1 Citizen’s Guide to Family Care 2009 Survival Coalition of Wisconsin Disability Organizations

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Citizen’s Guide to Family Care

2009

Survival Coalitionof Wisconsin Disability Organizations

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Vision Statement

The Survival Coalition of Wisconsin Disability Organizations is committed to creating a society in which:

•People with disabilities of all ages receive the services and supports needed, throughout their life span.

•People with disabilities can choose to live their lives as they wish and be full participants in community life.


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Mission Statement

The Survival Coalition of Wisconsin Disability Organizations will be a leader in

influencing the political process about resource allocation, laws, and policies

which will advance our Vision.


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Guiding Principles1. Survival Coalition is a cross-disability coalition which

works in partnership with local organizations, coalitions, consumers, advocates, and families throughout the state and makes intensive efforts to ensure that our priorities promote and advance the wishes of people with disabilities and their families.

2. Survival Coalition will promote policies, programs, and practices that advance integrated, individualized, community-based supports and services.


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The Basics of Family Care

How Does Managed Long-Term Care Work?


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Family Care: provides long term care (LTC) services for

adults with physical disabilities or developmental disabilities, and for elderly people

is a managed care program

will eventually replace county LTC services, and along with IRIS, will be the only way for people to get a broad range of LTC services

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Family Care: is administered by a Management Care

Organization (MCO)

can only be implemented in counties where there is an operating ADRC (Aging & Disability Resource Center)

was designed to be flexible, cost effective, comprehensive, and to give enrollees a real say in developing their service plans

includes an option for “self-directed services”

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Within the context of Managed Long Term Care, Family Care:

requires/authorizes the MCO to determine what LTC services you will receive, and to coordinate and oversee these services

is funded through a “capitated rate” (an average payment per person per month for every person enrolled in the program)

empowers each FC enrollee to have his/her own individual FC plan and budget which is to be based on individual needs and desired outcomes

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Family Care: places a lot of power in the hands of the MCO

requires the MCO to select the LTC providers which will be in the MCO’s “provider network”

gives the MCO the option of directly providing and/or contracting for services

could be administered by an MCO which is a county, a consortium of counties, a private corporation, or a Family Care district

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Family Care includes the following services that were available under COP and CIP: Adaptive aids Adult day services Case/care

management services Consumer-directed

supports Consumer education

and training Counseling &

therapeutic services

Financial management services

Habilitation Supportive Home care Vocational supports Home modifications Daily living skills

training

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…And some of the services currently available via the Medicaid Card: Personal Care Home Health Care (e.g.

PT, OT, Speech Therapy, Skilled Nursing, Respiratory Care)

Specialized Transportation

Durable Medical Equipment

Counseling & Therapeutic Resources

Case Management Medical Day Treatment

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Aging & Disability Resource Centers

(ADRCs): create a single point of entry for people enrolling in Family

Care

assess the eligibility of people with disabilities and elderly people to enroll in Family Care

provide information on Long Term Care services to anyone who requests it

provide free LTC “options counseling” to people considering admission to nursing homes, CBRFs, adult family homes, or assisted living

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Aging & Disability Resource Centers:

provide free benefits counseling on the full range of disability benefits

have an emergency response capability

engage in a variety of prevention and early intervention activity

have staff who can make home visits if the person cannot get to the ADRC location

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Family Care is Based Upon Meeting “Personal Experience Outcomes”Personal Outcome

Measure Some Implications to Consider

1. I decide where and with whom I live

-choice of home, housemates, roommates, live-in staff, supported or group living

2. I decide how I spend my day

-integrated employment or sheltered work?

-desired income

-choice of career

-choice to contribute to others

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Family Care Outcomes3. I make my own decisions regarding my supports and services

-what support I want, how much support, how I want to receive it, and from whom

4. I have relationships with family and friends I care about

- including support if needed to maintain or create these relationships

5. I do things that are important to me

-realizing that what a I now do may or may not be important to me

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Family Care Outcomes

6. I am involved in my community

-includes contact and opportunity for relationships with non-disabled people

7. My life is stable -continuity of services unless I wants a change

8. I am respected and treated fairly

-at work, at home, in dealings with the MCO and providers

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9. I have time, space, and opportunity for privacy

-an essential part of having a place that is and feels like home; important of privacy in receiving personal care

10. I have the best possible health

-includes prevention measures, regular check-ups, linkages between LTC and primary care

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11. I feel safe -includes adequate support and staff to ensure safety

-safety issues are not an excuse for institutionalization

12. I am free from abuse and neglect

-includes prevention as well as reporting and corrective action

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Show Me the Money

How do I get the outcomes and support I need?


