10.1 Information Available on the Eligibility Results
Once the screener has selected "CALCULATE ELIGIBILITY" a new screen will appear with important information. At the top of the page will be the following information that helps identify who produced this screen and when it was completed. Included is:
The page will then display the following chart:
For Comprehensive Community Service, the following Eligibility Results are possible:
For Community Recovery Services, the following Eligibility Results are possible:
For the Community Options Program, the following Eligibility Results are possible:
For the Family Support Program, the following Eligibility Results are possible:
For the Children's Waivers, the following Eligibility Results are possible:
Note: The Children's Waivers Functional Eligibility Results will list all the target groups for which the child meets the functional eligibility requirements. The decision of which specific target group to select for any particular child is the responsibility of the agency/county using the Children's Waivers.
For the Katie Beckett Medicaid Program, the following Eligibility Results are possible:
For the MH Wrap Around, the following Eligibility Results are possible:
Pending Results may include:
If a CLTS FS indicates that there are Pending Results for a child's functional eligibility, then only when those issues are resolved can one determine that a child actually meets the functional eligibility requirement for that particular program. However, meeting the functional eligibility for a program does not automatically make the child eligible for that program because there may be additional criteria that must be met prior to program eligibility.
Two exceptions to Pending Results:
At the bottom of the page is the reminder that "This does not
include FINANCIAL eligibility." This is important to keep in mind
because Financial Eligibility is of significant importance to certain
The results only indicate that the child meets (or does not meet) functional eligibility for certain programs. It does not mean that they meet program eligibility. Some programs have additional criteria including financial eligibility that need to be determined for program eligibility. The CLTS FS only determines functional eligibility.
If the functional eligibility is pending anything, than the child is
not considered functionally eligible for that program until the pending
issues are addressed. The Level of Care (LOC) or Target Group that the
child will meet once the pending issues are addressed is listed so that
plans for their eventual functional eligibility can be made accordingly.
Screeners, as knowledgeable professionals in the field who have met the child and reviewed valuable information about the child, are responsible for confirming that the results of the CLTS FS meet with their professional judgment. If the outcome is not what the screener expected, the screener should complete a thorough review of the screen. If the results are the same following this initial review, they should conduct an internal review with someone else from the same agency. If the results are still in question, the screener should contact the CLTS FS Clinical Advisor for assistance.
If the result is that the child is Not Functionally Eligible, the screener should always request an internal review by their agency/entity. Each agency/entity is responsible for screen/screener quality assurance at a local level. The CLTS FS Clinical Advisor may be consulted when specific questions arise but cannot verify eligibility results for any child.
Screeners should not attempt to change their answer choices on
the screen to get the results they anticipated. If the screener finds that
they unintentionally checked something incorrectly on the screen, they can
use the Edit button to make small changes to their answer choices and
recalculate eligibility. If the Calculate Eligibility button is selected
multiple times on a single child, the screener will be asked by State
Clinical Staff to provide an explanation for their repeated eligibility
Naturally the functional eligibility results are to be kept confidential. This page is not to be shared in total with a family. If requested, the screener can share the results for the program the family requested a screen for, but do not share the results for other programs.
If the screener sees from the results that the child has met the
functional eligibility for another program, the screener can refer the
family to that program. Screeners are not required to make such
referrals. The CLTS FS does not determine program eligibility so being
found functionally eligible for a program does not guarantee program
eligibility. Screeners should never tell a family that they are eligible
for any program other than the program the screener is offering.
The CLTS FS determines functional eligibility for multiple programs. Therefore, it may find children ineligible for multiple programs as well. When the functional eligibility results indicate that a child is no longer functionally eligible for a program that they are currently receiving services from, it is the screener’s responsibility to inform that program of their results. For example, if a screener is completing a CLTS FS for the Family Support Program and the results indicate that the child is no longer eligible for the Katie Beckett Program, the Family Support Program has a responsibility to inform the Katie Beckett Program of this change immediately.
As long as the CLTS FS is completed accurately, it does not matter who completed it or which program it is being completed for. The functional eligibility results are binding for all programs listed. It is important that the CLTS FS be completed based on fact and not subjectively as the results impact many programs for which the child may be functionally eligible.
This applies when ALL of the following conditions are met:
When the situation meets all of the above conditions, follow the procedure outlined below:
Step 1 If the screen results change the child’s functional eligibility for Katie Beckett Program - Medicaid from Functionally Eligible to Not Functionally Eligible:
2. Administrative staff at the KBP Central Office will forward your email to the assigned Katie Beckett Nurse Consultant. The Nurse Consultant will call you to discuss the screen results.
Step 2 If the screen results change the child’s eligibility for any other program (other than Katie Beckett) to Not Eligible or Not Functionally Eligible, then you must also contact all screeners for whom your screen changed eligibility results.
The screeners you contact must reply to you with the needed information within ten (10) business days. If the previous screener does not reply to your original request for their telephone and FAX numbers within 10 business days, then continue with your customary process for finalizing and communicating to the family the eligibility results for your program.
Step 3 If the child is currently active on BOTH Katie Beckett
Program – Medicaid and a
Step 4 You and the previous certified screener(s) will have a dialogue about the child’s needs and functional eligibility upon the exchange. Remember that there are many reasons why eligibility results may have changed, including a change in the child’s condition, a change in the child’s age or the family represented the child’s needs differently. You will discuss the need for any further information with the other screener(s) and agree on a method to collect this. If appropriate, you will make edits to the screen using the new or expanded information gathered during this process and recalculate eligibility.
Step 5 If you and the previous screener agree that the results of the most current finalized screen are accurate and reflect your experience with the child and family, then each screener will proceed with the actions appropriate to the program with which they work.
Note: The final agreed upon screen may have changed functional eligibility back to functionally eligible.
If the result of this process is that you and the previous screener are unable to reach an agreement about the screen results, you must refer this situation to the CLTS-FS Team for a final decision. Send an email to the CLTS FS Coordinator, Becky Burns, at Becky.Burns@Wisconsin.gov.
There are summary report options available for a completed individual CLTS FS. These reports can be viewed at the web site and can also be printed. The reports have been developed based on feedback from screeners and managers who operate the programs for which the CLTS FS determines functional eligibility. There are thre (3) report formats to choose from. The three reports are titled:
FS report w/eligibility
Family FS report w/notes
Family FS report
March 14, 2013