When your child is participating in the Children's Long-Term Support Medicaid Waivers (CLTS Waivers), you may be liable for a certain portion of the cost of your child's waiver services. After you and your service coordinator have finalized the development of your child's Individual Service Plan (ISP), your service coordinator will apply a formula to determine whether or not you will have a parents will have a Parental Payment liability.
All the rules, and the specifics of the formula, are described in detail in Administrative Rule DHS 1.
The Wisconsin Department of Health Services (DHS) Children's Services Section provides a Worksheet for Determination of Parental Payment Limit, F-01337 (Excel, 54 KB), which county waiver agencies may use to determine whether or not there will be a parental payment liability. The formula is based upon the rules in DHS 1, which take 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 service coordinator 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, 34 KB)
- Parental Payment Limit Frequently Asked Questions (PDF, 25 KB)
- Parental Payment Limit User's Guide for the Automated Workbook (PDF, 848 KB)
- Worksheet for Determination of Parental Payment Limit, F-01337 (Excel, 54 KB) Updated for 2015