1. ADRC IM Work Group Overview
April Heim (Southern Consortium Operational Lead and Rock
County Economic Support Division Manager)
Mary Fredrickson (Deputy Director, Human Services,
Winnebago County)
Debbie Waite (Deputy Bureau Director, Division of Medicaid Services,
Bureau of Enrollment Policy & Systems)

2. Background and History
Formed in August 2017
Meets regularly every 4 to 6 weeks
Started with 32 participants
MCO representatives added Feb 2018
51 Current participants:
19 IM
14 ADRC
7 MCO & ICA
11 DHS Staff
Is growing!

3. The Partners - Reasons for Formation of the Work Group
Aging & Disability Resource Center Perspective
Income Maintenance Perspective
DHS – Income Maintenance Perspective

4. Challenges Multiple players supporting an inter- connected process
Inconsistent service area boundaries
A complex process to the customer
Demanding work loads for staff - with limited resources

5. Challenge: Multiple Players
The long term care eligibility and enrollment process involves multiple players who each play a key role in that process
Income maintenance agencies – eligibility for
Medicaid and other programs
ADRC’s – functional screen and
options/enrollment/benefit counseling
MCO’s and ICA’s – long term care services
and care management

6. Challenge: Geographic Dis-alignment
IM Consortia
ADRCs
MCOs

7. The Geographic Dis-alignment (cont.)
Result – each entity likely dealing with multiple partners that are using different processes and tools

8. Other Challenges Income Maintenance move to call center model
Multiple hats for ADRC staff
Process partners may not be co-located
Resources to support the customer – always an issue!

9. Work Group Purpose Statement
To promote clarity of roles and support better coordination of the eligibility and enrollment process for customers applying for Medicaid Long Term Care programs. Specifically to:
Clarify roles of each entity
Identify and implement best practices which promote collaboration
Identify need for standardizing forms and informational materials

10. Work Group Purpose Statement (cont.)
To provide input to the proposed enrollment plan document to support the 2018 ADRC/MCO contract
Process used to review template and populate content
Status of work

11. Purpose 1 – Clarity of Roles & Improved Communication
The Work Group:
Brainstormed issues & opportunities
Grouped issues & opportunities into 8 buckets

12. Bucketed Issues and Opportunities
Issues/Opportunities
Potential Best Practices
Electronic Systems 9 7
Training 10 5
Forms and Notices
Worker Materials 1
Roles and Responsibilities 20 16
Inter-Agency Communications 12
Policy Clarifications
Miscellaneous Items 4 2

13. Sub-Work Groups Created
To discuss and categorize the issues and opportunities as:
“Pursue action item”
“Disseminate as best practice”
Identify as low or non priority
Cross representational participants
Facilitated by DHS Area Admin staff

14. Sub-Work Groups (cont.)
Three are operational at this time:
Roles and Responsibilities
Communications and Interrelationships
Forms, Notices, and Worker Materials

15. Chart Example – In Draft Form

16. Short Term “Wins”
CARES overview for non-IM workers – April 20th & October 19th
Systems fixes proposed for prioritization in CARES project portfolio
8-10 forms and notices gathered from partners to share statewide
MCO and ICA representatives now at table

17. Developing Process Flows
Developed application process flow
Drafting renewal process flow
“To do” list– create disenrollment process flow

18. DRAFT LTC Eligibility & Enrollment Renewal Process
IM Processes Renewal
Phone
If both spouses are on the line take electronic signature from each
If both spouses not on the line, pend for signature
Paper PPRF
ACCESS renewal (rare)
Face to Face 
45 Day Renewal Letter
Sent systematically by CARES
DRAFT
MCO’s
Proactively assist customers with renewals (from a report)
Help with the renewal paperwork
Ideally, turning in a complete renewal, with both signatures (if needed) and all needed verifications.
If a BC+ or MAPP case – complete the Divestment Document (not a standard form) – Western created this form for MCOs to use
Access CWW pages (via read-only access) to assist member, if needed
If case fails at renewal, the MCO will continue to try to resolve the issue
Once confirmed, the case will either be:
Ongoing – If the member remains eligible
Closed – if the member is no longer eligible
This will result in dis-enrollment from any Managed Long Term Care services the member may be receiving
After processing, IM will either:
Confirm ongoing benefits
If needed, manually send updated spousal income allocation form
Pend for any needed verifications
If PPRF is returned, pend the asset gatepost page for Divestment form (not a standard form – Western created this)

19. Remaining Issues & Challenges
Customer application assistance
Communication and exchange of information among partners
CARES access or portal structure
or other strategies
Relationship building

20. Next Steps Complete remaining sub-group work
Capture best practices in useable document
Disseminate and encourage use of standardized forms and tools
Develop plan and schedule to implement recommended action items
Develop strategy for broader sharing, dissemination and reinforcement of work
WCHSA
ADRC Directors
ADPAW
IMAC
MCO Association

21. Could use your help with…
Supporting deployment and dissemination
Identifying issues and challenges that may have been missed

22. Contact Information
Mary Fredrickson (920)
April Heim (608)
Debbie Waite – DHS (608)

23. Questions and Discussion