Waiver-Based Program

The Federal Center for Medicare and Medicaid Services (CMS) approves Wisconsin's Medicaid Waiver Programs. These waivers are called home and community based waivers. This waiver gives the state the flexibility to create and initiate alternatives to placing Medicaid eligible children in hospitals and institutions for the developmentally disabled. The waiver program recognizes that many children at risk of placement in these facilities can be cared for in their homes and communities preserving their independence and ties to family and friends at a cost no higher than institutional care.

The Medicaid Waiver is built upon values and support, individual choice, enhancement of the relationships, accessible and flexible service systems, and achievement of optimum physical and mental health, presence and participation in the community. The Medicaid Home and Community Based Waiver that supports eligible children who have a physical or developmental disability or traumatic brain injury or severe emotional disturbance is called the Children's Long Term Support Waiver Program (CLTS-W).

Katie Beckett Program

The level of care that the child must have is what is referred to as an institutional level of care. This is the same level of care that is needed for a child to access Medicaid through the Katie Beckett Program.

In Wisconsin, children and youth up to their 19th birthday, who have a disability and require an institutional level of care may qualify for Medicaid through the Katie Beckett program. Only the child's income and assets are considered, in the Katie Beckett program, not the family's income and assets. Eligibility for both the Katie Beckett program and the Children's Waiver Program is reassessed annually. Children who receive Medicaid through the Katie Beckett program and children receiving the Children's Long Term Support Waiver must continue to meet the level of care requirements as determined by the statewide functional screen.

CLTS-W

The CLTS-W is a flexible way to use Medicaid funding. The state approves or disapproves each CLTS-W application and service plan that is submitted by the county. Children must have Medicaid to receive the services through the Children's Waiver Program. Service plans must be individualized to meet the needs of the child and the family.

The following types of services are typically allowable, however services are individualized and they do vary according to the individual and family need under this program. Types of possible services:

• Child care
• Communication aids
• Counseling therapeutic resources
• Home modifications
• In-home intensive treatment for autism
• Respite care
• Service coordination
• Specialized equipment

Children's Services Specialists employed by the state are assigned to each county throughout Wisconsin. Children's Services Specialists form strong partnerships with the Ozaukee County Long Term Support Manager and case managers to ensure that client rights are being upheld and health, safety and welfare are being closely monitored and families are satisfied with CLTS-W Waiver services. These state staff may provide additional consultation and assistance with planning as well as conduct random annual reviews with consumers and guardians.

The Functional Screen is also submitted for the state's review and determination of initial eligibility and continued eligibility. A parental cost share is in place on a sliding fee scale. Services funded through the CLTS-W are intended to enhance the child's functioning in their home or foster home. There is a waiting list for this program in Ozaukee County. This program provides the primary financial foundation for the provision of comprehensive community based services to Ozaukee County children with disabilities.

Services Funded by Waiver

The following are a list of possible services funded by the waiver:

• Adaptive aids
• Child care and foster care services
• Communication aid
• Consumer education and training
• Counseling and therapeutic resources
• Daily living skills
• Day services
• Home modifications
• Personal emergency response systems
• Respite care
• Specialized medical and therapeutic supplies
• Specialized transportation
• Support and service coordination
• Supported employment
• Supportive home care

The waiver does not cover basic child care and foster care services costs, but only supplemental costs related to meeting additional needs for the child's disability. Experimental or aversive services will not be funded. Educationally necessary services under the Individuals with Disabilities Education Act (IDEA) will not be funded.

Eligibility

• A documented diagnosis is required.
• Ages birth to 22 years.
• An eligible level of care must be established by the Children's Functional Screen.
• Child must be residents of Ozaukee County.
• The child must be a state of Wisconsin resident for a minimum of 6 months.
• The child must have a source of medical assistance.
• There may be a parental fee.

Parental Fee

The State of Wisconsin Department of Health and Human Services CLTS-W has a Parental Fee System. Parental Fee means that families may be assessed a fee based on family income, family size, and individual service plan costs. View parental fee information and FAQs online.

Respite Care

The provision of services to eligible children with disabilities on a short term basis in a number of different settings. Respite care services are those services provided on a short term basis to relieve the primary caregiver of their care giving duties. Respite care services can be provided in a residential setting, institutional setting, the home of the child, the home of the caregiver, or possibly in another community setting not mentioned here with permission of the family and county social worker.

All respite provided in an institutional setting does require the Department of Human Services Long Term Support Division Manager's prior approval and possibly approval from the assigned state Children's Services Specialist.

Case Management Services & Service Coordination

Ozaukee County Department of Human Services employs case management staff that shares the responsibility with consumers and their families or guardians to develop individual support plans for consumers, which are then submitted to the state for approval. Case managers will work with consumers to coordinate and monitor ongoing services, offer general information, provide referrals for various programs and provide consultation and assist in problem solving.

The case management staff provides support and service coordination that involves the assessment of needs, strengths, preference, goals and outcomes of individuals / families collaboratively with the individual and relevant others. A plan is developed based on self-directed approach to the maximum extent possible. Service coordination helps determine needs, eligibility, access community providers and financial resources.

The case manager's responsibilities are:

• Assisting with the identification, development and implementation of consumer's goals and plans.
• Assuring consumer participation, choice, and control.
• Completing specific program assessments.
• Creating needed resources. Coordinating and monitoring services. Developing and presenting reports to the court.
• Determining eligibility for services.
• Helping to identify natural as well as other types of support.
• Monitoring satisfaction, quality, health and safety.
• Promoting creative use of funds and other resources that may be needed to achieve outcomes.
• Providing Information and referral services, etc.
• Securing funding for allowable services. Ensuring ongoing compliance with program regulations to maintain the funding.
• The development of individualized case plans.

All participants in the CLTS-W, and Family Support Program receive case management services.

Home Modifications

Home modifications are generally alterations to a person's primary residence that address needs associated with accessibility, health, safety or life in the community. Home modifications may include materials and services that assist in the assessment of need for a modification, as well as the actual construction of the modification. There are many specific rules that must be followed including prior authorization per the CLTS-W regulations.

Enrollment

New Applicants:
 Ashley Schultz
 262-284-8200