Did You Know? Now You Know! A Parent s Perspective on Navigating Supports and Services for a Child with a Disability. familyvoicesofwisconsin.

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1 Did You Know? Now You Know! A Parent s Perspective on Navigating Supports and Services for a Child with a Disability

2 Today s Presenters (Insert your photo here) (Insert your photo here)

3 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

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

6 Five Regional Centers

7 Systems of Support

8 Systems of Support What? 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

9 How Are Formal Supports Organized? Federal Government State Government Local Systems of Government & Counties Formal Support Systems

10 Ex: Children s Long-Term Support Waiver Federal 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

11 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

12 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

13 Wait Lists: A Reality Check There 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.

14 What Services or Supports Can Have a Wait List in Wisconsin? Can have a wait list CANNOT 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 Birth to 3 Services Medicaid Card Services Includes dentists and mental health professionals * There may be a delay in receiving these services.

15 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 Keep programs informed if you move or have a change in status. Be creative Not everything needs a formal solution!

16 W e b L i n k s 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

17 Medicaid

18 Medicaid What? 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

19 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)

20 There Are 3 Ways to Define Eligibilty for Medicaid* 1. Disability (Katie Beckett) Considers only child s income There Are Different Doors to Medicaid 2. Income (BadgerCare) Considers family income Do not need a disability 3. Income & Disability (Supplemental Security Income, SSI) *Proof of citizenship is required for ALL Medicaid programs

21 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

22 Is this Child a Good Fit for BadgerCare Plus? BadgerCare Plus: A health care coverage program for low-income Wisconsin residents. 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

23 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

24 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:

25 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

26 Mental Health Services Covered by Medicaid Medicaid covers a variety of supports, services and medications for children with mental health or behavioral health challenges: 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 HealthCheck Other Services (HCOS): An option to cover mental health services not typically covered by Medicaid card, like residential or day treatment programs.

27 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.

28 Respite Care vs. Personal Care: What s the Difference? Respite Care Services 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 Personal Care Services 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 28

29 Resources to Learn More about Medicaid ABC for Health Helps clients resolve coverage questions and navigate multi-payer questions. Aging and Disability Resource Center Unbiased information on all aspects of life related to aging or living with a disability; age 17 ½ and older. Family Voices of WI Family friendly fact sheets on navigating Medicaid and other important supports and services. Five Regional Centers Medicaid Handbook Well Badger Resource Center Specialists who can help get answers, find services, and connect you to community resources. Their services are free and private. The benefits plan for Medicaid. It gives useful information on covered services. Assists parents in finding resources for their children with special needs, from birth to age 21.

30 R e s o u r c e s Autism / Behavioral Treatment Services FAQ Diapers/Incontinence Supplies for Families in Medicaid HMO Diapers/Incontinence Supplies and Medicaid HealthCheck Other Services A Step by Step Guide to Accessing Services through HealthCheck Katie Beckett Brochure & Consultant Lists Mandatory Services in the State Health Plan Medicaid and Transportation to a Medical Appointment Personal Care Services and Medicaid Supplemental Security Income What you should know before applying for SSI for your child Handouts Click to go to Handouts

31 W e b L i n k s Forward Health: dhs.wisconsin.gov/forwardhealth/index.htm Katie Beckett Program: dhs.wisconsin.gov/long-term-care-support/services-children/katiebeckett SSI (Supplemental Security Income for Children): ssa.gov/disability/disability_starter_kits_child_eng.htm Wisconsin Medicaid: dhs.wisconsin.gov/medicaid

32 Children s Long-Term Support Medicaid Waivers

33 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 families

34 What Are Long-Term Supports? Long-Term Supports: Programs and services that help an individual live in the community. Some Examples: Adaptive aides Home modifications Parent training and education Peer supports Respite Specialized equipment Vehicle modifications

35 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.

36 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

37 Rosy vs. Realistic: Completing the CLTS Functional Screen Ben can dress himself independently. vs. vs. Realistic Ben 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. vs. 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. Functional Screen 37

38 Long-Term Support Programs Programs for Children Children s Community Options Program (CCOP) Children s Long-Term Support Waivers (CLTS)

39 CLTS Functional Screen: A Reality Check CLTS 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 39

40 R e s o u r c e s 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 Mental Health Fact Sheet Series What Are Outcomes What is the Katie Beckett Program? Handouts Click to go to Handouts

41 W e b L i n k s 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

42 Takeaways: Lynn s Thoughts Brigit s Thoughts

43 Family Voices of Wisconsin