Member Q&A 2017-09-22T14:58:08+00:00

Questions & Answers for Members

We have listed some of the questions most frequently asked by members. We encourage you to reach out to your local Aging and Disability Resource Center (ADRC) with your questions.

What is Family Care? 2017-09-25T10:16:33+00:00

Family Care is a comprehensive and flexible long-term care service system which recognizes the need for support in fostering independence and quality of life. It is regulated by state and federal agencies, funded by Medicaid, and administered by approved managed care organizations like My Choice Family Care to help seniors and adults with disabilities receive the care and services they need to remain independent in the community.

Who can become a member of My Choice Family Care? 2017-09-25T10:16:42+00:00

Below is a list of initial requirements, regulated by the State of Wisconsin, for eligibility within Family Care. You must be an adult living in one of the counties served by My Choice*, AND be:

  • 65 or older and in need of supportive services
  • 18 or older with a physical disability
  • 18 or older with a developmental/intellectual disability

Individuals must also be financially eligible for Medicaid, and be functionally eligible as determined by the Wisconsin Adult Long-Term Care Functional Screening. To enroll in this program, you must begin at your local Aging and Disability Resource Center, where you will learn about all your possible options and get information on starting your application.

*Please note: There are certain circumstances in which a person can be a “legal resident” of one county but actually reside in another county. Please call (414) 287-7600 and ask to speak to our Associate General Counsel for more information about this issue. You may also read this memo for more information.

Why do you call us members? 2017-09-25T10:16:53+00:00

We consider the people who are enrolled in Family Care to truly be members of their team.

What is the residency requirement for My Choice Family Care? 2017-09-25T10:17:01+00:00

My Choice Family Care currently serves adults that reside in the following Wisconsin counties*:

  • Kenosha County
  • Milwaukee County
  • Ozaukee County
  • Racine County
  • Rock County
  • Sheboygan County
  • Walworth County
  • Washington County
  • Waukesha County

My Choice is continuing to expand its service area, and is going through certification to be available in 26 Wisconsin counties by 2018. Those new counties are: Buffalo, Clark, Crawford, Dane, Grant, Green, Iowa, Jackson, Juneau, La Crosse, Lafayette, Monroe, Pepin, Richland, Sauk, Trempealeau, and Vernon.

*Please note: There are certain circumstances in which a person can be a “legal resident” of one county but actually reside in another county. Please call (414) 287-7600 and ask to speak to our Associate General Counsel for more information about this issue. You may also read this memo for more information.

How can I get more information about or sign up for Family Care? 2017-09-25T10:17:10+00:00

Anyone interested in learning more about their options for long-term care, including applying for Family Care, should contact their local Aging and Disability Resource Center (ADRC). All services provided by county ADRCs are free and available to all residents of that county, regardless of income or assets. They can provide detailed and unbiased information on virtually any topic related to ongoing care and overcoming challenges.

What benefits are available in Family Care? 2017-09-25T10:17:18+00:00

Services available through My Choice Family Care are part of the “Family Care Benefit Package.” They include most of the things necessary for a person to live as independently as possible. The full list of benefits is:

  • Adaptive Aids (general and vehicle)
  • Adult Day Care
  • Alcohol and Other Drug Abuse Services (except those provided by a physician or on an inpatient basis)
  • Care/Case Management (including assessment and care planning)
  • Assistive Technology/Communication Aids
  • Community Support Program (except physician provided)
  • Consultative Clinical and Therapeutic Services for Caregivers
  • Consumer Education and Training
  • Counseling and Therapeutic Resources
  • Daily Living Skills Trainings
  • Day Services/Treatment
  • Durable Medical Equipment and Medical Supplies (except for hearing aids and prosthetics)
  • Financial Management Services
  • Home Delivered Meals
  • Home Health
  • Home Modifications
  • Housing Counseling
  • Mental Health Day Treatment Services (in all settings)
  • Mental Health Services (except those provided by a physician or on an inpatient basis)
  • Nursing Home including Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) and Institution for Mental Disease (IMD) (IMD coverage is for people under age 21, or 65 and older)
  • Nursing Services (including respiratory care, intermittent, and private duty nursing)
  • Occupational Therapy (in all settings except for inpatient hospital)
  • Personal Care
  • Personal Emergency Response System
  • Physical Therapy (in all settings except for inpatient hospital)
  • Prevocational Services
  • Relocation Services
  • Residential Services:
    • Adult Family Home (AFH)
    • Community-Based Residential Facility (CBRF)
    • Residential Care Apartment Complex (RCAC)
  • Respite Care
  • Self-Directed Personal Care
  • Skilled Nursing Services RN/LPN
  • Specialized Medical Equipment and Supplies
  • Speech and Language Pathology Services (in all settings except for inpatient hospital)
  • Supported Employment
  • Supportive Home Care
  • Training Services for Unpaid Caregivers
  • Transportation (except ambulance)
  • Vocational Futures Planning

Family Care members can choose to self-direct one or more of the services above.

