Wisconsin provides long-term care resources to seniors through its Department of Health Services, Long Term Services and Supports (DHS, LTSS). This office provides information and access to resources for long-term care services, both state-funded and through Medicaid waiver programs. On a state basis, the DHS LTSS division oversees the Aging and Disability Resource Consumer Page, which is the first stop for aging and seniors services in the state.

The state’s regional Area Agencies administer additional resources for seniors over 60 on Aging. Established under the Older Americans Act (OAA) in 1973, Area Agencies on Aging (AAAs) respond to the needs of Americans aged 60 and over in every local community. Wisconsin has three of these agencies. Milwaukee and Dane are single-county agencies that also serve as county aging units. The Greater Wisconsin Agency serves the other 70 counties and 11 federally recognized Indian Tribes on Aging Resources as the contract and oversight agency. TheAAAs assess the current needs of older people in their planning and service area and, assess available services, programs, and institutions; develop plans to help address the service gap. In addition, they help assure access to services, programs, and institutions, advocate for the needs of older people, and serve as a focal point for evidence-based health promotion and disease prevention activities.

Wisconsin’s Department of Health Services also offers two Medicaid long-term care programs (also known as Medicaid waivers) that assist seniors who are typically eligible for Medicaid long-term care benefits for nursing homes to remain in their community or even in their own homes. The programs are called: 1) Family Care and 2) IRIS (Include, Respect, I Self-Direct).

Medicaid Waiver Programs for Assisted Living and In-Home Care

Wisconsin Family Care Medicaid Waiver (HCBS Family Care Waiver)

Family Care is a long-term care program which helps frail elders and adults with disabilities get the services they need to remain in their homes. This comprehensive and flexible program offers services to foster independence and quality of life for members while recognizing the need for interdependence and support. The goal of Family Care is to: 1) Give people better choices about the services and supports available to meet their needs; 2) Improve people’s access to services; 3) Improve the overall quality of the long-term care system by focusing on achieving people’s health and social outcomes; 4) Create a cost-effective long-term care system for the future.

In addition, Wisconsin operates the Family Care Partnership Program, which uses Managed Care Organizations to administer services more effectively by facilitating member choice. A key component of the Partnership Program is team-based care management. Under this arrangement, the participant, his or her physician, and a team of nurses and social workers develop a care plan together. The team coordinates all service delivery. Participants often keep their own physician, who, in most cases, is added to the Partnership provider network. The eligibility requirements under Medicaid are the same. There were 1,339 seniors enrolled in the Family Care Partnership Program.

Services

Services include Adaptive aids, adult day care, case management, communication aids/interpreter services, consumer education and training, counselling and therapeutic resources, customized goods and services, daily living skills training, day services/treatment, financial management services, home modifications, housing counselling, home-delivered meals, Personal Emergency Response Services, Prevocational Services, Relocation Services, Residential Services (Adult Family Home, Community-Based Residential Facility, Certified Residential Care Apartment Complex), respite care, self-directed personal care, skilled nursing, specialized medical equipment and supplies, specialized transportation, support broker, supported employment, supportive home care, training services for unpaid caregivers, and vocational futures planning.

Eligibility

  1. Health: Applicants must require a Nursing Home Level of Care or Intermediate Level of Care.
  2. Financial: This waiver has a special income limit equal to 300% of the Federal Benefit Rate, meaning that an individual can only receive $2,523 per month in income to qualify for the benefit. In addition, the individual cannot have assets that exceed $2,000 (or $3,000 for a couple) to qualify. The use of a Miller Trust, or Qualified Income Trust, is not allowed for funnelling income into the trust for purposes of care to access the benefit. As of February 2022, the Family Care waiver does not allow a “medically needy” spend down category for eligibility unless they are physically disabled. The non-applicant spouse can keep $137,400 in assets (the Community Spouse Asset Share) and receive a monthly allowance of up to $1,132.50 for an individual and $1,525.83 for a couple for other expenses without affecting the applicant’s financial eligibility (the Spend Down “Medically Needy” income limits).

Practical Considerations

There are financial caps on the amount of the benefit that can be disbursed through the program, which differs based on the region in the state. The Family Care waiver serves not only the senior population (aged 65+) but also the physically and intellectually disabled.

