Family Care and Family Care Partnership Waiver Renewal

 What are the waivers? Why did we renew them?

The Wisconsin Department of Health Services (DHS) recently renewed the Family Care and Family Care Partnership 1915(b) and 1915(c) waivers. The new waivers will be in effect January 1, 2025, through December 31, 2029. We must renew the waivers every five years.

A waiver is a special set of rules that allows us to have Medicaid programs like Family Care. Together, the 1915(b) and 1915(c) waivers are the rules that make up the Family Care program. The programs help older adults and adults with disabilities. The goal is to get members the services they need to live in a home setting when possible.

You can view the renewed 2025–2029 waivers:

• The 1915(b) waiver (PDF) describes how Family Care works. This includes service delivery and provider choice.
• The 1915(c) waiver (PDF) describes Family Care and Family Care Partnership eligibility, services, member rights, and finances.

 Summary of changes

We heard a lot of valuable feedback in 2023  from members, family, friends, caregivers, providers, managed care organizations, tribal leaders, advocates, and other partners. We used public input to draft proposed changes to the program waivers.

Changes aimed to:

Service updates and improvements

• Made Competitive Integrated Employment (CIE) Exploration into an independent service. It is a service designed to help members explore career opportunities and decide if they want to work in general workplaces in the community. This service includes job shadowing, informational interviews, employment planning, and education about employment services for people with disabilities. CIE Exploration was previously covered under the Supported Employment- Individual Employment Supports service.
• Created Health and Wellness, a service that includes healthy lifestyle services like exercise and cooking classes, wellness services like meditation and yoga, and education and training about sexuality. Parts of Health and Wellness were previously covered under the Counseling and Therapeutic Resources service. Other parts are new.
• Made Remote Monitoring and Support an independent service. It covers technology and services for live support from a remote caregiver. Remote Monitoring and Support was previously covered under the Assistive Technology and Supportive Home Care services.
• Renamed Communication Aids to Communication Assistance and made it an independent service. Communication aids were previously covered under Assistive Technology. Communication Assistance includes services and items to help with hearing, speech, communication, or vision impairments.
• Made Vehicle Modifications into an independent service. Vehicle modifications were previously covered under the Adaptive Aids service.
• Covered other Adaptive Aids under Assistive Technology. Members will not lose access to any services because of this change.
• Updated the employment service descriptions to better describe the types of items or activities each service may include.
• Expanded options for covering technology. This includes software, apps, and devices that help members meet their long-term care goals.

Note: Care teams can help find the right mix of services for members. They must approve of all services before the member receives them. Managed care organizations (MCOs) will only pay for services if they are in the Family Care benefit package, they support the member’s long-term care outcomes, and they are a cost-effective way to meet the member’s needs.

Expanding access to providers

• Added transportation network companies like Uber and Lyft as providers of waiver transportation services.
• Added individual drivers as providers of Community Transportation. This will allow families to get paid for driving members to activities in the member’s service plan.
• Added more provider types for Respite, Home-Delivered Meals, Day Habilitation, and Prevocational Services.
• Updated provider qualifications to expand options for providers to be qualified and make sure providers have the right training.

General updates

• Described DHS’ new adult incident reporting system. The system helps DHS and managed care organizations track and look into incidents.
• Made changes to make Family Care and Family Care Partnership more like other DHS programs. This will make it easier when members switch from one program to another. These changes will not impact access to services.
• Made general changes that meet federal requirements and follow current DHS policies and practices

 The process DHS used to renew the waivers

The renewed waivers will be in effect January 1, 2025. DHS used this timeline and steps to keep the renewed waivers on schedule:

• June 2023: Partners gave input in an online survey.
• July 2023: Partners gave input during online public input sessions.
• January 2024: DHS finalized proposed changes and internal approvals began.
• March 2024: DHS sent a notice to the state Joint Finance Committee about our intent to renew the waivers.
• June 2024: A 30-day public comment and tribal consultation began.
• September 2024: DHS submitted proposed changes to the Centers for Medicare & Medicaid Services (CMS).
• November 2024: CMS approved the waiver renewal applications.
• January 2025: The renewed waivers are in effect.

 What we heard in 2023

DHS invited Family Care and Family Care Partnership members, family, friends, caregivers, providers, managed care organizations, advocates, and other partners to share their input. We heard from:

• Nearly 250 webinar attendees during two online public input sessions in July. View the presentation slides in English (PDF), Hmong (PDF), and Spanish (PDF).
• More than 1,500 survey respondents from June to August.
• Tribal communities during two in-person meetings in July and August.
• About 25 members of the Member Advisory Group during an online meeting in July.

DHS heard a lot of valuable feedback. DHS used the input we received to draft changes to the Family Care and Family Care Partnership waivers. We found six themes in the survey, input sessions, and other outreach. Many of the themes are complex issues. While DHS can’t fix them all through the waiver renewal, we are committed to addressing these issues. Many of these issues have several causes.

DHS is committed to addressing these issues. We will use this feedback to find more ways to improve the program.

Six input themes:

• Transportation: More reliable, flexible, and convenient transportation. This includes more options for self-direction of transportation, and more provider types.
• Unpaid caregiver support: More support from care teams and the Family Care program to help with feelings of burn out. Members, families, and support people also wanted more options and time for respite care. For example, more respite on nights and weekends.
• Workforce shortages: Difficulty finding direct care workers, day services, and residential services.
• Care management: More time with and help from care managers.
  • More contact or time with care managers. This would help care teams get to know members and families better. They would also better understand their goals and values.
  • More knowledge of community resources and services. This would help create better individualized support plans.
  • Keeping the same staff on their care team. Care managers change often. This gets in the way of knowing and trusting their team.
• Mental health support: More help with mental health needs. Care managers should connect members to resources and services for mental health and emotional support.
• Knowledge of services: More help with knowing the services and supports program members can get through Family Care. And more help with how to request them from their managed care organization.

Thank you to those who shared their input and helped spread the word!

 Have questions?

Send questions or ideas to DHSDMSFCRenewal@dhs.wisconsin.gov.