Family Care: Benefits
Family Care offers a full range of long-term care services. When a person enrolls in Family Care, they join a managed care organization (MCO). MCOs provide services to members based on need, situation, and preference. If you enroll in Family Care, your MCO care team will give you a full list of benefits.
How are services approved?
MCO care teams can help find the right mix of services for members. They must approve all services before the member receives them. If you are a Family Care member and you need a service that is not approved, talk with your care team.
Members work with their care team to explore options to meet their needs. These options could include help from family, friends, and other support people. They could also include paid services and supports family and friends can’t provide. After the member and their care team talk about all the options, the care team approves the Family Care services the member needs.
MCOs are responsible for helping members meet their long-term care outcomes, but they also must consider how much services cost. MCOs may only approve a service if it:
- Is in the Family Care benefit package.
- Supports the member’s long-term care outcomes.
- Is the most cost-effective way to meet a member’s needs.
What services could be covered?
A member’s MCO care team may recommend any of the services or supports listed below:
Adult day care
Adult day care services are provided to a group of adults in a setting outside the home for part of the day. It’s for adults who need social interaction. It’s also for those who need supervision, help with daily activities, and support to be healthy and safe. Services may include personal care, light meals, medical care, and transportation to and from the day care site.
Alcohol and other drug abuse (AODA) treatment
Individual and group outpatient and day AODA treatment services provided by non-physician providers, such as therapists, psychologists, and other professionals.
Assistive technology
Assistive technology includes items that help people with daily activities at home, work, and in the community. They may include technology like tablets, mobile devices, or software, items called adaptive aids, and a fully trained service dog from a reputable provider. The service may also include an assessment of a person’s assistive technology needs and repair or maintenance of devices or items.
Communication assistance
Communication assistance includes items and services needed to help with hearing, speaking, reading, or other forms of communication. Items may include alternative or augmentative communication systems, speech amplification devices, electronic technology, mobile applications, and software. Services may include sign language interpretation or facilitation, assessment of communication needs, repair and maintenance of communication devices, and training to be able to use communication devices.
Coordinated professional care and treatment for adults who live with severe mental illness. Clients receive a range of services in the community. Services aim to meet a member’s unique needs, reduce symptoms, and lead to recovery.
Competitive integrated employment (CIE) exploration
CIE exploration services help members explore career pathways. They also help members decide if they want to work in the community alongside people who do not have disabilities. Services include business tours, job shadowing, informational interviews, or employment planning. Members can also get education about employment services for people with disabilities and help with identifying interests, knowledge, and skills that may be useful for finding a job.
Consultative clinical and therapeutic services for caregivers
Consultative clinical and therapeutic services help unpaid caregivers and paid support staff carry out a treatment or support plan. Services include assessments, development of home treatment plans, support plans, intervention plans, and training and assistance to carry out the plans. Services also include training for caregivers and staff who serve members with complex needs (beyond routine care).
Consumer education and training
Consumer education and training services help people with disabilities develop self-advocacy skills, support self-determination, exercise civil rights, and get the skills needed for control and responsibility over other support services. These services include education and training for members and their caregivers or legal decision makers. It may pay for enrollment fees, books and other educational materials, and transportation to training courses, conferences, and other similar events.
Counseling and therapeutic services
Counseling and therapeutic services treat personal, social, physical, medical, behavioral, emotional, cognitive, mental health, or alcohol or other drug abuse disorders. It may include help adjusting to aging and disability, help with relationships, and recreational, art, or music therapy. It may also include nutrition, medical, weight, or grief counseling.
Daily living skills training
Daily living skills training helps members do everyday tasks. This includes skills that help the member be independent and take part in community life. Examples include teaching money management, home care maintenance, food preparation, mobility training, self-care skills, and the skills necessary for accessing and using community resources.
Day services
Day services are regularly scheduled activities provided outside the home to a group of adults. Day services help members participate in the community, learn social skills, and develop the skills needed for activities of daily living and community living.
Durable medical equipment and supplies
Durable medical equipment and supplies are medically necessary devices and supplies that can help treat an illness, injury, or improve functioning.
Financial management services
Financial management services help with managing service dollars or personal finances. If a member chooses to self-direct one or more services, this service includes a person or agency paying service providers after the member authorizes payment. These services also help members budget to ensure money is available for housing and other needs.
Health and wellness
Health and wellness services help members maintain or improve their health, well-being, social skills, and inclusion in the community. They include activities that focus on developing healthy habits; classes, lessons, and events related to physical activity and nutrition; wellness services like yoga and mindfulness classes; and sexuality education and training.
Home-delivered meals
Home-delivered meals (sometimes called "meals on wheels") include the preparation and delivery of one or two meals a day if a member is unable to make or get healthy meals without help. Home delivered meals can also help members if they are unable to manage a special diet recommended by a health care provider for a medical condition.
Home health services
Home health services are a variety of services that are delivered in a member’s home through a home health agency. They can include nursing services, home health aide services, personal care services, and physical, occupational or speech therapy.
Home modifications
Home modifications include items and services that make a member’s home safer and easier to get around in. This may include ramps, stair lifts, wheelchair lifts, kitchen or bathroom modifications, specialized accessibility or safety adaptations, and voice-, light-, or motion-activated electronic devices that increase the member’s self-reliance and ability to live independently.
Housing counseling
Housing counseling helps members find accessible, affordable, and safe housing in the community. Housing counseling includes exploring home ownership and rental options, identifying financial resources, identifying preferences of location and type of housing, identifying accessibility and modification needs, and locating available housing. Housing counseling does not include payment for rent or mortgage.