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Long-term Care Functional Screen: used to establish level of care for Family Care

eligibility and to provide information helpful to people making decisions about how to meet their long-term care needs

an inventory of needs or list of activities that people need to perform, or have performed for them in the course of every day life.

gathers information about whether a person needs help, and how much help they need in performing activities.

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Long-term Care Functional Screen cont. looks at both activities of daily living (ADLs) and

instrumental activities of daily living (IADLs). asks questions about cognition, behavior,

diagnoses, medically-oriented tasks, transportation, and indicators for mental health problems, substance abuse problems and other conditions that put a person at-risk for institutionalization.

differences in services available to nursing home level of care individuals and non-nursing level of care individuals.

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Comprehensive Assessment

A look at your needs, strengths, resources, and preferences

There must be a face-to-face meeting with you to discuss your needs and preferences

You have a right to have to have other people involved including family, friends or an advocate.

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Comprehensive Assessment cont.

MCO staff must ask you what you want your life to be like, and what you see as your most important support needs.

Your answers must be used in deciding what personal outcomes your service plan will try to achieve for you.

Even if you are already receiving some services, MCO staff must help you identify any needs and personal outcomes that you have that are not being met.

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Family Care Outcomes I decide where and with whom I

live

I make decisions regarding my supports and services

I decide how I spend my day

I have relationships with family and friends I care about

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Family Care Outcomes cont.

I do things that are important to me

I am involved in my community

My life is stable

I am respected and treated fairly

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Family Care Outcomes cont.

I have privacy

I have the best possible health

I feel safe

I am free from abuse and neglect

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Resource Allocation Decision Method (The RAD)

The MCO is responsible for helping you to achieve your personal outcomes, but also considers cost in designing services and choosing providers.

Most MCOs do this through a process called the Resource Allocation Decision (RAD) Method.

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Resource Allocation Decision Method

Designed to develop cost-effective (not necessarily the same as “cheapest”) way to meet individual’s outcomes;

Starts with person defining individual outcomes;

Creatively looks at options; Includes gifts and strengths of person, family,

community; May sometimes be a process of negotiation

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Read Me My Rights

Citizen Rights and Protections Within

Family Care


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Rights – ADRC guaranteed

Information and assistance

Advocacy Long Term Care

Options Counseling Benefits Counseling Prevention and Early

intervention

Choice Counseling Enrollment assistance Disenrollment

counseling Transitional services Emergency response Grievance system

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Rights—MCO Guaranteed: Opportunity to self manage some or all of

your supports Comprehensive Assessment within 30

days of enrollment that:-identifies your needs and

strengths -helps you identify LTC outcomes e consistent with your values and preferences

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Rights—MCO Guaranteed:

Full participation in development of your individual service plan (ISP) within *60 days of enrolling, including:

-The right to assistance from anyone you choose in developing the ISP

The ISP must comprehensively address all your LTC needs while assisting you to be as self reliant as possible

* For people transitioning from COP or CIP, this planning process is within the 1st 6 months

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Rights—MCO Guaranteed:

Participate in selection of service provider agencies

Request out of plan service providers under certain circumstances

Grievance system

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General Rights of All People Enrolling in Family Care: Freedom from unlawful discrimination in

applying for or receiving the family care benefit

Accuracy and confidentiality of client information

Prompt eligibility, entitlement and cost-sharing decisions and assistance

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General Rights, cont.

