Supports for Children with Long-Term Support Needs

SW 644: ISSUES IN DEVELOPMENTAL DISABILITIES

Supports for Children with Long-Term Support Needs

Alice Thorson, MSSW & Julie Bryda, MSSW

Unit 1 - Overview

Overview

(Slide 1-2)

ALICE THORSON: Hi, my name is Alice Thorson. I'm from the Bureau of Long-Term Support with the Department of Health Services with the state of Wisconsin. And I'm here to talk about the supports in Wisconsin for children with long term support needs.
Overview

(Slide 3)

This is a snapshot of funding options for children. There are five listed here. The Medicaid program, the Katie Beckett Program, the Birth to 3 program, the Family Support Program, and Children's Long-Term Support waivers.

Overview

(Slide 4)

For all of those programs, eligibility needs to be determined for childrenin Wisconsin an online screening tool is used for that purpose. A certified screener meets the child, gathers information about the child's disability and needs, and then enters that information into the online screening tool, which determines eligibility.
The child needs to have substantial limitations in three out of five areas. Which includes self-care, receptive or expressive language, learning, mobility, or self-direction.
The screener enters information regarding the child's abilities, so along the lines of self-care, communication, intellectual ability, and behavior, into the functional screen, and it determines the level of care for the child. For eligibility, a child needs to have substantial delays in three out of five areas. Which include self-care, receptive and expressive language, learning, mobility, and self-direction.

Overview

(Slide 5)

The functional screen determines eligibility for the following programs. The functional screen isn't necessary for all programs, but it is necessary for the Family Support Program, Katie Beckett Program, the Children's Long-Term Support Waivers, the Community Options Program, comprehensive community services, and mental health wrap-around services.

Overview

(Slide 6)

The Medicaid card is an important part of children services. Not only because it provides funding for medical needs, similar to insurance, but also because agencies use it to access funding for children through the Medicaid waivers.

Overview

(Slide 7)

Occasionally, children are eligible for multiple target groups. There are three target groups, developmental disabilities, physical disabilities, and severe emotional disturbance. When a child is eligible for multiple groups, the county works with the child and accesses the funding that meets the needs the best.

Unit 2 – The Katie Beckett Program

The Katie Beckett Program

(Slide 8)

Then I'm going to skip over the Katie Beckett Program.

The Katie Beckett Program

(Slide 9)

The Katie Beckett Program is a program that allows children to access Medicaid funding through special eligibility. It applies to children through the age of 18, until they turn 19. They must still meet a level of care for developmental disabilities, physical disabilities or severe emotional disturbance. And a disability determination is required.

The Katie Beckett Program

(Slide 10)

Although the Katie Beckett Program allows children to access Medicaid through different rules, there is still financial eligibility that needs to be looked at. In addition, the care for the child at home, the cost for that cannot be greater than the care for the child if they were in an institutional setting. And about 5100 children are currently served in Wisconsin.

Unit 3 –The Family Support Program

The Family Support Program

(Slide 11)

The next programthat I'm going to talk about is the Family Support Program.

The Family Support Program

(Slide 12)

The Family Support Program is founded on the philosophy that families know best what their child with disabilities needs. It's a more flexible funding source, although the maximum amount that a family can receive is $3,000 in one year, so it is a short term program.
A level of care through the functional screen is required, but the disability determination is not required.

The Family Support Program

(Slide 13)

The Family Support Program can help fill gaps and provide payment for services that other programs aren't able to. Also, the Family Support Program is used to help families keep their children living at home, instead of needing to go into an institution.
Unit 4 – CLTS Waivers

CLTS Waivers

(Slide 14)

The Children's Long-Term Support Waivers are Medicaid waivers for children with long-term support needs in Wisconsin.

CLTS Waivers

(Slide 15)

There are three target groups for the Children's Long-Term Support Waivers. Those include children with developmental disabilities, children with physical disabilities, and children with severe emotional disturbance.
CLTS Waivers

(Slide 16)

To meet the Children's Long- Term Support Waiver eligibility, the child must meet an eligible level of care. So they need to fit into one of the three target groups that I just mentioned. The important thing is that children reside in an eligible setting, which means that they live at home or in a foster care, but cannot live in an institutional setting. They need to meet any applicable residency requirements for Wisconsin. They also need to have been determined to need the waiver services.

