2. Transition, Publicly Funded Long Term Care and Integrated Employment in Wisconsin Counties with Family Care & IRIS 1 State of Wisconsin Department of Health Services Division of Long Term Care Office of Resource Center Development (10/2012)

3. Our Goal Publicly Funded Long Term Care Transition Integrated Employment Helping Students with Disabilities Get Ready for Life After High School 2

4. Learning Objectives? Introduce Manual Transition Planning Publicly Funded LTC Integrated Employment 3

5. 4

6. Quality of Life Outcomes I 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. 5

7. Interesting Facts Approximately 45K students in special education Wisconsin (ages 14-21). Approximately 8K leave school districts across the state annually. 6

8. Key Players in Transition Student Parents Teachers Community DVR Guidance Social Worker Psychologist Transition Coordinator Aides ADRC Staff Support Staff Universities, Technical /Community Colleges Employers Independent Living Services Social Security Administration Paraprofessionals School Administrators 7

9. 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 Options 18 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 8

10. Student Role Identify 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. 9

11. Parent Role Help 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. 10

12. Teacher Role Develop understanding of students 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. 11

13. Why Self-Determination? To live life as you choose in accordance with your interests, needs, and abilities. Self-Determination Exercising the right to make choices & direct your life. Self-Advocacy Knowing and standing up for your rights. How? Provide opportunities to make decisions and choices at home. 12

14. Transition Planning Start planning no later than 9 th grade; Several questions are provided to assist with planning; and Students can express their goals and desires several ways. 13

15. What have I learned? Pg. 9 14

16. Important Things that Happen At 18 Resolve 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). 15

17. Guardianship Parents 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 16

18. 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) 17

19. What have I learned? Pg. 14 18

20. Provides Information about services, resources, and programs Functional Screen Financial 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 Call ADRC Managed Care Organization (MCO) At least 17 yrs and 6 months old 19

21. Connecting with the ADRC Call the ADRC for answers to disability related questions Ph. 20

22. 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. 21

23. 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). 22

24. 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

25. 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)). 24

26. 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. 25

27. 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; and Create a cost effective LTC system. 26

28. Long Term Care (LTC) Target Groups Adults 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

29. Eligibility Determination Financial Eligibility Functional Screen 28

30. Financial Eligibility Based on income Generally individuals eligible for Medicaid will be financially eligible for publicly funded LTC services. 29

31. Functional Screen inventory 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. 30

32. Publicly Funded LTC Services Adaptive aids Adult day care Adult family home Durable Medical Equipment Disposable Medical Supplies Communication aids/interpreter services Community-Based Residential Facility (CBRF) Consumer education and training Counseling and therapeutic resources 31

33. 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 32

34. Publicly Funded LTC Services Respite care SDS support broker Skilled nursing services Specialized medical equipment and supplies Supported employment Supportive home care Transportation Vocational futures planning 33

35. 34

36. Family Care Medicaid (Title 19) Forward Card Publicly Funded Long Term Care 35

37. 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. 36

38. 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! 37

39. Eligible Person Selects 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 MCOs provider network or works to develop own providers. Success Measured by Personal Outcomes. 38

40. Quality of Life Outcomes I 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. 39

41. Not Eligible for LTC Services Referral to DVR; Consult Disability Benefits Specialist; Post Secondary Education and Training; Ticket to Work: Voluntary employment program through SSA. 40

42. Appeals & Grievances Eligibility decision; Any care plan changes; Additional information on appeals and grievances is available from the ADRC. 41

43. Independent Living & Housing Options Support Services in the Home Supervised/Supported Apartments Community Based Residential Facilities Adult Family Care Homes There Are Varying Degrees of Independence 42

44. Independent Living Centers Eight Independent Living Centers in Wisconsin Assist people with disabilities Live independent lives Be active participants in community life 43

45. What have I learned? Pg. 21 44

46. 45

47. 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 Internships 2-4yr College or Tech School Adult Service Agencies LTC Employment Support 46

48. Working with a disability? Plan for the Future Learn 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, dont wait for it to happen! Prepare for Work Participate 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! 47

49. Employment First Strategies that identify employment in integrated, community-based businesses earning at or above minimum wage. Integrated, community-based employment as the preferred 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! 48

50. Key Employment Definitions Employment- 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. 49

51. Employment Strategies Competitive Employment Supported or Customized Employment Self-Employment/Micro-Enterprise Community Rehabilitation Programs Segregated Work Activities (previously known as sheltered employment) Real Jobs, Real Wages, Real Business Settings: no sub-minimum wage 50

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53. Educational Options at 18 Stay in High School until 21. Some students will choose to attend college or receive technical training, certification, etc. Coordinate with DVR as appropriate. 52

54. Why stay in school? Complete educational objectives Graduate Complete Transition Goals Vocational Assessment Job Shadowing Supervised & Supported Employment 53

55. What have I learned? Pg. 28 54

56. Social Security Disability Benefits Disability Determination Supplemental Security Income (SSI) Social Security Disability Insurance (SSDI) Employment Supports Ticket to Work Plan to Achieve Self- Support (PASS) SSDI Employment Supports SSI Employment Supports Student Earned Income Exclusion 55

57. SSI + Work Larger Total Income SSI and Work SSI + = Work Income 56

58. Medical Assistance Also known as Medicaid, Title XIX (19) Forward Card Provides Coverage for services such as: Students receiving Medicaid, need to contact Social Security and reapply as an adult at age 18. Doctor Services Hospital Stays Prescriptions Other Medical Needs Transportation Personal Care Assistants 57

59. 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. 58

60. 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. 59

61. Vocational Rehabilitation Services Two separate determinations must be made before an individual receives DVR services: Eligibility determination; and Placement on the order of selection waiting list. The Rehabilitation Act requires that people with the most significant disabilities be served first. 60

62. What have I learned? Pg. 33 61

63. Transition Checklist Pg. 34 62

64. Resources http://dhs.wisconsin.gov/LTCare/Generalinfo/RCs.htm http://www.wsti.org/ http://dpi.wi.gov/sped/transition.html http://dwd.wisconsin.gov/dvr/pdf_files/tag.pdf http://dwd.wisconsin.gov/dvr/ http://www.ssa.gov/pgm/links_disability.htm http://dwd.wisconsin.gov/dvr/tran.htm http://apse.org/ 63

65. Contact Information Presenter Cell Ph. Email: Presenter Cell Ph. Email: 64 State of Wisconsin Department of Health Services Division of Long Term Care Office of Resource Center Development (10/2012)