General Questions
How are decisions about my care made?
You and your care team will work together to evaluate and select the best option for your care needs. We use the Resource Allocation Decision (RAD) method to identify the best way to meet your needs.
Can I choose my own providers?
Your care team will work with you to select service providers from our extensive provider network. You may also choose to hire your own help through our self-directed supports program.
What do I need to do if I become a member?
You will be responsible for:
- Updating Your Care Team: This includes any changes in your condition or residence.
- Using Approved Providers: All providers you choose must be from our approved provider network.
- Getting Care Team Approval: You must get approval from your care team for all services.
- Making Timely Payments: All payments for services must be made in a timely manner.
What are my rights as a member?
- You will always be treated with respect and dignity.
- You have the right to receive information about your services that will be protected under the Health Insurance Portability and Accountability Act of 1996 (HIPPA).
- You have the right to make decisions about your health care.
You can view your rights in more detail in any of our Member Handbooks.
What if I disagree with a decision made regarding my services?
If you are unhappy with the services you receive, you may file a grievance. There are several ways to file an appeal or grievance. Our Member Rights Specialists are available to assist you through the process. Visit our Grievances and Appeals page for more information.
PACE Specific Questions
What is PACE?
PACE, the Program of All-inclusive Care for the Elderly offers a benefit package that combines medical care, long-term care and prescription drugs to help frail and disabled individuals age 55 and older live as independently as possible for as long as possible within the community.
Who assists me when I join PACE?
When you enroll in the Community Care PACE program, you will be assigned to an interdisciplinary care team. Your team of health care and long-term care professionals will complete an assessment and work with you to develop a cost-effective care plan that uses natural supports or paid services from our provider network which meets your needs and identifies your outcomes. Your team will help coordinate and authorize the services you need.
What is covered in the PACE benefit package?
The PACE program covers medical care, long-term care, prescription drugs and some over-the-counter medications. You will receive additional services if they are part of your care plan and authorized by your team. Such services may include dental, vision and hearing care, therapy services, activities in our adult day centers, durable medical equipment and supplies, supportive home care, residential services and transportation. Your team will work with you to determine your needs and authorize the services that you receive.
For more information, visit our PACE Services & Benefits page or refer to the PACE Enrollment Agreement & Member Handbook.
How are decisions about my care made?
Decisions about your health care, long-term care and medications are made by you and your team of healthcare professionals, who are committed to providing quality care to keep you as healthy as possible. Your team may also use Resource Allocation Decision Method (RAD) to identify the best way to meet your needs and which supports and services to authorize.
Can I choose my own providers?
Community Care employs its own staff of highly skilled primary care physicians to serve members. If you are in need of a specialist outside of the team, you will work with your care team to select service providers from our extensive provider network. In addition to your primary care, you may also choose to have more responsibility and be more involved in managing your long-term care services through our self-directed supports option.
What rights do I have in the PACE program?
First and foremost, you have the right to be treated with respect and dignity. You also have the right to receive information about your services and have that information protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Additionally, you have the right to make decisions about your health care. Your care team is responsible to help you understand your rights and to ensure those rights are protected.
What if I disagree with a decision made regarding my services?
Member satisfaction is extremely important to Community Care. You always have the right to appeal if you disagree with a decision that stops or reduces a service or suspends a Medicaid service. If you are unhappy with the services you receive, you may file a grievance. There are several ways to file an appeal or grievance. Your team will help you understand your grievance and appeal rights and our Member Rights Specialists are available to assist you through the grievance or appeal process.
What do I need to do if I become a member?
Your participation in developing and following your care plan is essential to achieving your goals. As a member, you'll need to keep your care team up-to-date on changes in your condition or if you change your residence. Members must also use providers within our network, receive approval from the care team prior to receiving services and make timely payments for any monthly premiums they are responsible for. Your premium payment each month will depend on your eligibility for Medicare and Medicaid. You may or may not have a monthly premium. You may reference the PACE Member Handbook for more information.
What payments am I responsible for?
