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 means 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 SDS, program participants are given access to the funds that would otherwise be spent on their care services, empowering them to purchase goods and hire care service 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.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
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.
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 2023. 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.
Functionally, participants must be 18 – 64 years old and have a physical disability, or 65+ years old and considered a “frail elder.” Persons must also have a long-term care condition that will last more than 90 days.
Financially, the requirements are in line with Medicaid’s long-term care criteria. Monthly income for an individual in 2023 cannot exceed $2,742. Couples, when both spouses are applying, are each allowed $2,742 in monthly income, for a total of $5,484.
When only one spouse is applying, the applicant spouse is able to transfer up to $3,715.50 a month in income to their non-applicant spouse. This monthly maintenance needs allowance not only helps to lower the applicant’s income, it also is intended to prevent the community spouse from becoming impoverished.
In 2023, a single applicant can have assets up to $2,000. When both spouses are applying, the asset limit is $4,000. However, certain assets are considered exempt, such as one vehicle and an individual’s primary home, given the applicant’s equity value interest in the home is not more than $750,000, and the applicant, or their spouse, lives in the home.
In the case of a married applicant whose spouse is not also applying for Medicaid services, there are spousal impoverishment rules in place to prevent the non-applicant spouse from having too little money on which to live. As of 2023, the community spouse is able to retain a resource allowance of up to $148,620 of the couple’s assets. This is in addition to the $2,000 the applicant spouse is able to retain.
The Family Care program does a cost-share arrangement for individuals whose financial resources exceed the program’s thresholds.
Over the Financial Limits?
If one exceeds the financial limits, a Medicaid Planner may be able to help. It is highly recommended that one is consulted prior to applying for the program. Learn more.
Medicaid has a 60-month look-back period in which all transfers within this time frame are scrutinized. Assets are not allowed to be gifted in order to meet financial requirements, otherwise the individual will be penalized with a period of Medicaid ineligibility.
Benefits and Services
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.
- Adaptive Aids / Vehicle Adaptive Aids
- Adult Day Care
- Assistive Technology
- Alcohol and Drug Abuse Day Treatment Services
- Daily Living Skills Training
- Durable Medical Equipment
- Home Health
- Home Modifications
- Meal Delivery
- Nursing Services
- Personal Care
- Personal Emergency Response Services
- Prevocational Services
- Occupational Therapy
- Physical Therapy
- Relocation Services
- Residential Services (Adult Family Home, Community Based Residential Facility, and Residential Care Apartment Complex)
- Respite Care
- Specialized Medical Supplies and Equipment
- Transportation Assistance
How to Apply / Learn More
Interested individuals should contact their local Aging and Disability Resource Center (ADRCs) to begin the application process. Look up your local Wisconsin ADRCs here.
One can also learn more about these programs on the Family Care website.