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Long Term Care |
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As of August 2009 eleven counties in northwest Wisconsin have transitioned 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. Aging and Disability Resource Centers (ADRCs) will be the 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 http://www.adrcconnections.org o Douglas http://douglascountywi.org/adrc o Ashland, Bayfield, Iron, Price, Sawyer o Burnett, Polk · 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.
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. Our MCO is NorthernBridges their main office is in Hayward continue down the page for a link to their website. 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. 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
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Click here to find
information about the Long Term Care Screening Document.
http://dhs.wisconsin.gov/ltcare/FunctionalScreen/LTCFSSlideShow.HTM.
· You’ll need to decide which plan to enroll in: o Family Care: Managed Care under the direction of a Managed Care Organization (MCO) NorthernBridges with some options for self direction of services OR… http://www.northernbridges.com/index.html · The IRIS Waiver: you decide all of your care services. http://www.wisconsin-iris.com/ 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 to documents that describe the Independent Consulting Agency (ICA) http://www.wisconsin-iris.com/about_ICA.html and Financial Service Agency (FSA) roles and responsibilities within IRIS. http://www.wisconsin-iris.com/about_FSA.html These two functions exist within IRIS without additional cost from the participant’s budget. · Click here to see examples of the IRIS enrollment and disenrollment forms. http://www.wisconsin-iris.com/fsa_forms.html · 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 · 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
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