The absence of copays and deductibles are a major benefit to the PACE program. Based on your income, you may have a monthly cost share or spend down to remain eligible for Medicaid. You may also have to pay for your room and board each month. Cost share or spend down and room and board are two different things. It is possible that you may have to pay for both. Your cost share is determined by the Income Maintenance Agency based on your income and must be paid to maintain eligibility for Medicaid.
Am I eligible to become a member of the Community Care PACE program?
To be eligible for PACE, you must:
- Be 55 years of age or older
- Reside in Kenosha, Milwaukee, Racine, or Waukesha County.
- Be functionally eligible according to the Wisconsin Adult Long-term Care Functional Screen.
- Qualify for Medicaid or Medicare, or be able to pay out-of-pocket costs for the program.
In order to enroll in our PACE program, you'll need to contact your local Aging and Disability Resource Center (ADRC).
What are my rights and responsibilities at disenrollment?
You must continue to get services through Community Care PACE until your membership ends. You must continue to pay any monthly costs on time, including premiums and/or room and board charges. Community Care PACE must continue to furnish all needed services until your membership ends.
How do I appoint a representative?
Family Care Specific Questions
What is Family Care?
Family care is a Medicaid managed care program in Wisconsin that focuses on meeting the long-term care needs of elders and adults with disabilities that are Medicaid eligible.
Who assists me when I join Family Care?
As a Family Care member you receive care management services from a care team consisting of a care manager and a registered nurse. You and your care team together identify your needs and develop a plan to meet those needs. Community Care has a large network of service providers to choose from. You can also take direct responsibility in managing services yourself utilizing the program's self-direct your supports option.
What is covered in the Family Care benefit package?
You will work with your care team to develop a cost-effective care plan to meet your needs. The plan is flexible and can be modified as your needs change. It will include natural supports along with paid services from our provider network. These services could include housekeeping, medication management and bathing. Or possibly certain therapies, medical equipment and supplies or funding for assisted living or nursing home stays if determined that they will address your needs effectively. Services must be authorized prior to receiving them.
How are decisions about my care made?
Community Care is committed to using the Resource Allocation Decision (RAD) method to identify the most effective way to meet your needs. You and your care team will work together to evaluate your needs, discuss ways to meet will those needs and select the best option for you at the time.
What rights do I have in the Family Care program?
Can I choose my own providers?
Your care team will work with you to select service providers from our extensive provider network. You may also choose to hire your own help through our self-directed supports program.
What if I disagree with a decision made regarding my services?
Member satisfaction is extremely important to Community Care. You always have the right to appeal if you disagree with a decision that stops, suspends or reduces a service. In the instance that you are unhappy with your services, you may file a grievance. There are several ways to file an appeal or grievance. Your care team is responsible for providing you with the information you need to understand your rights and our Member Rights Specialists are available to assist you through the grievance or appeal process.
What do I need to do if I become a member?
Your participation in developing and following your care plan is important to achieving your goals. As a member, you'll need to keep your care team up-to-date on changes in your condition or if you change your residence. Members also must utilize providers within our network, receive approval from the care team prior to receiving services and make timely payments for any costs incurred. A PDF copy of our Family Care Member Handbook can be found HERE.
What payments am I responsible for?
You are responsible for payment of your Medicaid and/or Medicare copays and deductibles for your health care and medications. You may also have a cost share or spend down responsibility based on your income.
Am I eligible to become a member of the Community Care Family Care program?
To be eligible for Family Care, you must:
- Be at least 18 years old with a physical, intellectual, or development disability, or
- Be a frail adult age 65 or older.
- Be functionally eligible according to the Wisconsin Adult Long-term Care Functional Screen.
- Qualify for Medicaid.
In order to enroll in our Family Care program, you'll need to contact your local Aging and Disability Resource Center (ADRC).
Partnership Specific Questions
What is Partnership?
