State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

28.14 Home and Community-Based Waivers Long-Term Care Children's Long-Term SUPPORT

 

28.14.1 Children's Long-Term Support Waiver Program Introduction

The CLTS Waiver Program includes the following three target population groups:

• Developmental disabilities

• Physical disabilities

• Severe emotional disturbance or mental health disabilities

 

The CLTS Waiver Program is entered in CWW as a waiver type when a child or young adult is applying for HCBW. The Medicaid eligibility criteria for HCBW for children and young adults in the CLTS Waiver Program  are similar to the CIP IB Waiver except there is no disability determination required in order to qualify. Instead, the CLTS Functional Screen determination of institutional LOC meets the HCBS Waiver eligibility requirement.

 

County waiver agencies (CWAs) complete the level of care assessment and determine eligibility for the CLTS Waiver Program. Being enrolled in any form of full benefit Medicaid (see Section 21.2 Full-Benefit Medicaid), is a prerequisite for participation in the CLTS Waiver Program. If the child is eligible for a type of non-CARES Medicaid such as Foster Care Medicaid, Adoption Assistance Medicaid, SSI Medicaid, or Katie Beckett Medicaid, the child will be eligible as a Group A Waiver and will not be referred to IM.

 

CLTS Waiver Program applicants and participants who are not open for a type of non-CARES Medicaid must complete a health care application, and they must first be tested for eligibility using HCBW rules (see Section 28.14.2 HCBWLTC CARES Processing for the Children’s Long-Term Support Waiver Program).

 

Individuals can be eligible for the CLTS Waiver Program and HCBW Medicaid through age 21. When a CLTS Waiver Program applicant or member reaches 18 years old and their source of Medicaid is HCBW, they must apply for HCBW Medicaid as the primary person. Federal and state privacy and confidentiality protections prevent the parents of adults from automatically having access to protected information; therefore, these young adults must apply as the head of their own IM case.

 

When individuals ages 18-21 require HCBW Medicaid, CWA staff submits the following to IM:

• Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, F-10129
• Home and Community-Based Waiver Medicaid Enrollment for the Children’s Long-Term Support Waiver Program Form, F-02319
• Medicaid Waiver Eligibility and Cost Sharing Worksheet, F-20919
• Verification of the young adult’s income, if any.

 

To be eligible for HCBW, the child must be both Medicaid-eligible and functionally eligible. To determine eligibility for HCBW, only the child’s income is counted. There is no asset test. Since assets are disregarded, there can be no divestment in a HCBW Medicaid case for a child.

 

If an applicant or participant is ineligible for HCBW, he or she must then be tested for BadgerCare Plus.

28.14.2 HCBW LTC CARES Processing for the Children's Long-Term Support Waiver Program

To facilitate the application and renewal process and reduce the duplication of verification requests that could cause a burden to families who are applying for multiple programs, CWA staff working with a family whose child is functionally eligible and requesting HCBW will submit the following information to the IM agency.

 

For applications, CWAs work with families to complete and submit:

• A valid application for health care (see Section 2.4 Valid Application), including the Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, F-10129
• Home and Community-Based Waiver Medicaid Enrollment for the Children’s Long-Term Support Waiver Program, F-02319
• Medicaid Waiver Eligibility and Cost Sharing Worksheet, F-20919
• Verification of the child’s income, if any

 

For annual HCBW renewals, the family must submit a completed health care renewal (for example, a PPRF) and CWA staff will submit:

• Home and Community-Based Waiver Medicaid Enrollment for the Children’s Long-Term Support Waiver Program, F-02319
• Medicaid Waiver Eligibility and Cost Sharing Worksheet, F-20919
• Verification of the child’s income, if any

 

Eligibility should not be discontinued if the CWA has not yet made the level of care review.

 

HCBW requests must be processed differently depending on whether there are any other people on the case who are requesting health care. See Process Help Section 9.7 Home and Community-Based Waiver Medicaid for Children's Long-Term Support for processing instructions.

 

 

 

This page last updated in Release Number: 18-02

Release Date: 08/10/2018

Effective Date: 04/25/2018

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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