ADRC Professionals: Self-Directed Supports in Managed Care
Self-directed supports (SDS) is an option for people enrolled in Wisconsin’s managed long-term care programs, including:
- Family Care.
- Partnership.
- PACE (Program of All-Inclusive Care for the Elderly).
SDS offers you more control over the services and supports you get.
How SDS works
When you enroll in a long-term care program, you may choose a managed care organization (MCO). Your MCO helps you find and get the services you need. With SDS, you work with your MCO to decide which services you would like to manage. Your program will help you learn how to buy your own services and supports from the benefit package.
Here’s what you can expect.
A specific plan for SDS
- Each MCO has its own plan for offering SDS. They must have a way for you to do the following:
- Choose and hire your own support workers, who could be family, friends, neighbors, or agencies.
- Train and supervise your own support workers as they care for you and meet your needs.
- Pay workers within your budget and keep track of spending.
A choice in the services you self-direct
Based on your assessed needs, you may be able to self-direct all or part of your services. For example, you might self-direct your personal care services but have your care team manage providers that help you get medical supplies.
A care team that supports you
If you choose to use SDS, your care team will:
- Explain what’s available to you based on your assessed needs.
- Make sure you stay within your available budget to meet your health and safety needs.
- Help you find other support to manage SDS based on which services (if any) you decide to self-direct. Examples include fiscal employer agents who assist with new hire paperwork, payroll, and more.
SDS limits
Your MCO may put limits on the SDS option if:
- You are spending more than what’s in your budget.
- You have used program resources in a way that’s not allowed.
- You have used program resources in a way that puts your health and safety at risk.
- Someone else is making decisions for you that aren’t based on what you want.
Your MCO will work with you so you know how to manage SDS and avoid these limits.
Frequently asked questions
Family Care, Partnership, or PACE
You can self-direct part of your services. For example, you might self-direct your personal care services but have your care team manage providers that help you get medical supplies.
IRIS
You self-direct all your long-term care services. You will have an IRIS consultant agency, a fiscal employer agent, and others to help you along the way.
Family Care, Partnership, or PACE
When you enroll, a managed care organization (MCO) will assign a care team for you. Your MCO helps you find and get the services you need. During the assessment process, you work with your MCO to decide which services you want to self-direct, if any. If you choose to self-direct one or more service: 1. The MCO provides a budget for you to pay for these services. 2. You create a self-directed supports plan that outlines how you will direct the services. 3. Your MCO manages any other services you do not self-direct.
IRIS
When you enroll, you choose an IRIS consultant through an IRIS consultant agency. They support you as you choose services.
Your IRIS consultant agency shares your estimated budget with you. Your budget includes the funds you will use to create your IRIS plan.
You create your IRIS plan. It outlines your goals and what you need to meet them. It also includes the home and community-based services you’ll get as part of IRIS to meet those goals.
If you need help with personal care tasks, you may qualify for IRIS self-directed personal care. It is separate from the other services you get through IRIS.
You may adjust your IRIS budget if it does not cover the costs of all services you need. If you need a budget increase, your IRIS consultant will help you complete the required paperwork to request more funds.
For all programs, you can choose your own workers. They may be a family member, friend, or another qualified person. All workers need to complete a background check and be approved before they can be paid to provide services to you.
For all programs, there are options for how you get workers to provide self-directed supports:
- You can be the employer—This means you recruit, hire, train, and manage your workers. As an employer, you will be responsible for approving timesheets and setting hourly rates, as well as other tasks.
- You can work with an agency—This means another group manages the workers who provide services to you.
If you struggle to find workers or agencies, your MCO or IRIS consultant can suggest resources and providers that may be helpful.
Family Care, Partnership, or PACE
You will have a fiscal employer agent. They use the budget from your MCO to pay for services in your self-directed supports plan. You must approve the payment.
IRIS
Your IRIS fiscal employer agent pays the timesheets and claims for services listed in your IRIS plan. You must approve the timesheets for workers you hire. You can pay for some other services that IRIS does not cover with your Medicaid ForwardHealth card.