Did You Know? Now You Know! · Personal Care Services and Medicaid. Medicaid and Transportation to...

Did You Know?Now You Know!

A Parent’s Perspective on Navigating Supports and Services for a Child

with a Disability

familyvoicesofwisconsin.com

Today’s Presenters

(Insert your photo here) (Insert your photo here)


About this Presentation

• These slides have a lot of content• NO ONE expects you to remember all of this!

• The most important thing is to remember that there are services and supports in your community

• We’ll make this presentation available to you• Web links • Agency names• Handout information



Family Voices of Wisconsin Family Voices of Wisconsin is a network of families

who have children and youth with disabilities and/or special health care needs


1. Education and information, including trainings, fact sheets, and newsletters

2. Family Leadership activities including Advocacy for Change

3. Public Policy and Systems Change activities

Our work is focused on health care and community supports in three areas:

Five Regional Centers


Systems of Support


Systems of SupportWhat?• Funding and Regulation structures • Wait lists

Why?• Understand why programs have eligibility requirements that sometimes seem unfair

• Know what you can do while you wait


How Are Formal Supports Organized?

Formal Support Systems

Federal Government

Local Systems of Government

& Counties

State Government


Ex: Children’s Long-Term Support WaiverFederal Rules and Funding

• Centers for Medicaid and Medicare Services (CMS)

State Accountability and Funding• WI Department of Health Services (DHS)

County Implements Program to Families• County Waiver Agency


Ex: Children and Youth with Special Health Care Needs Resource Centers

Federal Rules and Funding• Health Resources and Services Administration (HRSA)• Maternal and Child Health Title V Block Grants

State Accountability • WI Department of Health Services (DHS)

Regional Funding• Five Regional Centers


Ex: Children’s Community Options Program

No Federal Involvement

State Funding • WI Department of Health Services (DHS)

County Funding and Administration• County Waiver Agencies

No Need for Citizenship – That’s a Federal Requirement


Wait Lists: A Reality CheckThere is NOT enough money for the services that people

with disabilities need to live in the community.

Wait lists exist throughout the state, but they may vary from county to county.

Wait lists affect the amount and quality of services received.


What Services or Supports Can Have a Wait List in Wisconsin?

Can have a wait list

• Children’s Community Options Program

• Formerly the Family Support Program

• Home and Community-Based Waivers

• Includes Children’s Long-Term Support Waiver

CANNOT have a wait list*

• Birth to 3 Services • Medicaid Card Services

• Includes dentists and mental health professionals

* There may be a delay in receiving these services.


Where Can Families Get Help While Waiting?• Independent living centers• Community equipment lending closets• Faith communities• Service organizations• National and community resources for one-time needs

Be creative—Not everything needs a formal solution!

Keep programs informed if you move or have a

change in status.


Children’s Mental Health Services:dhs.wisconsin.gov/mh/children.htm

Department of Public Instruction, Special Education: dpi.wi.gov/sped

Wisconsin Birth to Three Early Intervention Program: dhs.wisconsin.gov/birthto3/index.htm

Wisconsin’s Services for Children with Delays or Disabilities: dhs.wisconsin.gov/children/index.htm

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http://www.dhs.wisconsin.gov/mh/children.htm

http://dpi.wi.gov/sped

http://www.dhs.wisconsin.gov/birthto3/index.htm

http://www.dhs.wisconsin.gov/children/index.htm

Medicaid


MedicaidWhat?• What is Medicaid• Three common sources of Medicaid• What Medicaid can pay for

Why?• Being on Medicaid can open other doors• Getting the most from the Medicaid Program


What’s Medicaid?• Goal: To provide basic health care services • It’s called: Katie Beckett, Title 19, BadgerCare Plus, Medical Assistance and MA

• A federal program• Managed and partially funded by individual states

• Different in every state

Wisconsin’s Medicaid is handled by the Department of Health Services (DHS)


There Are 3 Ways to Define Eligibilty forMedicaid*

1. Disability (Katie Beckett)Considers only child’s income

2. Income (BadgerCare)Considers family incomeDo not need a disability

3. Income & Disability (Supplemental Security Income, SSI)

There Are “Different Doors” to Medicaid

*Proof of citizenship is required for ALL Medicaid programs

Is this Child a Good Fit for the Katie Beckett Program?

• The child must have a “marked and severe” limitation in functioning for at least 1 year

• The child’s disability must require an “institutional” level of care

• This will be assessed every year using the CLTS Functional Screen tool

• The child is under the age of 19• Only child's income is considered; not family income and

assets• Children may also be covered under private insurance


Is this Child a Good Fit for BadgerCare Plus?