Access—in a form or format that is accessible to you—to personal, program and service system information

Choice to enroll or disenroll in a MCO at any time

Information about and access to all services of resource centers and MCOs

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General Rights…

Support for all clients in understanding their rights and responsibilities related to family care

Assistance from Resource centers, MCOs and county agencies in identifying all rights to which a person is entitled

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General Rights…

Notice of any intended action at least 10 days in advance and in writing of any adverse action – termination, suspension, reduction of eligibility or services

File Grievances and/or request Fair Hearings

Seek assistance from the Independent Advocate/Family Care Ombudsman

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Advocacy and Appeal Rights – 3 optionsMCO grievanceDHS complaintState Fair Hearing

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Rights

Receive written notice of any adverse action, including termination, suspension or reduction of eligibility or covered services

File a grievance and/or request a fair hearing

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Notice of Adverse Action – must be in writing and must contain: Intended action of county agency, ADRC or

MCO Effect action will have on services member is

currently receiving Any law that supports action Member’s right to file grievance, appeal,

request dept. review or fair hearing

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Contents of Notice of Adverse Action, cont’d Info on how to file grievance or appeal or

request fair hearing Member’s right to appear in person before

ADRC, agency or MCO Info regarding agencies that can assist with

grievance, review, hearing Member’s right to review free copies of

record for appeal and how to request copies Right to continue services, pending appeal

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Continuing Benefits Pending Appeal Members must receive notice of right to

continue current services MCOs may not deny a request to continue

services However, member may be responsible for

cost of continued services if loses appeal and no hardship granted

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1. MCO Grievances

Member may file grievance with MCO Member may seek internal MCO assistance

in doing so MCO’s “Member Advocate” is to help

member pursue rights, but does not represent member

MCO’s Grievance Committee will hear grievance

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2. Grievances to DHS – 1 of 2 Can be filed locally with MCO or at state level

with DHS DHS process for review, investigation,

analysis of client grievances and appeals for informal resolution if: Client files grievance/appeal with DHS Client requests DHS review of county agency,

ADRC or CMO

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Grievances to DHS – 2 of 2

DHS required to complete review within 20 days of client request, unless client and DHS agree to extension

Concurrent review process whenever DHS informed that FC applicant/member has requested fair hearing

Grievances or appeals from MCOs, filed with DHS, handled by MetaStar

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3. Fair Hearing

May request without first filing for grievance Must request within 45 days after receipt of

notice of a decision in contested matter Receipt presumed 5 days after notice date Conducted by DHA’s ALJs

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Grounds for Fair Hearing – 1 or 2 Denial of eligibility or reduction of FC

benefit amount Cost-sharing determination Denial of entitlement Failure to provide timely services and

support items in a care plan Reduction of service/support items

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Grounds for Fair Hearing – 2 or 2 Service plan unacceptable because

Unacceptable place to live Care, treatment or support items insufficient to

meet member’s needs Care, treatment or support items are

unnecessarily restrictive or unwanted Termination of FC benefit Recovery of FC benefit payments

(All others: must first seek request by DHS)

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Hearing-Related Rights

May choose representative May inspect records relevant to

grievance/review/fair hearing Receive copies of documents free Decision within 90 days of receipt of request

for fair hearing

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Family Care Ombudsman

Applicants and enrollees age 18-59:Disability Rights Wisconsin www.disabilityrightswi.org ● Under contract with DHS to provide advocacy● All services are free ● Independent ● Experienced with disability and LTC issues ● Advocacy Specialists and Attorneys

Applicants and enrollees age 60+:Board on Aging and Long Term Care1-800-815-0015www.longtermcare.state.wi.us

http://www.disabilityrightswi.org/

http://www.longtermcare.state.wi.us/

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DRW’s Family Care Ombudsman Program – Types of Assistance Provide info and education on rights Inform applicants and members of services

and supports in benefit package Investigate complaints Resolve and mediate issues Work with enforcement agencies Represent consumers in grievances and

hearings

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Disability Rights Wisconsin

Consumers are encouraged to contact the DRW offices nearest them:

Madison: 608-267-0214 Toll-free: 800-928-8778

Milwaukee: 414-773-4646 Toll-free: 800-708-3034

Rice Lake: 715-736-1232 Toll-free: 877-338-3724

TTY/Textnet for all offices: 888-758-6049

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Self-Directed Supports in Family Care and IRIS

Thinking Outside the Box


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When you need support to help you live in the community, you have the right to make choices about the services you get to support you. This is called Self-Directed Supports.