Partnership is a managed care program in Wisconsin which offers a benefit package that combines medical care, and long-term care to help frail elders and adults with physical, intellectual or developmental disabilities live as independently as possible for as long as possible within the community. Partnership is a Medicare Advantage Special Needs Plan for people who have Medicaid and are also eligible for Medicare. People who are only eligible for Medicaid may also enroll in Partnership. Partnership members with Medicare receive prescription drugs and certain over-the-counter medications from Community Care. Partnership members who do not have Medicare receive prescription drugs and certain over-the-counter medications from Wisconsin Medicaid and should contact Wisconsin Medicaid Member Services at 1-800-362-3002 for more information.
Who assists me when I join Partnership?
As a Partnership member, you will receive care management services from an interdisciplinary team consisting of a nurse practitioner, a care manager and a registered nurse. Together you and your care team will assess your needs and develop a care plan to help you meet them.
For more information, download the Partnership member handbooks.
What is covered in the Partnership benefit package?
Partnership covers health care services and long-term care services. Such services may include dental, vision and hearing care, supportive home care and residential services. Partnership members with Medicare receive prescription drugs and certain over-the-counter medications from Community Care. Partnership members who do not have Medicare receive prescription drugs and certain over-the-counter medications from Wisconsin Medicaid and should contact Wisconsin Medicaid Member Services at 1-800-362-3002 for more information. Partnership may also provide therapies, medical equipment and supplies. You and your care team work together to evaluate your needs and develop a cost-effective care plan that identifies the appropriate natural supports and services for you. Your team must authorize all services before you receive them.
For more information on benefits, visit Partnership Services & Benefits.
How are decisions about my care made?
Decisions about your health care and long-term care are made by you and your team of healthcare professionals, who are committed to providing quality care to keep you as healthy as possible. Your care team may also use the Resource Allocation Decision Method (RAD) to identify the best way to meet your needs and which services to authorize.
Can I choose my own providers?
You will work with your care team to select providers from our extensive provider network. You also have the option to self-direct some of all of your long-term care services, which allows you to take direct responsibility for managing the services you receive.
What rights do I have in the Partnership program?
First and foremost, you have the right to be treated with respect and dignity. You also have the right to receive information about your services and have that information protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Additionally, you have the right to make decisions about your health care. Your care team is responsible to help you understand your rights and to ensure those rights are protected.
What if I disagree with a decision made regarding my services?
Member satisfaction is extremely important to Community Care. You always have the right to appeal if you disagree with a decision that stops or reduces a service or suspends a Medicaid service. If you are unhappy with the services you receive, you may file a grievance. There are several ways to file an appeal or grievance. Your team will help you understand your grievance and appeal rights and our Member Rights Specialists are available to assist you through the grievance or appeal process.
What do I need to do if I become a member?
Your participation in developing and following your care plan is essential to achieving your goals. As a member, you'll need to keep your care team up-to-date on changes in your condition or if you change your residence. Members also must utilize providers within our network, receive approval from their care team prior to receiving services and make timely payments for which they are responsible.
What payments am I responsible for?
The absence of copays and deductibles for health care and long-term care services is a major benefit to the Partnership program. Based on your income, you may have a monthly cost share or spend down to remain eligible for Medicaid and stay enrolled in the Partnership program. If you live in a residential facility, you may also be responsible to pay for your room and board each month. Cost share or spend down and room and board are two different things. It is possible that you may have to pay for both.
Am I eligible to become a member of the Community Care Partnership program?
To be eligible for Partnership, you must:
- Be 18 years of age or older with a physical, intellectual or developmental disability.
- Be a frail adult age 65 or older.
- Reside in Calumet, Kenosha, Milwaukee, Outagamie, Ozaukee, Racine, Washington, Waupaca or Waukesha County.
- Be functionally eligible as determined by the Wisconsin Adult Long-term Care Functional Screen.
- Be eligible for Medicaid (You may also be eligible for Medicare. If you are eligible for Medicare, you must be enrolled in Medicare parts A, B and D and obtain your Medicare coverage from the Community Care Partnership Program).
In order to enroll in our Partnership program, you'll need to contact your local Aging and Disability Resource Center (ADRC).
