The Family Care and Family Care Partnership programs are long-term care programs for Wisconsin residents that offer a large variety of supports to help individuals remain living in their homes. Benefits may include, but are not limited to, personal care, adult day care, and home modifications.
These programs are designed to give participants greater control over what services they receive and who provides them. This concept is based on the Cash and Counseling model and is generically referred to by many names, including self-determination, consumer direction, and participant direction. In the Family Care and Partnership programs specifically, it is called Self-Directed Supports or SDS.
Both programs are managed care programs, which mean that one must enroll with a managed care organization in order to receive services via these programs. Two former home and community based Medicaid waiver programs transitioned into this program: The Community Options Program Waiver (COP-W) and the Community Integration Program II (CIP-II).
Under these programs, some family members can receive payment for the caregiving services they provide to their loved ones.
Under SDS, program participants are given access to the funds that would otherwise be spent on their care services and empowered to purchase goods and hire care services providers of their choosing. In this case, program participants act as the employer. Their employees are referred to as Care Service Providers, Personal Care Attendants, or Direct Service Professionals. The programs help participants in their role as employers by providing payroll and other administrative services.
Program participants hire their caregivers. Although the Wisconsin program descriptions do not specifically state this, generally participants are free to hire friends, neighbors and even some family members to provide care as an alternative to home care companies. To be clear, these individuals must work as “employees”, they must work for an hourly wage that is consistent with the market rate and they must pay taxes on the wages they receive. Typically, spouses and legal guardians are not eligible, but the adult children can be paid caregivers.
As mentioned previously, there are two programs: Family Care and Family Care Partnership (often shortened to just “Partnership”). The main difference between these programs is the Family Care program is for personal (non-medical) care and the Partnership program is more comprehensive, including full medical care and prescription drugs. In addition, unlike Family Care, Family Partnership is not currently available statewide.
In addition to being a resident of Wisconsin, there are geographic (only for Family Partnership), financial, and functional requirements to participate in the Family Care and Partnership Programs.
1) Geographically, Family Partnership is available in 14 of 72 Wisconsin counties. An updated map of counties is available here. Five more counties are expected to come onboard in January 2022. These include the following counties: Fond du Lac, Manitowoc, Winnebago, Brown, and Shawano. Persons living in counties without coverage can become eligible if they move to a county with coverage. As previously mentioned, Family Care is available statewide.
The Family Care Partnership program is currently available in 14 counties. Here’s a link to a map of the service areas: https://www.dhs.wisconsin.gov/publications/p01789.pdf.
2) Functionally, participants must be 18 – 64 years old and have a physical disability, or 65+ years old and considered a “frail elder”. Persons must have a disability or dementia that requires them to receive assistance to manage their activities of daily living and continue living independently.
3) Financially, the requirements are like Medicaid’s long-term care criteria. Typically, monthly income for an individual in 2020 cannot exceed $2,349 and the “countable asset” limit, excluding the car and home, is approximate $2,000. The rules become more complicated when the individual has a healthy spouse or when excessive income and assets are placed in trusts. Only the applicant’s income is countable when their spouse is not also applying for benefits.
If one exceeds the financial limits, a Medicaid Planner may be able to help. It is highly suggested that one is consulted prior to applying for the program. Learn more.
The Family Care program does a cost-share arrangement for individuals whose financial resources exceed the program’s thresholds.
Each participant has their own care plan which can include any of the following services. Family Care does not include medical care but the Family Care Partnership program does.