2. Is My Child Eligible for the CLTS Program?
#2 in our series on the Children’s Long-Term Support Waiver
What is the Children’s Long–Term Support (CLTS) Waiver Program?
The 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. This fact sheet will explain the eligibility process.
Could My Child be Eligible for the CLTS Waiver 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 from a health care provider.
This includes a physical, developmental or emotional limitation that restricts a child’s ability to carry out daily living activities, such as dressing or eating, or impacts learning, communicating or mobility. To participate in the program, a child must be:
• Under the Age of 22 • A United States Citizen• A Wisconsin Resident
Significant Care Needs: In addition, a child must need a high level of care and help throughout his or her day.
The CLTS Program defines this as an institutional level of care like the care typically provided in a hospital, nursing home or facility for people with developmental disabilities.
As you consider whether your child might be eligible, think about all you do for him/her. This is the time to be realistic rather than overly optimistic or “rosy” about what your child can or might do on his or her best days. Consider the following: If you had to leave your child with a distant relative for a week, or a month, how would you explain all that you do to keep your child safe, healthy and cared for every day? It is important to mention things that might happen only occasionally, as well as things that happen every day.
Does My Child Need to be Covered by Wisconsin Medicaid?
Yes, your child must be eligible and meet all the eligibility requirements for Medicaid. For families whose income is above the BadgerCare Plus limit, your children may qualify for Home and Community-Based Service (HCBS) waiver Medicaid or the Katie Beckett Medicaid Program.
Eligibility for these Medicaid programs is based on the child’s level of care needs/disability and the child’s income.
If he or she is not currently enrolled, signing up for Medicaid, either through BadgerCare Plus, the Katie Beckett Program or SSI–Medicaid will be part of the process of enrolling in the CLTS Program.
Eligibility Process for the CLTS Waiver Program
Step 1: Contact your county Human Services Department at dhs.wisconsin.gov/clts/contact.htm.
Step 2: Review the initial eligibility requirements with staff (see page 1).
Step 3: Set up a call or visit to talk more about the long-term support programs, including the CLTS Waiver Program and Children’s Community Options Program. Another person (your child’s school, Birth to Three, doctor, a grandparent or other relative) can also contact the County to help a family start this process.
Step 4: If your family wants to move forward with determining if your child could be eligible, you will be contacted to schedule a meeting and may be sent initial paperwork including Release of Information forms that will be sent to the child’s doctors, school, or other providers.
Step 5: CLTS staff will set up a home visit to get to know your child and family and make an eligibility determination. This must be done within 45 days from the initial application. During that visit, a screening tool, called a Functional Screen, will be used to assess your child’s level of care needs and functional limitations.
The Functional Screen is a tool that collects information on your child’s health, need for supports and how he/she plays and interacts with others. Your input can be critically important in helping the worker fully understand a child’s limitations, care needs and challenges. This is the time to be realistic about what your child can do and the areas that need support—This is not a time to brag about your child. (See the Family Voices CLTS Fact Sheet #3.)
Step 6 : County Waiver Agency staff will work with your family to complete all needed paperwork. Medical records, school reports and your child’s IEP may be requested as part of determining eligibility. If your child is not yet covered by Medicaid, county staff can help your family complete the application and enrollment process.
Step 7: Your family will receive a letter from their county letting them know if your child is eligible for the CLTS Program. This process may take up to 45 days from the initial referral. If you have not heard back, call your county to ask for an update—It’s okay to call weekly while you are waiting.
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.