Family Care Independent Assessment: An Evaluation of Access, Quality and Cost Effectiveness for Calendar Year 2003 – 2004

I. Executive Summary

The 1999 Wisconsin Act 9 authorized the Department of Health and Family Services

(DHFS)1

to operate the Family Care program. DHFS is able to offer long-term care

services utilizing a capitated payment system after applying for both 1915(b) and a

1915(c) waivers and receiving approval for the waivers from the Centers for Medicare

and Medicaid Services (CMS). The two 1915(b) waivers (one for individuals age 60 and

over in Milwaukee County and one for adults in the other four pilot counties), allow

DHFS to limit the provision of long-term care services in those counties to individuals

who enroll in a Care Management Organization (CMO) using a ìcentral brokerî

(Resource Center). The two 1915(c) waivers (one for individuals with developmental

disabilities and one for individuals with physical disabilities) allows DHFS to provide

home and community based services, in lieu of institutional placement, for individuals

with long-term care needs that would qualify for Medicaid funding in a nursing home.

Through these waivers, the Department is able to pay a pre-paid capitation amount to the

CMOs who are then responsible for providing the services in the Family Care benefit that

are needed by the member. The five Family Care CMOs are Fond du Lac, La Crosse,

Milwaukee, Portage and Richland Counties.

– Family Care Independent Assessment

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