program, and especially the IRIS program, offers pathways for self-direction, allowing members to have greater control over their care and who provides it. To explore this option, it is best to discuss self-directed supports with an ADRC during the enrollment counseling process.
Conclusion: A Supportive System for Those in Need
Wisconsin's Family Care program provides a vital safety net for many older adults and individuals living with disabilities. By understanding the eligibility criteria—age, financial status, and functional needs—and working with the local ADRC, families can access the comprehensive long-term care services they need. The program's design, which emphasizes independence and community living, reflects a commitment to empowering individuals to age with dignity and receive care in their preferred setting.
For more information on the application process and resources, visit the official website of the Wisconsin Department of Health Services at https://www.dhs.wisconsin.gov/familycare/index.htm.
