State Long-term Care Programs: Balancing Cost, Quality, and Access

Comprehensive Delivery Systems

Presenter: Judith Frye, Director, Center for Delivery Systems Development, Office of Strategic Finance, Center for Delivery Systems Development, Wisconsin Department for Family and Health Services, Madison, WI.

Wisconsin's initial commitment to community care began with a State funded program in 1981. Medicaid home and community based services (HCBS) waivers followed through the mid-1980s. The Wisconsin Family Care Demonstration program is one of the most extensive examples of the reorganization of State long-term care delivery systems since the advent of home and community based services.

Judith Frye, Director of the Center for Delivery Systems Development in the Wisconsin Department for Family and Health Services, described the Family Care program as a "one-stop shop" for information about all long-term care services and access to a single organization to select services appropriate to the beneficiary. The program consolidates all Medicaid waiver and State plan long-term care services into a single menu of options to support independence and quality of life.

Consumers or family members contact an Aging and Disability Resource Center to obtain information about long-term care, a screening to determine which programs are appropriate, and counseling to help the consumer make choices. Consumers seeking services enroll in a Care Management Organization (CMO). Assessment and care plans are developed with the consumer by interdisciplinary care teams who authorize and coordinate services. CMOs receive a monthly capitation payment that is a blended payment based on the historical costs of all enrolled consumers in a county. The rates include a managed care discount, an administrative allowance, and a risk adjustment.

Early results from the pilot program have eliminated waiting lists for HCBS services and realized savings of $33 per member per month in acute and primary services that are not a part of the capitation payment. Additional data suggests that drops in the number Medicaid nursing home days in the pilot counties has exceeded reductions in non-pilot counties. However, other factors such as facility closings have contributed to the decline in the pilot counties.

Additional Resources

Family Care Options for Long-term Care. An overview of Wisconsin's family care program. Madison (WI): Wisconsin Department of Health and Family Services; 2002 Apr.

Alecxih LMB, Linkins K, Zeruld S, et al. Wisconsin family care implementation process evaluation report II: final report. Madison (WI): Wisconsin Legislative Audit Bureau; 2001 Aug.

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