Long-Term Care Programs

Long-term care is any service or support that a person may need as a result of getting older or having a disability that limits their ability to do the things that are part of their daily routine. Long-term care services include things such as assistance with bathing, dressing, making meals, going to work, and paying bills. Long-term care services may be provided in people’s homes, in small and large residential care facilities, in or group homes, in nursing facilities, or in the workplace, in addition to other settings.

What is Long-Term Care (LTC)?

Long-term care is any service or support that a person may need as a result of getting older or having a disability that limits their ability to do the things that are part of their daily routine. Long-term care services include things such as assistance with bathing, dressing, making meals, going to work, and paying bills. Long-term care services may be provided in people’s homes, in small and large residential care facilities, in group homes, in nursing facilities, or in the workplace, in addition to other settings. More information on long-term care services and service providers can be found in our ADRC Resource Guide. If you need assistance paying for these services, the ADRC can provide you information on publicly funded long term care programs.

Publicly funded long-term care programs are Medicaid programs that can pay for long term care services for those who meet eligibility criteria.

These programs serve frail elders and adults with physical, developmental, or intellectual disabilities, with the specific goals of:

Giving people better choices about where they live and what kinds of services and supports they may receive to meet their needs
Improving access to services
Improving quality through a focus on health and social outcomes
Creating a cost-effective system for the future

What are the eligibility criteria for long-term care programs?

To be eligible for the publicly funded long term care programs, you must:

Be aged 65 or older, or an adult with a disability
Meet applicable requirements for Wisconsin residency
Have long-term care service needs that meet program functional eligibility requirements. Functional eligibility is determined by the Long Term Care Functional Screen
Meet financial eligibility requirements

People receiving a long-term care benefit may be required to pay a cost share to the long-term care program they choose to enroll in.

Once your eligibility for publicly funded long-term care has been determined, the ADRC will provide information about the long-term care program options available to you. Options may include enrollment in Family Care, Partnership, PACE, or IRIS. You may also be able to choose to receive services through the Medicaid fee-for service system or to privately pay for services.

What publicly funded long-term care programs are available in Waukesha County?

Family Care

Family Care is a Medicaid long-term care program for frail elders and adults with physical, developmental, or intellectual disabilities. In Family Care, you will receive long-term care services to help you live in your own home whenever possible. When a person enrolls in Family Care, they join a managed care organization (MCO). Wisconsin Department of Health Services (DHS) pays MCOs monthly for each member they serve. The MCO uses the funds to find and schedule services for its members based on need, situation, and preference. If you enroll in Family Care, your MCO will give you a full list of services you may be eligible for. Additionally, MCOs have a full list of long-term care providers that they contract with to provide services. They make sure services for members are top quality.

If you are found functionally eligible at the non-nursing home level of care, you may only be eligible for a limited set of services.

Once enrolled in Family Care with an MCO, you will be assigned a care team consisting of a care manager and registered nurse. You and your team will develop an individual service plan that will focus on your long term care needs. This plan will then be coordinated by you and your Family Care team.

MCOs offering Family Care in Waukesha County include:

Visit the DHS website on Family Care for more information.

Partnership

Partnership is a Medicaid long-term care program for frail elders and adults with physical, developmental, or intellectual disabilities who meet a nursing home level of care. The Partnership program offers an integrated model of care that includes long-term care services, as well as medical services, such as physician services, hospital stays, medications, dental services, and other medical care. These services are delivered through interdisciplinary teams that may include a registered nurse, licensed social worker, nurse practitioner, rehabilitation and recreation therapists, dietitian and a doctor who work together to ensure your complete social, personal and medical care needs are met.

MCOs offering Partnership in Waukesha County include:

Visit the DHS website on Partnership for more information.

Program of All-Inclusive Care for the Elderly (PACE)

PACE, like Partnership, integrates your long-term care services, health and medical care services (primary and acute care), and prescription medications. PACE is available to individuals who are 55 or older and meet a nursing home level of care. PACE services are primarily delivered at a PACE center and supplemented with care in your home or a setting of your choice. PACE includes coverage of many services including but not limited to dental, vision, hearing and foot care, home health services, transportation, caregiver respite, physical and occupational therapy, home delivered meals and end of life/palliative care. The interdisciplinary team is the same as Partnership.

MCOs offering PACE in Waukesha County include:

Community Care

Visit the DHS website on PACE for more information.

Include, Respect, I Self-Direct (IRIS)

IRIS is a self-directed program for Wisconsin’s frail elders and adults with physical, developmental, or intellectual disabilities who meet a nursing home level of care. IRIS is built on the principles of self-determination and self-direction. In IRIS, a budget is established for you based on your long-term care needs. You get to decide what goods, support, and services will help you achieve your goals and, using your budget, you will help create a support and service plan to meet your needs. In IRIS, instead of contracting with an MCO, the State contracts with an Independent Consultant Agency (ICA) and a Fiscal Employment Agent (FEA) that assist you in managing your care plan.

ICAs serving Waukesha County include:

FEAs serving Waukesha County include:

Visit the DHS website on IRIS for more information.

If you decide to enroll in a publicly funded long-term care program, the ADRC will complete enrollment or referral paperwork, finish the enrollment or referral process, and notify the managed care organization (MCO) or IRIS consultant agency (ICA) of the enrollment or referral date. Within three days after your enrollment date or referral, the MCO or ICA will contact you to begin working on your plan for services and supports.