Wisconsin home care programs

Home health: the medical benefit

In Wisconsin, skilled home health is ForwardHealth Home Health Services. It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Wisconsin Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Wisconsin the agency route is ForwardHealth Personal Care Services (MAPC). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. ForwardHealth Personal Care Services (MAPC) lets the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

Wisconsin's consumer-directed option is IRIS (Include, Respect, I Self-Direct). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: IRIS (Include, Respect, I Self-Direct) allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Wisconsin has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (IRIS (Include, Respect, I Self-Direct)), by the hour, as the participant's chosen aide.

Other ways Wisconsin pays for care at home

Waiver in-home services: Children's Long-Term Support Waiver Program (CLTS) and Family Care (SDS). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Family Care Partnership / PACE. One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: Alzheimer's Family and Caregiver Support Program (AFCSP). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (ForwardHealth Home Health Services).
• Needs daily help and wants an agency to supply and manage the aide: ForwardHealth Personal Care Services (MAPC).
• Wants to choose the aide, including a relative where allowed: IRIS (Include, Respect, I Self-Direct).
• Meets nursing-home level of care and needs more than personal care: Children's Long-Term Support Waiver Program (CLTS) and Family Care (SDS).