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Funding for Resident Expenses: Public Resources

CARE SERVICES

Medicaid Home and Community Based Services Waivers (COP-W and CIP II)

Medicaid (MA) Waivers are a source of funding for long term support services for persons who are otherwise eligible for MA-funded nursing home care. Two Waiver programs, the Community Options Program Waiver (COP-W) and Community Integration Program II Waiver (CIP II), are the primary sources of state reimbursement for personal, supportive, and nursing services provided in RCACs in Wisconsin. Waiver funds can only be used to pay for services. They cannot be used to cover room and board expenses, nor can the state funded Community Options Program be used to supplement Waiver funds or pay room and board costs.

The Medicaid Waivers can reimburse RCAC service costs up to 85% of the average cost of nursing home care to the MA program (in 2004, $77.81/ day or $2,367/month). At the same time, counties, which operate the Medicaid waiver programs across the state, are required to keep the average cost per waiver client within an established amount, currently $41.86/day or $1,273/month. This per diem amount has to cover the cost of any RCAC services and any other waiver services the person receives, plus the county's cost for case management and administration (approximately $5.65 /day or $172/month, though the actual amount varies from county to county).

Elderly people with incomes above the SSI rate of $792/month and less than $1,692/month (or more if there are exceptional medical costs) are eligible for Medicaid Waiver services but must pay part of the cost themselves. The participant's cost share is determined by formula. This formula allows people to keep a portion of any earned income they have plus an amount to cover the cost of housing, food, clothing, utilities and all other necessities. All of the person's remaining income is used as cost share to pay for waiver services.

After the minimum $65/month is deducted for personal needs, Medicaid waiver residents would have between $499 to 1,$627/month to pay for RCAC room and board. A typical MA Waiver resident would have $679 per month available for room and board. The amount any individual participant can afford would depend on the result of the eligibility determination and cost share calculation and deductions which is performed by the county human or social service department.

Contact: Your county human service or social service department. Information on financial eligibility and client cost sharing is available on the DHFS website at www.dhfs.state.wi.us/ltc_cop/COP.HTM.

Family Care

Family Care is a major initiative to redesign Wisconsinís long-term care system, beginning with pilot programs in five counties in the year 2000. Participating counties are: Fond du Lac, La Crosse, Milwaukee, Portage and Richland. Family Care combines a number of different funding sources (including the MA waivers, selected MA card services, and state funded Community Options Program) and provides a single capitated payment for Medicaid eligible persons with long-term care needs. Care management organizations (CMOs) in the participating counties use the funds to pay for care in whatever setting is preferred by and most appropriate for the individual, including the personís own home or apartment, assisted living, or a nursing home.

See the series of of reports contracted for in "Developing a Rate Setting Methodology" for further information about use of the Medicaid-Waiver and use of Family Care in RCACs:

Contact: Care Management Organizations in the pilot counties. Additional information is available on the WI DHFS website at www.dhfs.state.wi.us/LTCare/index.htm.

Medicaid Card

While RCAC is not a Medicaid provider type under Wisconsinís State Plan, Medicaid recipients are eligible to receive all Medicaid covered services while residing in an assisted living facility. Medicaid card services most likely to be provided in an assisted living facility include personal care, home health, private duty nursing, independent nurse practitioner and transportation. Providers must be MA certified and normal procedures for billing Medicaid are observed for services provided in assisted living facilities.

Contact: Your county economic support office for individual eligibility determination. Information on the Medicaid program is available at www.dhfs.state.wi.us/Medicaid/index.htm.

INCOME SUPPORT

Supplemental Security Income (SSI)

Supplemental Security Income is a monthly cash benefit paid by the federal Social Security Administration and state Department of Health and Family Services to people with little or no income who are blind, disabled or over the age of 65. It is intended to help cover the cost of housing, food, and other basic living expenses. The maximum SSI payment to an individual in 2004 is $647.78 per month; including both the federal benefit and state supplement.

In Wisconsin, people who receive SSI automatically qualify for Medical Assistance (also called Medicaid or Title 19) and will be sent a Medicaid card without a separate application.

Contact: Applications for SSI must be made at the Social Security Office. There is no separate application for the state supplement. Information about SSI and how to apply is available by calling 1-800-772-1213. Information is also available at www.ssa.gov and www.dhfs.state.wi.us/SSI.

Exceptional Expense Supplement (SSI-E)

The SSI-E supplement provides an additional monthly benefit of up to $95.99 per month for SSI recipients who reside in residential care facilities or require additional support services in order to live independently. Residents of certified RCACs who are SSI recipients may be eligible. The maximum total SSI payment to individuals, including federal benefit, the state supplement and the SSI-E Supplement, is $743.77/month.

Contact: Your county or tribal department of human or social services for an assessment and eligibility determination. Additional information is available at www.dhfs.state.wi.us/SSI.

RENTAL ASSISTANCE

Section 8 Housing Choice Vouchers

HUD Section 8 Housing Choice Vouchers may be used in assisted living facilities. The HUD Housing Choice Voucher program fact sheet explains in detail how the program operates. Several Wisconsin community or county Housing Authorities administer a Section 8 Housing Choice Voucher Program.

To be eligible, a household's gross annual income must be less than 50% of the county median income by household size. Voucher recipients pay approximately 30% of their adjusted monthly income towards rent and the Section 8 Voucher pays the balance. Assets are considered and income from assets is included in a household's gross annual income. Special considerations are given for medical expenses, which may be deducted from a household's gross annual income.

ENERGY ASSISTANCE

Energy assistance for tenants in apartment-style assisted living units may available through the Wisconsin Department of Administration, Division of Energy.

These sites have more energy related assistance information:

  1. U.S. Dept. of Health and Human Services – description of the LIHEAP program

  2. An Internet information service for state, tribal and local LIHEAP providers, and others interested in low-income energy issues.

FOOD STAMPS

Food stamps are available to a tenant in an RCAC who is eligible for them. In Wisconsin, the Federal Government oversees the State operation of the program (Wisconsin Department of Development). www.dhfs.state.wi.us/foodstamps/index.htm

Local county and tribal departments of human services, or social services, can help determine eligibility for food stamps or any other public assistance program. Contact the county or tribal aging office to speak with the benefit specialist about public benefits eligibility. The White pages of your phone book, under Aging, also lists the county or tribal offices. There is no charge for benefit specialist services for any person age 60 or older.


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Created by the WI Department of Health and Family Services and the WI Housing and Economic Development Authority in partnership with NCB Development Corporation's Coming Home Program, a national program of the Robert Wood Johnson Foundation