Institutional care
Care and treatment in an institutional setting, such as a nursing home, psychiatric hospital (also called institutes for mental disease (IMDs)), or intermediate care facilities for individuals with intellectual disabilities (ICF or IIDs).
Mental health treatment services
Individual and group mental health outpatient and day treatment services provided by non-physician providers, such as therapists, psychologists, and other professionals.
Nursing services
Nursing services include care that can only be provided by an advanced practice nurse, a registered nurse (RN), or a licensed practical nurse (LPN) supervised by an RN. It could involve keeping an eye on and recording symptoms and reactions, general nursing procedures and techniques, and may include assessment and ongoing monitoring of a medical condition.
Occupational therapy
A type of therapy that helps with learning or relearning to do everyday tasks and activities.
Personal care
Personal care services help members with daily activities and housekeeping needed to live in the community. This includes help with bathing, eating, dressing, managing medications, oral, hair, and skin care, meal preparation, bill paying, mobility, toileting, transferring, and using transportation. A physician must write an order for a member to get this service. If a member chooses to self-direct this service, they can choose the person or agency they want to provide the service and can act as their employer or co-employer.
Personal emergency response system (PERS)
PERS directly connects a member with health professionals in case of an emergency. It is a phone or other electronic system.
Physical therapy
A type of therapy that uses exercises to treat pain and help members maintain or improve strength and flexibility.
Prevocational services
Prevocational services are learning and work experiences that help members develop general strengths and skills to get jobs in community settings. Members can learn how to work with supervisors, coworkers, and customers. They can also learn about how to dress, follow directions, do tasks, solve problems, stay safe, and get around. These services help members get jobs in the community that pay them the usual wage and benefits paid to employees who do not have disabilities.
Relocation services
Relocation services include one-time expenses that help members move from an institution or residential care setting to their own home or apartment in the community. They can help pay for moving expenses, cleaning and organization, a security deposit, and utility connection costs. They can also help with furniture, cooking utensils, cleaning and household supplies, and basic furnishings and appliances.
Remote monitoring and support
Remote monitoring and support services help members get live support from a remote caregiver. The remote caregiver can make sure the member is safe and provide support in case of an emergency. This service provides technology like sensors, monitors, and other two-way communication devices. It also includes the support provided by remote caregivers and the repair and maintenance of devices. The member has to say in writing that they want this service.
Residential services
Residential services are provided in a homelike community-based residential setting. They include 1-2 bed adult family homes and settings for three or more adults (like 3-4 bed adult family homes or residential care apartment complexes). Services usually include personal care, help with daily activities, home care, treatment, and general support and supervision. Services may also include transportation and recreational or social activities, behavior and social support, and daily living skills training.
Respite care
Respite services provide short-term breaks for family or other primary caregivers. This helps relieve daily stress and care demands. Respite care may be provided in the member’s home, a residential facility, a licensed camp, a hospital, or a nursing home.
Specialized medical equipment and supplies
Specialized medical equipment and supplies are items that maintain the member’s health, manage a medical or physical condition, and improve functioning or independence. Items may include over-the-counter medications, medically necessary prescribed skin lotions, prescribed Vitamin D, multi-vitamins or calcium supplements, and books or therapy aids.
Speech and language therapy
A type of therapy that helps with communication and language skills. It can also include treatment for swallowing disorders.
Support broker
A support broker is a person or agency the member chooses to help plan, get, and direct self-directed supports. A support broker knows about local services and can help recruit, hire, train, manage, and schedule workers.
Supported employment services
Supported employment services help members get and keep jobs. The goal is to keep a job in the community at or above minimum wage, working alongside people who do not have disabilities. The job should also meet their personal and career goals.
- Individual employment services help members get a job, grow skills for that job, and get interviews. It could also include job coaching and training, rides to work, workplace personal assistance, benefits counseling, career advancement services, or self-employment support.
- Small group employment services are services and training provided in a business, industry, or community setting for groups of two to six workers with disabilities. Examples include mobile crews and other business-based workgroups employing small groups of workers with disabilities in community workplaces. Services may include small group career exploration and education, skill development, employment planning, job placement, meeting with employers, job coaching and training, rides to work, and work experiences matched to the member's interests and skills.
- Vocational futures planning and support helps members get, keep, or advance in a job in the community. This may include assistive technology assessment, creating an employment plan, career exploration, job seeking support, job coaching and training, and ongoing personal assistance at their job. Members can also learn more about work incentives and how employment may impact their benefits.
Supportive home care
Supportive home care helps with daily living activities and personal needs at home or in the community. Services help with staying safe in the home and community, routine housekeeping tasks like cleaning, cooking, and laundry, and major household tasks like yard care and snow removal. Services may also help with dressing, bathing, managing medications, eating, going to the bathroom, grooming, getting around, paying bills, using transportation, and household chores.
Training services for unpaid caregivers
Training services for unpaid caregivers help those who provide unpaid care, training, companionship, supervision, or other support to a member. It trains unpaid caregivers how to do treatments and use equipment in treatments and other services included in the member’s care plan and gives guidance on how to keep the member safe in the community.
Transportation services
- Community transportation services help members access community services, activities, and resources included in their care plan. This may include tickets or fare cards, reimbursement for mileage, as well as transportation of members and their attendants to destinations. It excludes emergency (ambulance) transportation.
- Non-emergency medical transportation services help members get non-emergency, Medicaid-covered medical services. Services may include tickets or fare cards, reimbursement for mileage, as well as transportation of members and their attendants to destinations. It excludes non-medical transportation, which is provided under community transportation—see above. It also excludes emergency (ambulance) transportation.