Who would be on my care team? 2017-09-25T10:17:26+00:00

The care team consists of the member, a nurse, and care manager, as well as any guardian, family, or other natural supports the member wishes to be involved. Providers from our network are also an extension of the care team, as they are involved in ensuring care plan delivery.

What is a member-centered plan? 2017-09-25T10:17:35+00:00

A member-centered plan (MCP) is an ongoing summary of personal experience, long-term care outcomes, needs, preferences, and strengths. The plan identifies the services and supports the member receives from family or friends, other natural supports, and paid services provided by My Choice Family Care. Members meet with their care teams regularly to review the member centered plan, and discuss how the plan is working for them.

Can I choose my own providers with the Family Care program? 2017-09-25T10:17:50+00:00

Yes. Members can choose providers from My Choice Family Care provider directory.

Members can also choose the Self-Directed Supports option if they want to manage a few, most, or all of their own services. SDS provides considerable choice and control over:

  • Who provides the services (such as a family member, friend, or agency)
  • What services are needed
  • How the member wants caregivers to perform specific tasks
  • When and where the member receives services

Care teams can provide members with additional information about the wide array of options available to members.

How are the support service needs decided? 2017-09-25T10:18:07+00:00

Within just 10 days of enrolling in Family Care, the care team meets personally with the member to discuss his/her abilities, challenges, expectations, and preferences as part of the assessment process. Together, they identify long-term care goals and discuss the services and supports that will best meet the member’s needs. There are a variety of discussion tools available to ensure teams are looking at a number of options to meet any given need through such avenues as self-direction, use of natural and community supports, and paid services through our network.

Care plans and outcomes, as well as functional and financial eligibility, are reviewed regularly to ensure the best possible results and use of resources

What if I have a complaint? 2017-09-25T10:18:15+00:00

My Choice wants to be sure that members are satisfied with their care and are not afraid to speak up if they have a concern.

Members are encouraged to work directly with their care manager and nurse whenever possible, or they can call the My Choice Family Care Member Liaison at 414-287-7621.

There are Ombudsman who can assist as well:
Disability Rights Wisconsin is the Ombudsman for enrollees and potential enrollees ages 18-59.
The Wisconsin Board on Aging and Long Term Care is Ombudsman for Family Care and Partnership enrollees and potential enrollees over 60.

Members can also file a grievance with the My Choice Grievance Committee. This committee is staffed by professionals and Family Care members.

Members also have the right to file an appeal with an Administrative Law Judge.

For additional information, refer to the Member Handbook.

How do I receive care after normal business hours? 2017-09-25T10:18:24+00:00

For urgent care needs, members can call us toll free at 1-877-489-3814. This is a free call from anywhere in the US. On-call staff is available 24 hours a day, seven days a week.

If there is a life-threatening emergency, call 911.

Do I have to pay for services? 2017-09-25T10:18:34+00:00

No. Members are not required to pay for any Family Care supports or services that have been approved by their care team as necessary to support their long-term care outcomes. If a member arranges for supports or services that are NOT in the member centered plan, those services would be the member’s responsibility.

There are two other types of expenses a member may be responsible for each month:

  • Cost share and/or spend down (see below)
  • Room and board
What is a cost share or spend down? 2017-09-25T10:18:45+00:00

A cost share or spend down is the monthly amount that some members may have to contribute toward the cost of their services. This amount is calculated by the State’s Income Maintenance Division, not by the managed care organization. Cost share or spend down is based on income. Individuals must pay their cost share or spend down every month to remain eligible for Medicaid and Family Care. Please refer to your Member Handbook for more information.

What is room and board? 2017-09-25T10:18:54+00:00

For members who live outside of their own home or apartment (in a Group Home, Adult Family Home, or Nursing home, for instance), those facilities charge a “room and board” rate which covers the cost of the residence itself, plus groceries, utilities, etc. Just as rent for an apartment or a mortgage for a house is a persons’ own responsibility, so is “room and board” in a facility. My Choice works with residential providers to keep room and board rates affordable for members.

Can Family Care help me with transportation? 2017-09-25T10:19:01+00:00

Mobility in the community is an important factor when it comes to a sense of independence. Transportation is part of the Family Care benefit package and teams can assist with authorizing local rides as needed.

Can I get a new care manager or nurse? 2017-09-25T10:21:41+00:00

Yes you can. If a member would feel more comfortable or better served by a change in care team, they can contact the My Choice Member Liaison directly at 414-287-7621.

What is needed to renew my Medicaid eligibility? 2017-09-25T10:20:52+00:00

Once a person is enrolled in Family Care, eligibility must be reviewed annually, or when individual needs or one’s financial situation changes. Members are notified and his/her care team will assist with resources to complete and submit a renewal in a timely fashion.

Success Stories
How to Enroll