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Self-Directed Supports

… are part of our state law within Family Care:

“Each person may arrange for, manage and monitor his or her family care benefit directly, or with the assistance of another person.”

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Self-Directed Supports

Are also part of a new, flexible Self-Directed Supports Waiver (IRIS)

Designed specifically for Self-Directed Supports

Began in July, 2008

In counties that are included by Family Care

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Self-Directed Supports Can Help People Describe and Achieve the Outcomes They Want

SDS includes much more than hiring your own “staff”

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Key Self-Directed Supports & Long-Term Care Outcomes

I decide where and with whom I live!

I decide how I spend my day!

I make decisions about my supports and services!

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Care management for all members incorporates consumer participation and respect for choice

Self-Directed Supports are a new way for people to direct their LTC goods, services and supports

Available to all Family Care members

Each member can choose which supports to direct

Self-Directed Supports inManaged Care

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Members play a more active role Deciding how resources are allocated for services and

supports to meet personal outcomes -– even to buy services or supports that are not part of the MCO’s benefit package

Selecting their own workers, including family, friends, neighbors

Employing workers (or having an agency serve as the employer of workers the member chooses)

Partnering with others Helping create new agencies

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Overview of how it works: MCO should ask person about their interest in

SDS as part of initial conversation and assessments

MCO can provide help if the member needs assistance with learning self direction

Can include selecting, creating, directing where and who to live with, what to do during the day, and nearly all other long-term care supports

Can be just selecting and directing workers

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The care management team makes a budget available to member to direct the supports the member has selected: Member creates an “SDS Plan” for how the

resources will be used Care management team approves plan Member carries out the plan


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Self-Directed Supports inManaged CareFor supports or services that a person purchases

directly, rather than through an agency, an MCO makes assistance with self direction available thru:

Fiscal intermediary - provides strictly payroll support – checks, withholding, tax filing, etc.

Co-employment agency – functions as “Employer of record” and offers help with recruiting, screening, interviewing, hiring, training, firing workers

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Interdisciplinary Team (IDT) Role: IDT continues to support members

Manage supports not directed by member Authorize resources available to member Secure training/TA for members or workers Monitor member’s use of resources Monitor member’s health and safety


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IRIS: Self-Directed Supports Waiver

Include –participants are supported to be active members of their communities

Respect – participants’ preferences are honored; participants direct their own lives and long term supports.

I – (the participant) am in charge of my own plan.

Self-Direct – includes me managing my own services and life.

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• New option in how persons receive LTC goods, services and supports

• Alternative to Managed Care

• Began July 1, 2008

• Participant access is synchronized with Family Care expansion in each county

• New option in how persons receive LTC goods, services and supports

• Alternative to Managed Care

• Began July 1, 2008

• Participant access is synchronized with Family Care expansion in each county

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IRIS IRIS is offered to all persons including individuals who have guardians.

Using the individual’s Long Term Care Functional Screen, an individual allocation is calculated by the local ADRC.

initial projected allocation may be reviewed/adjusted

updated annually to reflect the cost of living adjustment (COLA)

includes ongoing waiver long-term care costs

People with current functional screens may learn their projected IRIS allocation before making the choice to participate by asking their county case manager, their MCO care manager, or contacting the ADRC.

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IRIS

Individuals who choose IRIS will coordinate and direct all of their services. Family, friends, or others may help.

Assistance and support is provided through an “Individual Consultant”

People may also choose to hire a support broker if they can budget those costs within their individual allocation.

People also have access to services through Medicaid and/or Medicare.

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IRISIRIS participants:

• Make their own decisions within their allocated budget about the goods, supports and services they will receive.

• Make their own decisions about who provides these supports and services.

• Make their own decisions about when and where supports and services are received.

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IRIS

IRIS participants select:

• Their own physician and other health care providers who accept Medicaid as payment just like in Family Care.

• Persons eligible for Medicare receive prescription drug benefits through the Medicare Part D plan they choose.

• DHS is working on allowing IRIS participants to self-direct their Medicaid Personal Care Card services.

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IRISAllowable Supports and Services include:

• All community-based, long-term care waiver services; and

• A new option: Participant Customized Goods and Services: defined as … a service, support or good that enhances the participant’s opportunities to achieve outcomes related to living arrangement, relationship, community inclusion, work and functional or medical status.

