Transition, Publicly Funded Long Term Care

and Integrated Employment in

Wisconsin Counties with

Family Care & IRIS1

State of WisconsinDepartment of Health Services

Division of Long Term CareOffice of Resource Center Development

(10/2012)

Our Goal

Publicly Funded

Long Term C

areTr

ansi

tion

Integrated Employment

Helping Students with Disabilities Get Ready for

Life After High School

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Learning Objectives?

Introduce ManualTransition Planning

Publicly Funded LTC

Integrated Employment

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Quality of Life OutcomesI decide where and with

whom I live.I make decisions

regarding my supports and services.

I decide how I spend my day.

I have relationships with family and friends.

I do things that are important to me.

I am involved in my community.

My life is stable. I am respected and

treated fairly. I have privacy. I have the best possible

health. I feel safe. I am free from abuse and

neglect.

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Interesting Facts

Approximately 45K students in special education Wisconsin (ages 14-21).

Approximately 8K leave school districts across the state annually.

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Key Players in TransitionStudentParentsTeachersCommunityDVRGuidanceSocial WorkerPsychologistTransition CoordinatorAides

ADRC StaffSupport StaffUniversities, Technical

/Community CollegesEmployersIndependent Living

ServicesSocial Security

AdministrationParaprofessionalsSchool Administrators

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I know my dreams and goals

Parents or guardian help me with my goals

Teachers help me with my goals

Division of Vocational Rehabilitation (DVR) can help me reach my employment goals

Social Security can help with benefits like Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), Medical Assistance (MA) or Ticket to Work

Student

Aging and Disability Resource Center (ADRC)

Provides information about services, resources and programs.

Education

Employment

Independent Living Options18 Yrs Old

At 17 yrs & 6 months call Aging and Disability

Resource Center & at 18 Call Social Security

Living My Dream: Transitioning to Life After High School

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Student RoleIdentify my interests, talents, and passions to

pursue after leaving high school.Actively participate in the IEP process and

identify my employment and independent living goals.

Work toward achieving my goals.Identify supports (people and resources) that can

help me achieve my goals.Stay in School.Develop Self-determination & Self-advocacy

skills.

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Parent RoleHelp my son/daughter identify interests, talents,

& passions.Work with IEP team.Work with son/daughter to achieve post school

goals.Collaborate with identified support systems.Support my son/daughter in advocating for

him/herself.

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Teacher RoleDevelop understanding of student’s abilities,

interests, passions.Develop & implement transition plan with student

& family.Work with student & family to achieve post school

goals.Collaborate with identified support systems.Support student in advocating for him/herself.

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Why Self-Determination?To live life as you choose in accordance with

your interests, needs, and abilities.

Self-DeterminationExercising the right to make choices & direct

your life.Self-AdvocacyKnowing and standing up for your rights.

How?Provide opportunities to make decisions and

choices at home.12

Transition PlanningStart planning no later than 9th grade;

Several questions are provided to assist with planning; and

Students can express their goals and desires several ways.

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What have I learned? Pg. 9

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Important Things that Happen At 18Resolve the issue of guardianship and/or related

alternatives.

Understand Adult Rights & Responsibilities.

Disability Determination through SSA and apply for SSI and Medical Assistance if appropriate.

May get personalized information directly from Aging and Disability Resource Center (ADRC).

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GuardianshipParents need to resolve the issue of

guardianship and/or related alternatives

• Guardianship is the legal power to care for another person and manage his/her affairs: Guardian of the estate -finances Guardian of the person –personal needs Person may be appointed as both

• Some alternatives may include: Health care power of attorney Conservatorship Representative Payee Dual Signature Accounts

 

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Entitlement vs. Eligibility High School Adult Services

Special education services are free

Services based on IEP initiated by school district

Progress toward IEP goal is monitored and communicated to parents & students

Individuals with Disabilities Education Act (IDEA)

Adult services based on eligibility & vary by agency

Services based on ISP initiated by adult

Progress toward goals are monitored by consumer & require self-advocacy

Section 504 of the Rehabilitation Act & the Americans with Disabilities Act (ADA)

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What have I learned? Pg. 14

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Provides Information about services, resources, and programs

Functional ScreenFinancial Eligibility

Counsel individuals about eligibility for various programs and benefits

LTC Services: Family Care

Aging and Disability

Resource Center

Eligibility Determination

Options/Enrollment Counseling

Path to Publicly Funded Long Term Care Services

CallADRC

Managed Care Organization (MCO)

At least17 yrs and 6

months old

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Connecting with the ADRCCall the ADRC for answers to disability

related questions

Ph.