• Family income limit based on 306% of the Federal Poverty Level for child eligibility

• Limit will vary annually

• To apply, go to ACCESS.wi.gov

• When can I enroll my child? • Any time—BadgerCare does not have an open enrollment period

BadgerCare Plus: A health care coverage program for low-income Wisconsin residents.


Is this Child a Good Fit for SSI?Supplemental Security Income (SSI): A program offered through the Social Security

Administration that provides monthly cash benefits and Wisconsin Medicaid to those who qualify.

Disability Standard• Your child must have a “marked and severe” limitation in functioning

• This limitation, or condition, must last for at least 1 year~AND~Income Standard• For children under 18-years old, family income is considered• For youth over 18-years old, individual’s own income is considered


Healthcare Navigators• Adams• Columbia• Dane• Grant• Green• Green Lake• Iowa• Kenosha

• Lafayette• Marquette• Milwaukee• Outagamie• Portage• Racine• Richland

• Rock• Sauk• Walworth• Waukesha• Waupaca• Waushara• Winnebago

Go to: http://www.coveringwi.org/enroll


http://www.coveringwi.org/enroll

Mandatory Services in Wisconsin’s State Medicaid Plan (*red indicates mandatory federal services):

• Case management services• Chiropractic services• Dental services• *Family planning services • *EPSDT (Health Check), including

autism treatment services• Home and Community-Based

Services Waivers (including CLTS)• *Home health services or nursing• Hospice care• *Inpatient hospital services• *Inpatient hospital, nursing home• Intermediate care facility services • Laboratory and X-ray services• Drugs listed in Wisconsin’s Medicaid

drug index• Medical supplies and equipment

• Mental health and psychosocial rehabilitative services

• *Nurse midwife services• *Nursing services• Optometric• Outpatient hospital services• Personal care services• Physical and occupational therapy• *Physician services• Podiatry services• Prenatal care coordination • Respiratory care services• Rural health clinic services• Skilled nursing home services• Speech, hearing and language disorder• Substance abuse services• Transportation to obtain medical care


Mental Health Services Covered by Medicaid

• Visits with private or community-based mental health providers• County-administered, mental health programs

• For children with more complex mental health, behavioral or substance abuse needs

• Coordinated Services Teams (CST): “Wraparound” program – intensive, holistic care planning

• Comprehensive Community Services (CCS): Community-based supports and services• Family is an important team member as treatment and service plans are

made


Medicaid covers a variety of supports, services and medications for children with mental health or behavioral health challenges:

HealthCheck Other Services (HCOS): An option to cover mental health services not typically covered by Medicaid card, like residential or day treatment programs.

What Can the Medicaid Card Pay for? • Diapers for children over 4-years old• Medical transportation• Over-the-counter medications*• Services needed due to “medical

necessity” including:• Mental Health Services• Personal Care Services• Behavioral Therapy

*“Health Check Other Services” may need to be used to access services.


Respite Care vs. Personal Care: What’s the Difference?

• Assists a child with daily-living activities like feeding, toileting, bathing and dressing

• MUST be provided in the home

• Paid for as a Medicaid Card benefit

• Short-term relief or “time off” from caregiving responsibilities for parents and families

• Can be provided at home or in the community

• Paid for by state and county programs including CCOP and CLTS Waivers

Respite Care Services Personal Care Services

familyvoicesofwisconsin.com28

Resources to Learn More about Medicaid

Medicaid Handbook

ABC for Health


Well Badger Resource Center

Five Regional Centers

Aging and Disability Resource Center

Helps clients resolve coverage questions and navigate multi-payer questions.

The benefits plan for Medicaid. It gives useful information on covered services.

Unbiased information on all aspects of life related to aging or living with a disability; age 17 ½ and older.

Assists parents in finding resources for their children with special needs, from birth to age 21.

Specialists who can help get answers, find services, and connect you to community resources. Their services are free and private.

Family Voices of WI Family friendly fact sheets on navigating Medicaid and other important supports and services.

http://www.emhandbooks.wisconsin.gov/meh-ebd/meh.htm

http://www.safetyweb.org/

https://wellbadger.org/

http://www.dhs.wisconsin.gov/cyshcn/regionalcenters.htm

https://www.dhs.wisconsin.gov/adrc/index.htm

http://www.familyvoicesofwisconsin.com/publications/factsheets/

Katie Beckett Brochure & Consultant Lists

Mandatory Services in the State Health Plan

Supplemental Security Income

A Step by Step Guide to Accessing Services through HealthCheck

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Personal Care Services and Medicaid

