Family Care Benefit Package

Many people in our community need assistance due to a physical or developmental disability or because of the increasing challenges that come with aging. This help, referred to as long-term care, includes many different services, such as personal care, housekeeping or nursing services. Long-Term Care can be any health or support service that you need because of a chronic illness or disability that prevents you from carrying out day-to-day activities. The following services are included in the "Family Care Benefit Package."

Adaptive Aids (general and vehicle)
Adult Day Care
Alcohol and other Drug Abuse Services (except those provided by a physician or on an inpatient basis)
Assessment and Case Planning
Case Management
Communication Aids/Interpreter Services
Community Support
Counseling and Therapeutic Resources
Daily Living Skills Training
Day Services and Treatment
Durable Medical Equipment and Medical Supplies (except for hearing aids and prosthetics)
Home Health
Home Modifications
Meals delivered to Member’s home
Mental Health Services (except those provided by a physician or on an inpatient basis)
Nursing Facility
Nursing Services (except for in-patient hospital stays)
Occupational Therapy (in all settings except for inpatient hospital)
Personal Care
Personal Emergency Response System Services
Physical Therapy (in all settings except for inpatient hospital)
Prevocational Services
Residential Services: Intermediate Care Facility for People with Mental Retardation (ICF/MR), Residential Care Apartment complex (RCAC), Community Based Residential Facility (CBRF) and Adult Family Home (AFH)
Respite Care
Specialized Medical Supplies
Speech and Language Pathology Services (in all settings except for inpatient hospital)
Supported Employment
Supportive Home Care
Transportation: all Medicaid covered transportation services (except ambulance)

Providers must obtain prior authorization from the Member’s Care Manager for all services to be rendered or the Milwaukee County Department of Family Care may not cover the cost of the service. The Milwaukee County Department of Family Care will not reimburse providers at rates higher than the Medicaid rate for Medicaid services included in the Family Care Benefit Package.

Family Care Benefit Package Exclusions

The following Medicaid Services are not included in the "Family Care Benefit Package". Medicaid eligible Members can access these services with their Forward Card.

Alcohol and other Drug Abuse services provided by a physician or in an inpatient hospital setting
Audiologist
Chiropractic
Crisis Intervention
Dentistry
Eyeglasses
Family Planning Services
Hearing Aids
Hospice
Hospital, Inpatient and Outpatient, including emergency room care (except for Outpatient Physical Therapy, Occupational Therapy, Speech, Mental Health services from a nonphysician and Alcohol and other Drug Abuse from a non-physician)
Independent Nurse Practitioner services
Lab and X-Ray
Medication
Mental Health Services provided by a physician or in an inpatient hospital setting
Optometry
Physician and Clinic Services (except for Outpatient Physical Therapy, Occupational Therapy, Speech, Mental Health services from a non-physician and Alcohol and other Drug Abuse for a non-physician)
Podiatry
Prenatal Care Coordination
Prosthetics

The Milwaukee County Department of Family Care may consider paying for the services listed above on an individual basis even though they are not a Family Care benefit. Providers must obtain prior authorization from the Care Manager before rendering the service if they want the Milwaukee County Department of Family Care to cover the cost of the service.

Providers should continue to bill Medicaid fee-for-service for Medicaid services that are not included in the Family Care Benefit Package when provided to Medicaid-eligible Milwaukee County Department of Family Care Members.

For Members who are not eligible for Medicaid, providers should bill Members or the Members’ commercial health insurance for any services that are not included in the Family Care Benefit Package.