DSL MEMO SERIES 2000-08
August 23, 2000
STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living
To:
Area Administrators/Assistant Area Administrators
Bureau Directors
COP Lead Agency Directors
County COP Contacts
County Departments of Community Programs Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Executive Directors, Wisconsin Partnership Program Sites
Independent Living Centers
Long Term Support Planning Committee Chairpersons
Pathways Local Sites
Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From:
Sinikka McCabe, Administrator
Division of Supportive Living
Re:
COP EMPLOYMENT REQUIREMENT, HARDSHIP CRITERIA, WAIVER MANDATE AND MAPP
Document Summary
This memo instructs counties in implementing new COP eligibility
requirements relating to: an expanded waiver mandate; required employment; participation
in a health and employment services program; and the criteria and procedure for waiving
these requirements based on undue hardship. |
- New Statutory Requirement in Community Options (COP)
This memo provides clarification and instruction to county agencies for implementing
the expansion of the waiver mandate as it relates to current or potential COP recipients
funded with 100% COP funding.
Changes to COP eligibility were included in the 99-01 state budget passed in October
1999 (1999 Wisconsin Act 9). Under section 46.27 (6r) of the Wisconsin Statutes, a new
provision (f) reads:
(6r) ELIGIBILITY. No county may use funds received under sub. (7) (b)
to pay for long-term community support services provided to any of the following:>
(f) A person who has attained the age of 18 but has not attained the
age of 65 unless that person is engaged in gainful employment or participating in a
program that is certified by the department to provide health and employment services that
are aimed at helping the individual achieve employment goals. The department may waive
this paragraph for any individual for whom its application would cause undue hardship.
As a result, current or future participants of 100% COP funding must apply for
Medicaid under the Medicaid Purchase Plan (MAPP). This program became effective on March
15, 2000.
Individuals with disabilities over the age of 18 years who were previously ineligible
for Medicaid because of excess income and/or assets, may now become eligible so long as
they meet all of MAPP’s requirements. One of these requirements states that to be
eligible for MAPP, a person must be gainfully employed or must be enrolled in a Health and
Employment Counseling Program.
However, there are specific "Hardship Criteria" which exempt recipients
and/or applicants funded with 100% COP from this waiver mandate expansion.
Regardless of whether or not this mandate applies, certain individuals may benefit from
MAPP since Medicaid eligibility makes Medicaid coverage available for card services. The
Economic Support Specialist and/or the Health and Employment Counseling certified screener
can assist your COP clients in making this determination.
- Hardship Criteria
Individuals may be exempt from the expanded waiver mandate, including the work and
employment counseling requirements, and may receive or continue to receive 100% COP funds
if they meet any of the following hardship criteria:
- Individuals who are COP eligible because they meet Level I of the COP Functional Screen
(Severe Medical Conditions).
- Individuals who are COP eligible because they meet Level III A (1) and (2) of the COP
Functional Screen (Alzheimer’s and Related Diseases).
- Individuals who have been deemed unemployable or unsuitable for employment by a
certified Health and Employment Counseling Program either at application and/or at
recertification time, or at any point in the process.
- Individuals who reside in a county where Health and Employment Counseling Screeners are
unavailable or where existing Health and Employment Counseling Screeners are not required
to serve the individual’s target group.
Since the legislative intent of this provision is to capture federal Medicaid (MA)
funding for individuals currently being funded 100% with GPR funds under the COP program,
the following individuals may also be exempted from the requirement under s.46.27 (6r) (f)
because minimal or no additional federal revenue will be generated by their inclusion.
- Individuals for whom the use of COP is limited to 90 days while the waiver is being
processed.
- Individuals for whom the use of COP results in lower GPR costs under COP than under the
waiver.
- Individuals who are already enrolled in any Medicaid Waiver program and who are also
receiving COP funding for non waiver allowable services.
- Individuals who do not meet Medicaid Purchase Plan financial eligibility criteria under
s. 49.472.
- Individuals who are waiver ineligible because of target group, or level of care, or
living arrangement, or service provider.
- Individuals who are waiver ineligible because they do not meet the Medicaid Purchase
Plan disability criteria.
Individuals who meet these hardship criteria but choose to participate in MAPP should
be supported to do so in their care plan. As stated above, one of the requirements to
participate in MAPP is that the individual be gainfully employed or that he or she be
participating in a Health and Employment Counseling Program.
- Gainful Employment
A person who is already gainfully employed may be referred directly to the
Economic Support Specialist for MAPP eligibility screening. A person shall be considered
to be gainfully employed if the individual receives income for service or activities and
that income would be considered taxable by the federal Internal Revenue Service. For
example, an individual who is working full-time or part-time (even if only for a few hours
per week) or who is self-employed may be considered gainfully employed.
- Health and Employment Counseling Program (HEC)
HECs became available on June 1, 2000. Individuals who are not gainfully
employed must participate in HEC as one of the conditions for MAPP eligibility. These
individuals should be referred to the county’s HEC certified screener. See the
attached listing. This listing may expand as additional screeners become certified in the
future. As a service to clients, county staff may become certified screener by
participating in a one day, free training. The next training session will take place in
October 2000. Contact the Center for Delivery Systems Development, at 608/261-7816 to
request information on this or future training.
Whether or not a county agency chooses to become a HEC certified screener, the county
must establish policies to address those instances when COP referrals to MAPP do not
result in continuing Medicaid eligibility after enrollment in HEC and/or those instances
when Medicaid is lost for any reason (i.e., status on COP waiting list).
See attachments which will provide guidance as to whom the new COP
eligibility
requirement apply. These requirements will be included in the next revision of the
COP Guidelines.
Regional Office Contact:
Assistant Area Administrators
Central Office Contact:
For COP Eligibility:
Rita Cairns
Long Term Support Section
Bureau of Aging and Long Term Care Resources
P. O. Box 7851
Madison, WI 53707-7851
608/266-6891
e-mail: CairnRI@wisconsin.gov
For Medicaid Purchase Plan:
Karen Tritz
Center for Delivery Systems Development
P. O. Box 1379
Madison, WI 53701-1379
608/266-2361
e-mail: TritzKL@wisconsin.gov
cc
Chuck Wilhelm, OSF
Diane Waller, OSF
Peggy Bartels, DHCF
Attachments:
Tool to Identify Individuals on 100% COP
Funding who are Required to Apply for the Medicaid Purchase Plan (MAPP).
MAPP Application Process for Individuals who
are Funded with 100% COP Funds
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