#1 in our series on the Children’s Long-Term Support Waiver
What is the Children’s Long–Term Support (CLTS) Waiver Program?
The Children’s Long-Term Support (CLTS) Waiver Program provides funding and support for families who have children with disabilities, who are Medicaid eligible, so they can care for their children at home and participate in their communities.
The program is funded by the federal and state government but administered at the county level, so families typically work directly with their county to apply for and receive CLTS services.
This fact sheet provides an overview of the CLTS Program. For more information on eligibility, enrollment, creating Individual Service Plans, appealing a denial and more, see additional Family Voices of Wisconsin CLTS Fact Sheets in this series.
The CLTS Waiver Program is one of the long-term support programs for children. The Children’s Community Options Program (CCOP) is another program that can help children with special needs. Both programs can help pay for supplies, services and supports above and beyond what private health insurance or Medicaid, also known as the Forward card, covers.
Some Examples of What Long–Term Support Programs Can Pay for Include:
- Home modifications such as a fence or ramp.
- Adaptive aids and vehicle modifications such as computers, standing frames or ramps.
- Supplemental child care costs above what you would pay for a typically-developing child.
- Parent training and education such as going to conferences or buying books.
- Counseling and therapy such as music or hippotherapy.
- Respite such as in-home direct care providers.
Who is Eligible for the CLTS Program?
A child may be eligible if he or she has a significant disability and is living at home. A child’s eligibility is based on his or her “functional limitations” and not just a diagnosis. This includes a physical, mental or emotional limitation that restricts a child’s ability to carry out daily living activities.
A child also needs to be eligible for Medicaid.
Enrolling in the CLTS Program
The CLTS Program is administered by County Waiver Agencies, so families will work directly with county staff. To start the enrollment process, contact your county human services department. (A list can be found at dhs.wisconsin.gov/data/ servicesearch.htm.) Families living in southeastern or southern Wisconsin should contact Compass(compasswisconsin.org). They will help with intake, application and eligibility determination.
How is My Child’s Eligibility Determined?
A screening tool called a functional screen will be used by county or Compass staff to determine your child’s eligibility for the CLTS Waiver Program. The tool collects information on your child’s health, need for supports and how he or she plays and interacts with others.
As the parent/family member, your input and insights are an important part of the process! Try to be as realistic as possible about your child’s needs and abilities.
If your child is determined not eligible, consider which details might have been missed and what limitations or care needs might not have been fully explained to the screener. Most often, this is the reason why children who should qualify might not qualify. You can ask to review the screen with the screener, and ask for a second review by the screening agency. If you disagree with the result, you can file an appeal to ask for a formal review.
What Happens After My Child is Enrolled?
You will receive a letter from your county letting you know if your child is eligible and the date to be enrolled in the CLTS Program. A service coordinator will be assigned to your child and he or she will then meet with your family to get to know your child’s needs and challenges. The service coordinator will then partner with you to create an Individual Service Plan (ISP). This annual plan documents the supports and services to be provided including those that the CLTS Program will pay for each year. (See Family Voices of Wisconsin CLTS Fact Sheet #4.)
As you talk with your child’s service coordinator, think about goals, also called outcomes, for your child. The ISP will include services to help your child and family meet these outcomes. (SeeFamily Voices of Wisconsin CLTS Fact Sheet #5.)
Each child enrolled in the CLTS Program will need to be reevaluated each year by their service coordinator to make sure that they are still eligible for the program.
What Does the CLTS Program Cost?
There may be a Parental Payment, or fee for participating, for families who have incomes above 330% of the Federal Poverty Level. The annual fee depends on your income and the cost of your child’s ISP. Your service coordinator will let you know if you have a Parental Payment and your family will receive a bill from the county (seedhs.wisconsin.gov/clts/waiver-costs.htm).
What if a Service or Item is Denied?
If you want to appeal a denial, the best place to start is to work directly with your child’s service coordinator. You can also complete the county’s grievance process and/or seek an appeal by requesting a fair hearing with the State Division of Hearings and Appeals. (See Family Voices of Wisconsin CLTS Fact Sheet #8.)
Will We Have to Wait for Services?
In the past, an eligible child could be placed on a wait list for several years before he or she could be enrolled and start to receive funding and services. However, new state funding means that starting in 2019, most children who are eligible won’t have to wait long to be enrolled in the CLTS Program. Keep in mind that eligibility determination may take time, so families may wait before all paperwork and enrollment requirements are completed.
If you have questions, contact your Regional Center for Children and Youth with Special Health Care Needs. To find your Center, go to dhs.wisconsin.gov/cyshcn/regionalcenters.htm or call 800.642.7837.