• Any community setting people choose ( including Adult Family Home, CBRF and RCAC; however the IRIS budget was not designed to include these three settings).

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IRISRole of the ADRCs (and counties for people

transitioning from CIP and COP) Provide information and counseling about the

individual’s publicly funded long-term care choices

• Provide key information to individuals about IRIS, which includes the individual’s budget allocation (generated from the Long-Term Care Functional Screen)

• Refer the individual who chooses IRIS to the Independent Consultant Agency.

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IRIS

State DHS manages two statewide contracts:

1. Independent Consultant Agency (The Management Group) oversees independent consultant activities and provides overall program management

2. Financial Services Agency (Milwaukee Center for Independence) completes criminal background and employment checks, claims payment functions, and assorted program reporting.

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IRIS

Independent Consultant Agency (ICA):

Provides an orientation to IRIS

Approves and monitors participant plans

Tracks participant health and safety issues

Meets State oversight obligations

Maintains a 24/7 toll free number with on-call service after regular business hours

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IRIS

Independent Consultants:

assist participants as necessary and desired by each person;

help people stay eligible by keeping track of program requirements;

secure training/TA for participants;help participant identify when and how to get in

touch with the ADRC to request an updated functional screen when there is a change in condition.

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IRIS

Financial Services Agency (Milwaukee Center For Independence):

Completes required criminal background checks, employment verifications, and also completes all payroll tasks;

Receives and monitors cost-share payments;

Pays claims as listed on support/service plan after participant authorizes payment

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IRIS

Financial Services Agency (cont):

Provides orientation and skills training program to participants who hire their own support persons

Maintains a toll free number with call service during business hours and voicemail service after regular business hours

Sends monthly spending reports to participant, ICA and Department

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IRIS

IRIS Quality Management assures:

Quality Standards are followed;

Each participant has quality management plan;

A back-up plan for worker no-shows or other urgent situations is developed by the participant and the Independent Consultant;

Critical Incidents are reported and tracked by the Independent Consultant Agency.

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Thinking Outside the Box

Breaking free of the old service models … creating

your own supports … in the company of others

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Long-Term Care “Outcomes” I decide where and

with whom I live

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Supported Living

Each person lives in their chosen home as an owner or tenant and support comes "into" the home.

Everyone can be supported within their home with support customized for how much or how little is needed.

People can choose who they wish to live with, and who they wish to provide support

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Supported Living The support provided is flexible and

based on the person's needs, preferences and wishes.

The right kind of support is not only about professional staff: informal and 'natural' support from families and others is vital.

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Long-Term Care Outcomes

I decide how I spend my day.

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Customized Employment Individualized! Relies on a process of discovery,

NOT assessment, to determine the true strengths, requirements, and interests of a job seeker with a complex life.

Meaningful work in the community for a competitive wage.

Meets the needs of both the market place/work place and the job seeker.

Results in a win/win work relationship Supported employment is one but not the only

means to find and maintain a job Emphasis on reaching out to family, friends,

community

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Integrated Employment:

Most people with disabilities served by the long-term care system are not working in integrated employment: most are currently unemployed or employed in facility-based settings, some making sub-minimum wages.

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Employment in FC for People with Developmental Disabilities - 2006

Number Percent of

Employed

Percent of

Total Clients

Prevocational/

Sheltered Workshop

478 61.4% 32.1%

Community 366 47.0% 24.6%

From Home 5 0.6% 0.3%

Total

Employed778 52.3%

Total

Clients1487

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Employment in FC for People with Physical Disabilities - 2006

Number Percent of

Employed

Percent of

Total Clients

Prevocational/

Sheltered Workshop

36 25.2% 1.9%

Community 90 62.9% 4.8%

From Home 18 12.6% 1.0%

Total

Employed143 7.7%

Total

Clients1859

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Family Care, IRIS & Integrated Employment

Offer a more comprehensive benefit package

People with physical disabilities have access to long-term support services for employment which were not always available under COP waiver.

Family Care can pay for personal care in the workplace, which was not available under COP, CIP or MA card. IRIS is working on adding that feature through self-directed personal care.

Family Care and IRIS cover the cost of transportation for people working in integrated employment.