Medicaid and Transportation to a Medical Appointment

Autism / Behavioral Treatment Services FAQ

What you should know before applying for SSI for your child

HealthCheck Other Services

Diapers/Incontinence Supplies for Families in Medicaid HMO

Diapers/Incontinence Supplies and Medicaid


Handouts

Click to go to Handouts


Forward Health: dhs.wisconsin.gov/forwardhealth/index.htm

Katie Beckett Program: dhs.wisconsin.gov/long-term-care-support/services-children/katie-beckett

SSI (Supplemental Security Income for Children): ssa.gov/disability/disability_starter_kits_child_eng.htm

Wisconsin Medicaid: dhs.wisconsin.gov/medicaid

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http://www.dhs.wisconsin.gov/forwardhealth/index.htm

https://www.dhs.wisconsin.gov/long-term-care-support/services-children/katie-beckett

http://www.ssa.gov/disability/disability_starter_kits_child_eng.htm

http://www.dhs.wisconsin.gov/medicaid

Children’s Long-Term Support Medicaid Waivers


Children’s Long-Term Support Medicaid Waivers What?• Eligibility• CLTS Functional Screen• What do they provide

Why?• Knowing how to apply can streamline

the process• If eligible, these programs can reduce

stress on familiesfamilyvoicesofwisconsin.com

What Are Long-Term Supports?

Some Examples:• Adaptive aides• Home modifications• Parent training and education• Peer supports• Respite• Specialized equipment• Vehicle modifications

Long-Term Supports: Programs and services that help an individual live in the community.


Is this Child Eligible for Long-Term Supports?• CLTS Waivers require the child to be living

with his/her family• Like the Katie Beckett Program, the child

must meet the “institutional”* level of care in one of three areas:

• Physical disabilities• Developmental disabilities• Severe emotional disabilities

• A parental cost share is placed on a sliding fee scale

• Ensures that cost is based on family income

*The institutional level of care is the same standard used to access

Medicaid through the Katie Beckett program. This is determined using

the “CLTS Functional Screen.”


How to Enroll in Children’s Long-Term Supports

County Human/Social Services Department• Contact your Regional Center to get the number

Compass Wisconsin: Threshold• Counties: Adams, Columbia, Dane, Green, Jackson, Jefferson,

Kenosha, LaCrosse, Lafayette, Marquette, Monroe, Ozaukee, Racine, Rock, Walworth, Washington and Waukesha

• Families in these areas can go directly to www.compasswisconsin.org


http://www.compasswisconsin.org/

Rosy vs. Realistic: Completing the CLTS Functional Screen

Ben can dress himself independently.

RealisticBen can dress himself

independently about one day a week, if I have the right clothes

out for him.

Mikayla can communicate her needs to me.

Most of the time, people who aren’t familiar with Mikayla do not know

what she wants or can’t understand her words or signs.

vs.

Functional Screen

vs.

vs.


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https://www.dhs.wisconsin.gov/forms/f0/f00367.pdf

Long-Term Support Programs

Programs for Children

• Children’s Community Options Program (CCOP)

• Children’s Long-Term Support Waivers (CLTS)


CLTS Functional Screen: A Reality CheckCLTS Functional Screen: A tool that determines a child’s functional

eligibility for programs.

• You have the right to appeal the decision if your child does not meet the eligibility standards

• Your child may repeat the functional screen in the future• Changes in needs or abilities as your child gets older

• You have the right to ask for the functional screen to be done for your child

• Even if the screener doesn’t think that your child will qualify

Remember familyvoicesofwisconsin.com

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Children’s Community Options Program (CCOP)

Comparing the Children’s COP and Children’s Long-Term Supports

Completing a Functional Screen (Rosy vs. Realistic)

Finding and Funding Respite Care for Your Child

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Mental Health Fact Sheet Series What Are Outcomes


What is the Katie Beckett Program?Handouts

Click to go to Handouts


Children’s Long-Term Support (CLTS) Waivers: dhs.wisconsin.gov/clts/index.htm

CompassWisconsin: Threshold: compasswisconsin.org

DHS Medicaid Waivers Manual (Allowable services covered by Medicaid Waivers, list starting on page 15):dhs.wisconsin.gov/waivermanual/index.htm

Family Care: dhs.wisconsin.gov/familycare/index.htm

IRIS: dhs.wisconsin.gov/iris/index.htm

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http://www.dhs.wisconsin.gov/clts/index.htm

http://www.compasswisconsin.org/

https://www.dhs.wisconsin.gov/waivermanual/index.htm

http://www.dhs.wisconsin.gov/familycare/index.htm

https://www.dhs.wisconsin.gov/iris/index.htm

Takeaways:• Lynn’s Thoughts

• Brigit’s Thoughts



Family Voices of Wisconsinfamilyvoicesofwisconsin.com

608.220.9598

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http://www.familyvoicesofwisconsin.com/

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