ADRC Professionals: Services Included in Adult Long-Term Care Programs—IRIS, Family Care, Partnership, and PACE
Wisconsin has public programs that offer services for older adults and adults with disabilities.
These programs include:
- IRIS (Include, Respect, I Self-Direct).
- Family Care.
- Partnership.
- PACE (Program of All-Inclusive Care for the Elderly).
- Medicaid.
- Medicaid ForwardHealth card Services
This handout shows which services are part of each program’s benefit package. Not all services are listed. The services you receive are based on your needs and other program requirements.
Terms to know
Before you view the table of services, make sure you know what each term means.
- Yes: The program includes and pays for the service. The service may need to be approved first.
- Limited: The program includes the service but with some restrictions.
- ForwardHealth card: You must use your Medicaid ForwardHealth card to pay for the service.
- Medicare: You must use your Medicare plan to pay for the service.
Long-term care services
You may need one or more of the following long-term care services:
| Long-term care services | ForwardHealth card services (not part of a program) | IRIS | Family Care | Partnership | PACE |
|---|---|---|---|---|---|
Care coordination A case manager and nurse keep track of your health, safety, and services | No | Help from fiscal employer agent and IRIS consultant | Yes: nurse and care manager | Yes: physician, nurse practitioner, nurse, and social worker | Yes: physician, nurse and care manager, PACE center coordinator, therapists, dietitian, and more |
Adult day care or respite care Services for adults who need social or health support and supervision | No | Yes | Yes | Yes | Yes |
Protective underwear, gloves, and other supplies Medical equipment, items, devices, and supplies | Yes | ForwardHealth card | Yes | Yes | Yes |
Alcohol and drug treatment Treatment for substance use disorders | Yes | ForwardHealth card | Yes | Yes | Yes |
Assisted living and residential care services A home-like living setting that includes care, treatment, and supervision | No | Limited | Limited | Limited | Limited |
Communication aids, translator, and interpreter An item, device, or system that helps you communicate | No | Yes | Yes | Yes | Yes |
Counseling and therapy Professional services and treatment | Yes | Yes | Yes | Yes | Yes |
Daily living skills training Teaching skills that help you do daily tasks | No | Yes | Yes | Yes | Yes |
Home health or personal care Services that help with daily tasks, such as taking medicine or bathing | Yes | FowardHealth card or self-directed personal care | Yes | Yes | Yes |
Home updates Looking at current home and making improvements based on need | No | Yes | Yes | Yes | Yes |
Hospice Care for a person with a terminal illness | Yes | Medicare or ForwardHealth card | Yes, Medicare, or ForwardHealth card | Yes, or Medicare card | Yes, or Medicare card |
Job services Support to get and keep a job | No | Yes | Yes | Yes | Yes |
Meals delivered at home Prepared, healthy meals sent directly to your home | No | Yes | Yes | Yes | Yes |
Medical transportation Transportation to get non-emergency, Medicaid medical services | Yes | ForwardHealth card | Yes | Yes | Yes |
Mental health, mental health day treatment, and community support programs Coordinated professional care and treatment in the community | Yes | ForwardHealth card | Yes | Yes | Yes |
Non-medical transportation Transportation services or items that give you access to community services and events | No | Yes | Yes | Yes | Yes |
Nursing home Skilled nursing or recovery services | Yes | No | Yes | Yes | Yes |
Physical, occupational, and speech language therapy Support that helps with movement, daily living, and communication skills | Yes | ForwardHealth card | Yes | Yes | Yes |
Self-directed goods and services A service, support, or item that helps with a long-term support need | No | Yes | Limited | Limited | Limited |
Supportive home care Help with daily tasks, such as eating, grooming, and house cleaning | No | Yes | Yes | Yes | Yes |
Wheelchairs and other equipment Controls, equipment, or devices | Yes | ForwardHealth card | Yes | Yes | Yes |
Health and medical services
Health and medical services come from a doctor, nurse, or other qualified medical provider.
These services include:
- Disease prevention
- Health maintenance
- Patient education
| Health and medical services | ForwardHealth card Services (not part of a program) | IRIS | Family Care | Partnership | PACE |
|---|---|---|---|---|---|
| Dental Care | Yes, but use Medicare first | Pay with Medicare and ForwardHealth card | MCO (Managed Care Organization) coordinates. Pay with Medicare and ForwardHealth card. | Yes, but must use a provider in network. | Yes, but must use a provider in network. |
| Doctor services | Yes | Pay with Medicare and ForwardHealth card | MCO coordinates. Pay with Medicare and ForwardHealth card. | Yes, but must use a doctor in network, except for emergency or urgent care. | Yes, but must use a doctor in network, except for emergency or urgent care. |
| Foot care (podiatry) | Yes | Pay with Medicare and ForwardHealth card | MCO coordinates. Pay with Medicare and ForwardHealth card. | Yes | Yes |
| Hospital | Yes | Pay with Medicare and ForwardHealth card | Pay with Medicare and ForwardHealth card | Yes, but must use a hospital in network, except for emergency or urgent care. | Yes, but must use a hospital in network, except for emergency or urgent care. |
| Prescription | Yes, but use Medicare Part D first | Pay with Medicare and FowardHealth card (use Medicare Part D first) | Pay with Medicare and FowardHealth card (use Medicare Part D first) | Yes | Yes |
| Vision (includes eyeglasses) | Yes | Pay with Medicare and ForwardHealth card | Yes Pay with Medicare and ForwardHealth card | Yes | Yes |
Notes
- With IRIS, you use a budget to buy services, supports, and goods based on your approved IRIS plan. You may employ service providers yourself or work with an agency.
- When you enroll in Family Care, Partnership, or PACE, you join a managed care organization. They make sure you get long-term care services. You choose your services and providers from a network.
- You cannot enroll or remain enrolled in IRIS if you live in a nursing home or community-based residential facility.
- If you need help with personal care tasks, you may qualify for IRIS self-directed personal care. It’s a separate type of service that the program offers in addition to other services you receive through IRIS.
Helpful reminders
- Estate recovery applies for Family Care, Partnership, PACE, and IRIS. It also applies to personal care paid for by Medicaid card services and nursing home paid for by Medicaid.
- Are you applying for Partnership? If you are eligible for Medicare, you must enroll in the Partnership managed care organization’s D-SNP (Dual Eligible Special Needs Plans).
- With PACE, you do not pay prescription copays or deductibles.
- Program services depend on you and the program you choose.
- With Family Care, Partnership, and PACE, all providers must contract with the managed care organization.
- With IRIS, the IRIS consultant agency and fiscal employer agent must authorize all providers.
- If you have Medicare or are covered under a private health care insurance plan, those plans will be billed before Medicaid because Medicaid is the payor of last resort.
Do you have questions?
Contact:
- Your local ADRC or Tribal ADRS
- Medicaid Member Services at 800-362-3002.