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Flexible care plans

Can include mix of employment and non-employment activities, to reflect individual’s preferences.

People can utilize creative approaches, including things like:-Paying co-workers for transportation; paying for

people to participate in car pools.-Paying employers for training and co-workers for

long-term on-the-job support. -Supporting micro-enterprise, self-employment & co-ops.

Facility-based pre-vocational and day services remain an option.

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No waiting lists (after initial Family Care phase-in)

MCOs & IRIS can pick up long-term support when DVR funding runs out.

Young people leaving high school with a community job can get support from IRIS or the MCO to keep that job.

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Self-employment (micro-enterprise) is another option for work. Provides an option for a person to create their own

work based on their interests, connections and skills.

“The type of business that a person with a disability can operate is limited only by imagination” US Department of Labor Office of Disability Employment Policy

It is a choice. It is not something everyone may want to do.

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What is self-employment?

Selling or producing a product, or service, or both. The person owns the business as a sole

proprietorship, general partner, LLC or independent contractor.

Part or full-time work activity. Sometimes referred to as microenterprise. Help to learn more available through Pathways

(Shannon Munn at [email protected])

mailto:[email protected]

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Why people are choosing self-employment….. Choice and Control Independence and Creative

Freedom Natural Skills/Talents Inclusion and Connections Expanded Work Opportunity Availability of Supports Accumulation of Wealth When given the choice,

people with disabilities pursue self-

employment at a slightly higher, rate

than the general population.

When given the choice, people with disabilities

pursue self-employment at a slightly higher, rate

than the general population.

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Family & Member-Governed Services and Cooperatives

Member owned or governed

Help people control where they work, where they live, how they get support

Can create what people want

Empowering to families and individuals

May decrease long-term costs of services

Support from the system

Often increase connections with community (ongoing assistance on these options is available through

Pathways to Independence – contact Dennis Harkins at [email protected])


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SDS Offers High Expectations for:

Regular Lives

Employment and Careers

Contribution and Meaning

A Home of One’s Own

Community Inclusion

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Last Thoughts

SDS offers flexibility and creativity through IRIS and through Family Care

Remember the Long-Term Care Outcomes …

Particularly …

I decide where and with whom I live!

I decide how I spend my day!

I make decisions about my supports and services!

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Importance of encouraging and supporting members and their families to:

Purchase, imagine, and create better support arrangements

Supported Living Customized Employment Micro-Enterprise Cooperatives Member and family governed services and supports

Use these new opportunities to say, “Nope, don’t want this any more” and negotiate something new

Oversee and guide implementation of supports and services

Last Thoughts (continued)

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Good SDS Resources

There is a lot of good information and support available about SDS --- people don’t need to do this on their own:

Self-Determination Wisconsin (a Wisconsin DD Board project) Dennis Harkins: [email protected] Naomi Silver (River Falls): [email protected]

Wisconsin Independent Living Centers: ilcw.org/ilclist.html

Websites & toll-free phone numbers Wisconsin DHS Long-Term Care site: http://

dhs.wisconsin.gov/ltcare/ IRIS information through ICA: 1-888-515-IRIS (4747), or on the

web at wisconsin-iris.com/ IRIS information through Wisconsin DHS on the web at http://

www.dhs.wisconsin.gov/bdds/IRIS/ Self-Determination Wisconsin (a web site on SDS in

Wisconsin): sdwisconsin.org Wisconsin/Waisman: SDS Resource Library:

cow.waisman.wisc.edu/sdswi.html



http://www.ilcw.org/ilclist.html

http://dhs.wisconsin.gov/ltcare/



http://wisconsin-iris.com/

http://wisconsin-iris.com/

http://www.dhs.wisconsin.gov/bdds/IRIS/



http://sdwisconsin.org/

http://cow.waisman.wisc.edu/sdswi.html

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A Family Care Reality Check

What’s Working and What’s Not

Pointers for Making it Work


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Family Care: What’s Working

Adult waiting lists are gradually being eliminated

Apparent reduction in new admissions to nursing homes

Family Care enrollees can get all their LTC services via one comprehensive program (not a patchwork of COP, CIP, county tax dollars)