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Aging and Disability Resource Center (ADRC)

Offers the general public a single entry point for information and assistance on issues affecting people with disabilities regardless of income.

A place to call for Students/Parents/Teachers with disability questions related to adulthood (18+).

Accurate unbiased information related to living and working with a disability.

Services can be provided at the center, via telephone, and/or through a home visit.

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Definitions “Physical Disability” means a physical

condition, including an anatomical loss or musculoskeletal, neurological, respiratory or cardiovascular impairment, which results from injury, disease or congenital disorder and which significantly interferes with or significantly limits at least one major life activity of a person” (WI Statutes 15.197(4)(a) 2).

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Definitions “Major life activity” means any of the following:

A. Self-care B. Performance of manual tasks unrelated to gainful

employment C. Walking D. Receptive and expressive language E. Breathing F. Working G. Participating in educational programs H. Mobility, other than walking I. Capacity for independent living (WI Statutes

15.197(4)(a)1).23

Definitions “Developmental disability" means a disability

attributable to brain injury, cerebral palsy, epilepsy, autism, Prader-Willi syndrome, intellectual disability, or another neurological condition closely related to an intellectual disability or requiring treatment similar to that required for individuals with an intellectual disability, which has continued or can be expected to continue indefinitely and constitutes a substantial handicap to the afflicted individual. "Developmental disability" does not include dementia that is primarily caused by degenerative brain disorder. (WI Statutes 51.01(5)(a)).

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Long Term Care (LTC) LTC is any service or support that a person

may need as a result of a disability that limits the ability to do the things that people need to do throughout the course of the day. This includes bathing, getting dressed, making meals, going to work and paying bills.

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Goals of Publicly Funded Long Term Care

Improve access to services;Offer better choices for support and services;Improve overall quality by focusing on

Personal Life Outcomes; Coordinate with unpaid and community-

based services; andCreate a cost effective LTC system.

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Long Term Care (LTC) Target GroupsAdults with primary physical disabilities; or

Adults with primary developmental disabilities;

or

Adults with mental health or substance abuse

problems if they are also in the above target

groups; and

Adults who meet Functional Screen and

Financial Eligibility for Medicaid Assistance. 27

Eligibility DeterminationFinancial EligibilityFunctional Screen

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Financial EligibilityBased on income

Generally individuals eligible for Medicaid will be

financially eligible for publicly funded LTC services.

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Functional Screeninventory of needs or list of activities that

people need to perform, or have performed for them, in the course of every-day life;

gathers information about whether a person needs help, and how much help they need, in performing the activities;

only experienced professionals who have taken a training course and have passed a certification exam can administer the screen.

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Publicly Funded LTC ServicesAdaptive aidsAdult day careAdult family homeDurable Medical Equipment Disposable Medical SuppliesCommunication aids/interpreter servicesCommunity-Based Residential Facility (CBRF)Consumer education and trainingCounseling and therapeutic resources

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Publicly Funded LTC Services Daily living skills training Day services Financial management services Home delivered meals Home modifications Housing counseling Personal emergency response system services Prevocational services Relocation services

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Publicly Funded LTC ServicesRespite careSDS support brokerSkilled nursing servicesSpecialized medical equipment and suppliesSupported employmentSupportive home careTransportationVocational futures planning

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Family Care

Medicaid (Title 19) “Forward” Card

Publicly Funded Long Term Care

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Comparison

Assistance coordinating LTC services.

Medicare or Medicaid card to pay doctor & prescription drugs.

Includes self directed supports option.

Self-Direct all LTC Services while managing within an individual budget.

Medicare or Medicaid card to pay doctor, home health or personal care and prescription drugs.

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Assistance coordinating LTC services.

Medicare or Medicaid card to pay doctor & prescription drugs.

Includes self directed supports option.

Self-Direct all LTC Services while managing within an individual budget.

Medicare or Medicaid card to pay doctor, home health or personal care and prescription drugs.

You Can Change Options!

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Eligible PersonSelects Managed Care Organization (MCO)

or IRIS.

Assisted by Inter-Disciplinary Care Management Team or an IRIS Consultant.

Participates in Determining Services.

Select LTC providers from MCO’s provider network or works to develop own providers.

Success Measured by Personal Outcomes.38

Quality of Life OutcomesI decide where and with

whom I live.I make decisions

regarding my supports and services.

I decide how I spend my day.

I have relationships with family and friends.

I do things that are important to me.

I am involved in my community.

My life is stable. I am respected and

treated fairly. I have privacy. I have the best possible

health. I feel safe. I am free from abuse and

neglect.

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Not Eligible for LTC ServicesReferral to DVR;

Consult Disability Benefits Specialist;

Post Secondary Education and Training;

Ticket to Work: Voluntary employment program through SSA.