CLTS Waivers

(Slide 17)

There are different ways for a child to receive funding through the waivers. One way is through local match, and the other is through state.

CLTS Waivers

(Slide 18)

In addition, no experimental or aversive treatments can be funded using CLTS waiver money. The services that are provided to children are based on individual need.
CLTS Waivers

(Slide 19-20)

This slide shows a list of the different types of things that can be covered through the CLTS Waiver program. To give you a couple of examples, an adaptive aid for a child could be an adaptive swing. Communication aids could be a device that helps the child talk. There are switches that a child can hit or a talking photo album, which parents will record to communicate with other people.Some of the other services include home modifications, which could be a ramp, an accessible bathroom, or an accessible kitchen. Or respite care, which can provide funding so that the parents can have a break if they need it from the care of their child.

Unit 5 – The History of CLTS Waivers

The History of CLTS Waivers

(Slide 21)

JULIE BRYDA: Hello, my name is Julie Bryda and I work for the Department of Health Services in the Bureau of Long-Term Support, and I'm going to give you a little bit of history of some of the services and programs that Alice just discussed in the history of Children's Long-Term Support Waivers.

The History of CLTS Waivers

(Slide 22)

In 1991, the home and community-based waivers were authorized by Congress for states to access dollars that were earmarked for institutional care to provide services for people in the community. In 1981, Wisconsin began accessing these programs as we saw it as a way to reduce the number of people that we had living in institutional settings here. At that time, we began accessing the home and Community-based waivers for a both children and adults. In 2003, Wisconsin began to look at providing long-term supports for children in the community.

The History of CLTS Waivers

(Slide 23)

In 2003, Wisconsin made application to the Federal Centers for Medicare and Medicaid for three children's waives. We made an application for children with developmental disabilities, with severe emotional disturbance and for physical disabilities. We did receive approval and began implementation in 2004. The children's waivers are unique in that they are time-limited. Children are eligible from age zero, up to the age of 22.

The History of CLTS Waivers

(Slide 24)

Prior to the waivers being applied for and approved in 1997, Wisconsin had begun efforts of redesign looking at how children’s services are implemented in Wisconsin and we worked with the Children's Council on how best to shape those and improve those for the future. The children's waiver was one avenue to do that.

The History of CLTS Waivers

(Slide 25)

Again, the home and community-based waivers were originally written for adults. Although children were included, their numbers were quite limited. With the approval of the children's waivers, those numbers increased quite significantly.

The History of CLTS Waivers

(Slide 26)

When a state receives approval for a home and community-based waiver, it is required to be implemented statewide. Every county in Wisconsin does administer the three children's waivers and various memos and directives were written by the Department of Health which describes a county responsibility to do that. County waiver agencies that do administer the waivers are required to implement policies and procedures that are written by the State of Wisconsin Department of Health based on the federal requirements through the Centers for Medicare and Medicaid.

The History of CLTS Waivers

(Slide 27)

One of the policies that county waiver agencies are required to have to implement, actually is the waiting list policy. Each county in Wisconsin is required to have a waiting list for long-term support services and the Centers for Medicare and Medicaid have given the state direction as to how that should be implemented. There is a memo on our department website which describes that policy.

Unit 6 – Where We Are Now: Children’s Services

Where We Are Now

(Slide 28)

Not all children are eligible for the Children's Long-Term Support Waivers, as Alice mentioned in her previous discussion about our children's long-term support functional screen. There are other funding programs, such as the Family Support Program, for example, where a child may not be eligible for the children's waivers but perhaps could be eligible for the family support program.
Along with the Children's Long-Term Support Waivers and the use of the federal funding for community services, Wisconsin monitors the delivery of these children services. Wisconsin does administer an annual family outcome survey. We do 100% of initial plan application review to review outcome-based service plans and to ensure that the service planning is family-centered along with family input.

Where We Are Now

(Slide 29)

To date, we have approximately 4,327 children being served under the Children's Long-Term Support Waivers. Over half of those children are children who have an autism-spectrum disorder, Asperger's or PDD-NOS. Regarding the other half of the children, it's a combination of children with physical disabilities and severe emotional disturbances.

Unit 7 – Funding Options for Children with Mental Health Needs