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Family Care: What’s Working

Family Care has a built-in mechanism for annual rate adjustments for the entire MCO—this may or may not result in an increase in anyone’s individual budget

ADRCs (Aging & Disability Resource Centers) are providing useful information and free benefits counseling to people

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Family Care: What’s not working

Pre-enrollment counseling (particularly by counties for people receiving COP and CIP) tends to be inadequate

Some enrollees are not given an adequate opportunity to participate in the development of their Family Care plans

Plans tend to begin with what was already in place --- too often there is little commitment to let people know they can change

Not enough commitment to informed consumer choice

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FC: What’s not working

Some people are not informed or are misinformed about the self-directed supports option

Some people denied the right to keep their current providers (in some instances this is because the MCO is paying inadequate rates)

Continued over-reliance (or increased reliance) on traditional group homes and large (3-4 person) Adult Family Homes

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FC: What’s not working

No maximum size (# residents) for CBRFs in FC

Continued over-reliance (or increased reliance) on facility-based services

Inadequate mental health services for many FC enrollees

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Pointers on Making it Work

Insist on playing an active role (with family or friends if you wish) in the development of your Family Care plan

-it’s up to you to specify the outcomes

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Pointers on Making it Work Assert your choices about:

where to live who to live with what kind of job to pursue level of service you need

(i.e. number of hours) which provider agency(ies) you want

to get services from which staff you would like to work with

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Pointers on Making it Work

Make sure your individual FC plan provides the mental health services you need (if any)

Ask for an in-depth explanation of both the self directed supports option inside Family Care, and IRIS (the Self Determination Waiver)

Use your complaint and appeal rights if FC is not working for you

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If you’re transitioning from COP or CIP to Family Care:

This is an opportunity to improve your life. You can ask for a change in the type of service, level of service, provider agency, staff, where you live, or where you work:

Would you like a job in the community with better wages?

Would you like to live in your own home?

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…transitioning from COP or CIP to Family Care:

If you were told when you first got COP or CIP services that “there isn’t enough funding to meet your needs…,” you should be able to fix that with Family Care or IRIS:

-they are designed to be comprehensive and cost-effective

-your ideas, family, friends and creativity are an important resource

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If you’re coming from the waiting list into Family Care:

The MCO has 24 months to bring everyone off the waiting list

Counties and ADRCs establish your place in the queue

There is no requirement for the ADRC to give a higher priority to people in crisis (but typically will do so)

Don’t wait until the ADRC contacts you—start thinking now about what outcomes and services are important to you

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If you’re coming from the waiting list into Family Care :

Consider all your options …Learn the differences among “regular”Family Care; The self-directed supports option within Family Care; IRIS; Learn about what is currently offered by service

providers; Join with others to think about creating supports.

If you prefer to wait until the end of the 24 month period to begin receiving services, let the ADRC know that—they will probably accommodate you.

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If You are making the Transition from High School

No waiting lists for services (after initial phase-in) Commitment for long-term funding of employment-related

support, thus: DVR funding after high school MCO or IRIS funding after high school (typically after initial DVR

funding) No need to wait until age 21 to graduate Opportunities for creativity and imagination by students,

families, teachers, MCOs, providers, communities … support for post-secondary education; self-employment; career discovery; co-op development; integrated employment … your idea here: ______________________________ .

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Before Leaving School:A Few Tips

Start learning what services and supports are available as early as age 14

You can ask the ADRC to determine your eligibility when you are 17 years, 9 months old

You can graduate at age 18 or stay in school and obtain support through Northern Bridges or IRIS

Meet with DVR

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Before Leaving School:A Few Tips

Start creating a clear vision to begin your

adult life: Where do you want to work or go on to college or tech

school? Where do you want to live? How do you want to spend your free time? What kinds of support will you need?

Meet with a Disability Benefit Specialist so you will know what your post-high school finances will look like.

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Already working?

If you are leaving high school with a paid job you would like to keep, and you need support to keep your job, begin to plan for continuing that support immediately.

Some people will not be eligible for Family Support or IRIS at all for up to 24 months after the date FC begins in their county --- but may well be eligible for DVR funding.

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Closing Session

Documents

1 Citizen’s Guide to Family Care 2009 Survival Coalition of Wisconsin Disability Organizations