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The Community Options Program Waiver (COP-W) and the Community Integration Program II (CIP-II) are both Wisconsin Medicaid waivers intended to assist persons that have impaired functional abilities. While there are no age restrictions for participants in these supportive programs, they are primarily intended for the elderly residents. There are less restrictive eligibility criteria for older applicants. Both waivers share the objective of providing nursing home eligible persons with services and supports to help them continue living outside of a nursing home environment, either at home or in assisted living.
In addition to home care, these waivers provide many types of non-care assistance intended to increase the participant's independence or decrease their reliance on caregivers or Medicaid support. For example, adult day care is covered during work hours on weekdays. Home modifications, such as walk-in tubs or wheelchair ramps may be covered for certain persons / homes. Respite care relieves caregivers temporarily as do home delivered meals.
Please note that one may hear Wisconsin Medicaid referred to as ForwardHealth or BadgerCare.
To qualify for these waivers, applicants must have a long term, chronic or irreversible functional impairment. They must require assistance to perform their activities of daily living such as bathing, grooming and transferring, but their impairments cannot be so severe that it would be less expensive to care for them in a nursing home. Impairments can be physical or mental.
To qualify financially for these waivers, applicants must meet Wisconsin's Medicaid limits. The state offers both Categorically Needy and Medically Needy programs.
WI Medicaid Financial Limits for 2017
Single applicants can have monthly income up to $2,205 and savings and financial resources of not more than $2,000. Homes, personal items, and the applicant’s car are generally exempt.
For those whose income in a month goes over the limit, there is an alternative pathway to enroll in the WI Medicaid long term care supports. This is called the “Medically Needy” program. The program considers the applicant's out-of-pocket medical expenses and medically necessary care expenses and their finances.
If it is determined that they cannot afford their cost of care, they qualify for Medicaid, at least conditionally. Their case is reviewed periodically to determine that they continue to meet the eligibility requirements. A different and much lower limit is set for the applicant's income after deducting their medical and care expenditures.
There are a variety of public benefits counselors and case managers as well as private Medicaid planners that aid in helping individuals and families to prepare for a Medicaid application. Learn more about using professional assistance here.
Benefits of these waivers are intended to increase's the recipient's ability to live outside of a nursing home environment. Candidates may be approved for any of the following:
Waiver candidates should be aware that there may be participation caps for these programs and waiting lists may exist. Wait lists are maintained at the county level and some counties may have shorter or no waiting lists at all.
To avoid waiting lists, low income elderly Wisconsin residents who are looking for in-home services only should consider applying to Wisconsin Medicaid Personal Care instead. This alternative program does not have waiting lists.