With rising healthcare costs, those with low incomes or limited resources tend to have difficulty accessing proper medical care. Medicaid is a US government program designed to remedy that, giving those that cannot afford the necessary medical care the chance to do it. Among the benefits of Medicaid is family care. Family care is one of the long-term programs under Medicaid, designed to alleviate the cost of accessing medical care for the elder or adults with developmental, physical, or intellectual disabilities. A family urgent care clinic is an example of facilities that facilitates this program, ensuring that these vulnerable groups get the necessary care to live everyday lives without committing to a facility like a nursing home.

Understanding the full scope of family care requires knowing what constitutes “long-term” care. It’s a fact that those with physical or mental disabilities have difficulty performing specific tasks as part of their everyday routines. These tasks include bathing and preparing meals, among others. The same is true for those with many chronic or terminal illnesses.

Two programs influenced the structure of family care. These include:

i)The Partnership Program: This framework is designed to provide long-term care for the elderly and frail. It comprises a group of organizations that provide the necessary caregiving. This initiative is spread across several geographical regions.

ii) Program of All-Inclusive Care for the Elderly (PACE): This program aims to provide long-term care for older adults with chronic illnesses. It includes giving prescription drugs as part of its ongoing care. These two programs provided the ideas on which the family care program was built.

There are two primary components of family care:

i)Managed Care Organizations: These entities ensure proper service delivery of the Family Care benefit packages. These packages are designed with each individual’s specific needs, preferences, and circumstances.

ii)Ageing and Disability Resource Centers (ADRCs): These are designed to be an all-encompassing entry point for older adults with disabilities and their family members to learn about the different options available to them regarding family care and how to access such resources.

Managed Care Organization Scorecard

The managed care organization (MCO) scorecard is used to give feedback on these parameters for better care and ensure the quality of the care provided and whether the recipients are satisfied.

General Outline of Family Care Benefit and Managed Care Organizations

The beauty of the family care program is that it can provide the needed care for the elderly and chronically ill, all through one channel. Members of this program (the Family Care Program) have to enroll to receive the services. To provide and coordinate the necessary services, the Department of Health Services provides the funding based on the number of registered members to ensure the efficiency of this program.

To facilitate this program, MCOs establish and maintain networks of long-term care providers. They monitor the program for any issues, ensuring an improvement in service delivery to the Family Care enrolled members.

The key highlights of the Family Care benefit package include:

1) Interdisciplinary Case Management

All registered members of the Family Care Program work with a team, usually consisting of a nurse and a care manager. Developing a suitable program that encompasses the member’s individual needs and preferences is key to the effectiveness of good long-term care. The nurse and care manager see that the member’s care is ideal for their situation.

2) Services by Location

Many members of the Family Care Program are frail, meaning moving from one distant location to another is a huge hassle. The program is such that members receive the services at their place of residence. It could be their home or a supported apartment. Alternative residential facilities like residential care apartment complexes or adult family homes could also be used by members, meaning they’ll need to receive such services there.

3) Participation in the Kind of Services Received

Members are actively involved in decision-making. They play a crucial role in shaping their long-term care plans. Members are encouraged to make informed decisions about the care they receive. The managed care organizations provide the necessary information and support to ensure this.

Ultimately, thousands of people with physical and mental disabilities can now enjoy tolerably everyday life because of family care benefits. These vulnerable individuals can now access critical care that would otherwise be out of their reach by registering as members.

By Manali