28.1 Home and Community-Based Waivers Long-Term Care Introduction

Community waivers enable elderly , blind, or disabled people to live in community settings rather than in state institutions or nursing homes. They allow Medicaid to pay for services and supports permitting a person to remain in a community setting that normally are not covered by Medicaid.

Community waivers include the following programs:

CIP I (CIP 1A and CIP 1B).
CIP II.
CLTS Waiver Program. This program serves children with physical disabilities, developmental disabilities, and severe emotional disturbance or mental health needs.
COP-W .
Family Care.
Family Care Partnership.
IRIS .
PACE .

To be eligible for these waivers, a person must meet all of the following:

Meet Medicaid LOC requirements for admission to nursing homes.
Meet nonfinancial requirements for Medicaid.
Meet financial requirements for Medicaid.
Reside in a setting allowed by community waivers policies.
Have a need for LTC services.
Have a disability determination if he or she is younger than 65 years old. Exceptions to this include the following:
- A finding of disability made prior to the person’s 18th birthday, which remains in effect on the person’s 18th birthday, will be considered to meet the disability requirement until either an adult disability determination can be done or the child’s disability determination is no longer in effect, whichever occurs first).
- People younger than 65 years old who meet both of the following criteria may be enrolled in Family Care, Family Care Partnership, PACE, or IRIS without first obtaining a disability determination from DDB :
- - Functionally eligible for Family Care, Family Care Partnership, PACE, or IRIS at a nursing home level of care
  - Eligible for one of the following Medicaid or BadgerCare Plus categories: BadgerCare Plus Standard Plan, Wisconsin Well Woman Medicaid, Medicaid through adoption assistance, or Foster Care Medicaid

The Eligibility Results page of the long-term care functional screen indicates Family Care, PACE, Partnership, or IRIS eligibility for people who meet this criteria. Because CARES requires that they have a disability determination, these eligible Family Care Partnership or PACE members should be coded as presumptively disabled as long as they qualify for one of the Medicaid or BadgerCare Plus categories listed above.

Note: A person who is MAPP -disabled may be eligible as a Group A participant even if a regular disability has not been determined by DDB .

This page last updated in Release Number: 17-03

Release Date: 11/03/2017

Effective Date: 11/03/2017

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030