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 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
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
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.
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.
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.
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:
Dept. of Health and Human Services – description of
the LIHEAP program
- An Internet information service for
state, tribal and local LIHEAP providers, and others
interested in low-income energy issues.
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).
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.