Wisconsin Self-Directed Supports- Elderly and PD Medicaid Waiver (HCBS IRIS Waiver)

The IRIS Program is a Medicaid Home and Community-Based Services (HCBS) waiver for self-directed long-term support. This program is an option for adults with long-term care needs. The Wisconsin Department of Health Services, Division of Medicaid Services (DMS) oversees the program. IRIS is available to Wisconsin residents determined financially eligible for Medicaid, functionally in need of a nursing home or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care, and living in a county where managed long-term care and IRIS are available. Eligible people can choose IRIS or managed care through their local Aging and Disability Resource Center (ADRC).

Services

Services include: Adaptive aids, adult day care, communication aids/interpreter services, consumer education and training, counselling and therapeutic resources, customized goods and services, daily living skills training, day services/treatment, fiscal employer agent, home modifications, housing counselling, IRIS Consultant Agency Provider, Live-in Caregiver, home-delivered meals, Personal Emergency Response Services, Prevocational Services, Relocation Services, Residential Services (Adult Family Home, Certified Residential Care Apartment Complex), respite care, self-directed personal care, skilled nursing, specialized medical equipment and supplies, specialized transportation, support broker, supported employment, supportive home care, and vocational futures planning.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: In 2022, this waiver has a special income limit equal to 300% of the Federal Benefit Rate, meaning that an individual can only receive $2,523 per month in income to qualify for the benefit. In addition, the individual cannot have assets that exceed $2,000 (or $3,000 for a couple) to qualify. The use of a Miller Trust, or Qualified Income Trust, is allowed for the use of funnelling income into the trust for purposes of care in order to access the benefit. Further, the IRIS waiver allows a “medically needy” spend down category for eligibility, meaning you can spend your income on medical and other remedial care and have that amount deducted from your countable income. The non-applicant spouse can keep $137,400 in assets and receive a monthly allowance of up to $1,132.50 for an individual and $1,525.83 for a couple for other expenses without affecting the applicant’s financial eligibility.

Practical Considerations

The medically needy spend-down category is available to participants in the IRIS waiver. This waiver is for seniors who wish to have more self-direction in their long-term care planning. However, it is a significantly smaller program than the Family Care waiver and does not offer case management services or the ability to live in a community-based residential facility. IRIS Self-Directed Personal Care (SDPC) is a self-directed option that is available only to participants in the IRIS program and is another unique aspect of the IRIS waiver. IRIS SDPC can be used at work or in community settings outside the home. Participants may also hire family members to provide personal care. Participants are not eligible for IRIS SDPC if they live in a group residential setting, such as an adult family home or residential care apartment complex unless the residential provider is a relative.

Wisconsin Community Options Program Medicaid Waiver (HCBS COP Waiver)

Community Options is a program available in a limited number of counties that helps people who need long-term care to stay in their own homes and communities. Its purpose is to provide cost-effective alternatives to expensive care in institutions and nursing homes. Elderly people and people with serious long-term disabilities receive funds and assistance to find services they are not able to get through other programs.

Services

Services include home modification, respite care, adaptive equipment, financial counselling, care management, communication aids, home health care, residential services, personal care, and housekeeping.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: This waiver has a special income limit equal to 300% of the Federal Benefit Rate, meaning that an individual can only receive $2,523 per month in income to qualify for the benefit. In addition, the individual cannot have assets that exceed $2,000 (or $3,000 for a couple) to qualify. The use of aMiller Trust, or Qualified Income Trust, is allowed for the use of funnelling income into the trust for purposes of care in order to access the benefit. Further, the COP waiver allows a “medically needy” spend down category for eligibility, meaning you can spend your income on medical and other remedial care and have that amount deducted from your countable income. The non-applicant spouse can keep $137,400 in assets and receive a monthly allowance of up to $3,051.66 for other expenses without affecting the applicant’s financial eligibility.

Practical Considerations

The COP waiver is the smallest of Wisconsin’s Medicaid long-term care waiver programs and is limited geographically. Further, this waiver’s target population (although available to seniors over 65 years old) is the elderly population with severe long-term disabilities, and the care provided is tailored to that population.

Conclusion

For the HCBS Medicaid waivers, the county administers the wait lists, and the Department of Human Services Medicaid Waiver Manual sets forth how the county prioritizes eligible beneficiaries on the waitlist. Generally, the wait list is administered on a first-come, first-served basis; however, there are exceptions based on the needs of the waiver participant. The Family Care program is now available statewide and is not at capacity. However, this does not mean there is still not a wait list in the specific county as applications are processed.

Access all state Medicaid Waiver pages.