When your child is participating in the Children's Long-Term Support (CLTS) Medicaid Waiver Program, you may be liable for a certain portion of the cost of your child's waiver services. After you and your support and service coordinator (SSC) have finalized developing your child's Individual Service Plan (ISP), your service coordinator will apply a formula to determine whether or not you will have a Parental Payment liability.
All the rules, and the specifics of the formula, are described in detail in Wis. Admin. Code ch. DHS 1.
The Wisconsin Department of Health Services (DHS) has issued a Worksheet for Determination of Parental Payment Limit, F-01337 (Excel), which county waiver agencies may use to determine whether a parental payment liability exists. The formula is based upon Wis. Admin. Code ch. DHS 1, which takes into consideration the size of your family, your family's income, and current federal poverty guidelines.
Your payment liability must be reassessed at least annually during your child's annual recertification, and may be reassessed more often if there are significant changes to your child's service plan or to your family's financial situation. Be sure to talk with your SSC if you feel the payment liability should be recalculated. Choose from the links below for more information.
- Administrative Rule DHS 1
- Federal Poverty Guidelines
- Parental Fee Declaration form, F-01338 (Word)
- Parental Payment Limit Frequently Asked Questions (PDF)
- Parental Payment Limit User's Guide for the Automated Workbook (PDF)
- Worksheet for Determination of Parental Payment Limit, F-01337 (Excel) Updated for 2021