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Wisconsin Long Term Care

In March 2009 eleven counties in northwest Wisconsin will begin a transition from the current long term care (LTC) delivery system to managed care. The State of Wisconsin mandated this change in an effort to reduce waiting lists for services and control costs while empowering consumers to have more choice in their care planning. In the State of Wisconsin, managed care is called Family Care. A managed care organization (MCO) operates much like other health maintenance organizations, or HMOs, wherein vendors (example: care providers, transportation providers, therapy providers, etc.) work together with the MCO to provide services to consumers.

What this means for people currently receiving long term care services is that they may move from the current county systems (for example, the Community Options Program – COP, the Community Integration Program – CIP, or other waiver programs) to a managed care district under our regional Managed Care Organization (MCO). Our regional MCO was recently named NorthernBridges. Our family care district includes ALL eleven counties listed below.

Alternatively, there is a statewide waiver, IRIS (Include, Respect, I Self-Direct) that provides an option outside of Family Care to those who do not wish to become a member of the managed care organization NorthernBridges; rather, they will use the IRIS waiver to select the services they need. Continue reading below for more information about these options along with information about waiting lists.

Aging and Disability Resource Centers (ADRCs) will be the common entry point for people looking for long term care services; ADRCs will provide a number of other services including information and referral to anyone in their district. ADRCs will be in four main groups, with satellite offices in each county. The four ADRC groups are:

o Barron, Washburn, Rusk

o Douglas

o Ashland, Bayfield, Iron, Price, Sawyer

o Burnett, Polk

Several links to other documents and Internet addresses follow. Click on any of the links for more information. When you are finished, you can close the web page or document to return to this page and continue. Please contact North Country Independent Living if you require information in an alternate format. And please be aware that information changes often; we update the information as frequently as possible.

· To help define some of the terms and acronyms around Family Care and the SDS Waiver or IRIS click here. Acronyms in Family Care

· To read more about Self-Directed Supports (SDS) or what is known as self-determination, click here. These are examples of things to think about… choices you should have in planning. You will need to have Adobe Acrobat Reader to open this document. Free downloads are available on the internet if you do not already have this software. PEONIES

· To see a brief summary about Self Directed Supports in Family Care and the IRIS Waiver, click here. NCIL summary of Family Care

· Persons currently receiving LTC services under COP, CIP, the Alzheimer’s waiver or other county programs, and those who are on waiting lists for long term care will begin a screening process at the nearest Aging and Disability Resource Center (ADRC). The staff at the ADRC will help you determine your eligibility for long term care services. There are two basic requirements to obtain long term care services in Wisconsin:

o You need to be functionally eligible: you are at risk of placement in a long term nursing care facility because of long term health/disability needs (aging, developmental disability, physical disability).

o You need to be financially eligible: you don’t have adequate funding to pay out-of-pocket for the long term care services you need. The ADRC and your County Economic Support will help you determine eligibility.

· Click here to find information about the Long Term Care Screening Document. http://dhs.wisconsin.gov/ltcare/FunctionalScreen/LTCFSSlideShow.HTM You will need to download the document and be able to view a PowerPoint presentation to open this document. You can download a free PowerPoint reader at http://www.microsoft.com/downloads/details.aspx?FamilyId=428D5727-43AB-4F24-90B7-A94784AF71A4&displaylang=en . You can also contact North Country Independent Living and have a hard copy of this document sent to you.

· You’ll need to decide which plan to enroll in:

o Family Care: Managed Care under the direction of a Managed Care Organization (MCO) with some options for self direction of services OR…

o The IRIS Waiver: you decide all of your care services.

o There is a third option: you can continue to purchase needed goods and services by just using your MA card and not enrolling in Family Care or IRIS.

· Click here to go the Managed Care Organization, NorthernBridges, in our 11-county district. http://www.nwfamilycare.com/

· Click here to go to learn more about the history of the self-directed supports waiver IRIS. http://www.dhs.wisconsin.gov/bdds/sds/

· Click here to go directly to the IRIS website. http://www.wisconsin-iris.com/

· Click here to go to documents that briefly describe the IRIS Waiver Program. IRIS Brochure Flyer

· Click here to go to a document that details the process for accessing the IRIS Waiver. SDS Role and Timeline A shortened version of this process is available by clicking on this document. IRIS Referral Flowchart

· Click here to go to documents that describe the Independent Consulting Agency (ICA) and Financial Service Agency (FSA) roles and responsibilities in IRIS.

· Click here for a referral flow chart on IRIS, along with enrollment and disenrollment forms.

· Click here to go to the newly named statewide Department of Health Services, DHS (formerly Department of Health and Family Services, DHFS). http://dhs.wisconsin.gov

· Link to a Public Service Announcement from your Northwest Wisconsin Long Term Care Options Collaborative (NW-LTCO)

· Link to a diagram explaining the Aging & Disability Resource Center’s involvement in your care planning. SDS particulars flow chart comparison - DHFS

· Click here to go to a list of services within IRIS compared with Family Care Managed Care. Note that IRIS is now available for people living in Adult Family Homes (AFH) and other multi-consumer housing, but consumers will have some limitations due to that housing option. SDS Waiver-FC Services Comparison List DHFS 07-08

· Click here to go to an explanation about IRIS and Managed Care programs. This is a video that will require high speed internet access to play properly. If you have dial-up service, you will be unable to watch the video, but it is available for viewing: contact North Country Independent Living and arrange for a training and information session. http://media1.wi.gov/DHFS/Viewer/Viewers/Viewer320TL.aspx?mode=Default&peid=42221a4b-341d-4080-8b84-eebbfd57baa2&pid=ea0d00b4-6d48-472a-8163-777569aca9ac&playerType=WM7

· Click here for a timeline of transition planned for your county. Family Care Transition schedule by county

· Click here for frequently asked questions (FAQ) about Family Care as it relates to people with developmental disabilities. http://dhs.wisconsin.gov/managedltc/stakeholders/pdf/qafordd.pdf

· If you are on a waiting list, contact your local ADRC or County to get more information on the screening process. The ADRC will help determine your functional and financial eligibility for long term care services. We will update this website as ADRCs are developed in our 11-county Family Care District, and include links to their websites. The ADRCs are still in the development stage, and their web pages are still under construction. Follow the links below to existing ADRC pages.

o Barron County ADRC http://www.co.barron.wi.us/connect.htm

For a list of services the ADRC is to provide, click here: Functional Elements of an ADRC

If you are NOT currently on a waiting list, contact your county Department of Health and Human Services to get ON a waiting list. This is particularly important to parents/guardians of children transitioning out of school, or who will reach age 17 years, 9 months by the time their county is set to roll into Family Care. Click on your county below to link to their website and look for further links to Departments you seek.
- Ashland http://www.co.ashland.wi.us/
- Barron http://www.co.barron.wi.us/
- Bayfield http://www.bayfieldcounty.org/
- Iron http://www.ironcountywi.org/
- Price http://www.co.price.wi.us/
- Rusk http://www.ruskcounty.org/
- Polk http://www.co.polk.wi.us/
- Sawyer http://www.sawyercountygov.org/
- Burnett http://www.burnettcounty.com/
- Douglas http://www.douglascountywi.org/
- Washburn http://www.co.washburn.wi.us/

There are many disability advocacy and support groups in Wisconsin and nationally; check under “Links” or “Community Resources” on this website to find some of these groups.

Stay tuned for updates here! We hope to soon feature links to some empowering and creative options for vocational and other initiatives that are developing in our area and around the state.

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