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Appeals & GrievancesEligibility decision;

Any care plan changes;

Additional information on appeals and grievances is available from the ADRC.

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Independent Living & Housing OptionsSupport Services in the HomeSupervised/Supported ApartmentsCommunity Based Residential FacilitiesAdult Family Care Homes

There Are Varying Degrees of

Independence

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Independent Living CentersEight Independent Living Centers in

WisconsinAssist people with disabilities

Live independent livesBe active participants in community life

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What have I learned? Pg. 21

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I want to work!

Student

What Can I Do if I Want to Work?

High School Work

Experience

DVR

Learn About My Interests

& Abilities

Paid Part/Full Time Integrated Employment

Job Shadow

Social Security

Work Incentives

Paid Internship

s

2-4yr College or

Tech School

Adult Service

Agencies

LTC Employment Support

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Working with a disability?

Plan for the FutureLearn your interests and

abilities.Set employment goals.Share your dreams and

visions.Ask what do I want to do

right after high school and five years after.

Plan for the future, don’t wait for it to happen!

Prepare for WorkParticipate in work

experience through the high school.

Develop self-advocacy skills.Complete a career inventory.Know what you can do with

and without assistance.Apply to DVR four semesters

prior to completing high school.

Everyone can work!

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Employment FirstStrategies that identify employment in integrated,

community-based businesses earning at or above minimum wage .

Integrated, community-based employment as thepreferred outcome for individuals with disabilities.

Individuals with disabilities are held to same standards, responsibilities, and expectations as any working age adult.

Employment First is about raising expectations!

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Key Employment DefinitionsEmployment- Regular employment in the

workforce on the payroll of a company (unless self employed) at minimum or prevailing wages with commensurate benefits.

Integration - Interaction with co-workers without disabilities and customers is assured.

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Employment StrategiesCompetitive EmploymentSupported or Customized EmploymentSelf-Employment/Micro-EnterpriseCommunity Rehabilitation ProgramsSegregated Work Activities (previously

known as sheltered employment)Real Jobs, Real Wages, Real Business

Settings: no sub-minimum wage

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Educational Options at 18Stay in High School until 21.Some students will choose to attend

college or receive technical training, certification, etc.

Coordinate with DVR as appropriate.

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Why stay in school?Complete educational objectives

Graduate

Complete Transition GoalsVocational Assessment Job ShadowingSupervised & Supported Employment

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What have I learned? Pg. 28

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Social SecurityDisability Benefits

Disability Determination

Supplemental Security Income (SSI)

Social Security Disability Insurance (SSDI)

Employment Supports

Ticket to WorkPlan to Achieve Self-

Support (PASS)SSDI Employment

SupportsSSI Employment

SupportsStudent Earned

Income Exclusion55

SSI + Work

Larger Total Income

SSI and WorkSSI

+ =

SSI

SSI Work Income

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Medical AssistanceAlso known as Medicaid, Title XIX (19)

Forward CardProvides Coverage for services such as:

Students receiving Medicaid, need to contact Social Security and reapply as an adult at age 18.

Doctor Services Hospital StaysPrescriptions Other Medical NeedsTransportation Personal Care

Assistants

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Medical Assistance and Work

It is possible to continue receiving Medical Assistance while working.

In Wisconsin, Medicaid will continue up to the yearly wage maximum of $32,044 (2012) .

Contact Social Security for details.

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Division of Vocational Rehabilitation (DVR)

• Provides employment services and counseling to individuals with disabilities.

• Provide or arrange for services to enable an individual to go to work.

• Provide training and technical assistance to employers regarding disability employment issues.

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Vocational Rehabilitation Services Two separate determinations must be made

before an individual receives DVR services:

Eligibility determination; andPlacement on the order of selection waiting

list.The Rehabilitation Act requires that people

with the most significant disabilities be served first.

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What have I learned? Pg. 33

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Transition Checklist Pg. 34

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Resourceshttp://dhs.wisconsin.gov/LTCare/Generalinfo/

RCs.htmhttp://www.wsti.org/http://dpi.wi.gov/sped/transition.htmlhttp://dwd.wisconsin.gov/dvr/pdf_files/tag.pdfhttp://dwd.wisconsin.gov/dvr/http://www.ssa.gov/pgm/links_disability.htmhttp://dwd.wisconsin.gov/dvr/tran.htmhttp://apse.org/

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Contact InformationPresenterCell Ph. Email:

PresenterCell Ph. Email:

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State of WisconsinDepartment of Health Services

Division of Long Term CareOffice of Resource Center Development

(10/2012)