I have been determined functionally and financially eligible. How long do I have to decide which program – Family Care or IRIS – is right for me?
- That depends on several factors.
- Once determined financially eligible for Medicaid, you will need to decide which program is best for you. The decision timelines is determined by Western Region for Economic Assistance based on state guidelines. We will call you once eligibility is determined and schedule a time to review.
How do I know if I qualify for services?
There are several criteria used to determine eligibility based on individual need.
- To be eligible for a publicly funded Long-Term Care Program, you must be functionally and financially eligible.
- Functional eligibility is completed by the ADRC;
- Financial eligibility is completed by the Western Region for Economic Assistance (WREA).
- The ADRC will assist you in applying for financial eligibility. There are several criteria used to determine eligibility based on individual need.
What kind of questions will I be asked on the Long-Term Care screen, which impact the functional eligibility?
- Review of Instrumental Activities of Daily Living (IADL) – complex sets of skills we need in order to live independently.
- using the telephone
- shopping/meal preparation
- using transportation
- taking medication(s)
- managing finances
- Review of Activities of Daily Living (ADL) – essential activities that a person needs to perform to be able to live independently.
How long will it take to get enrolled?
- Enrollment is determined case by case, and by the complexity of information needed to complete the process.
- The ADRC has 30 days to complete your functional screen once you requested to be screened.
- The Western Region for Economic Assistance has 30 days to process your Medical Assistance application
- These timelines are contingent upon other factors
- Other factors that may affect this process include, but are not limited to: scheduling availability – client and staff, receipt of medical records, financial verifications.
- Therefore, the entire process could take a minimum of up to 60 days to determine both functional and financial eligibility. Document verification could extend this timeframe if initial deadlines aren’t able to be met
I’m not sure if I am comfortable having a stranger come into my home, but I can’t afford to pay my friend/relative to help me…
- That’s understandable. If you qualify for the Long-Term Care Program, depending on your level of care eligibility, you can choose your caregiver. All caregivers must be able to pass a caregiver background check administered by the Medicaid funded program, before being being authorized as a caregiver in a Medicaid program
I’m already enrolled, but I feel like I’m not getting any services or help from my managed care organization. What do I do?
- Call the ADRC. We can help you find out what is going on and talk with your care organization to make sure your needs are being met. If you are still not satisfied, we can discuss other options.
I know I won’t financially qualify for the Long-Term Care Program, so what else can I do to get the help I need?
- We have a Private Pay list at the ADRC. Private pay means you hire and pay for services, without Medicaid funding. This is an option that can also assist you in spending down your assets to reach Medicaid income/asset guidelines. If you choose, you can continue managing your own Long-Term care plans privately.
I am taking care of my significant other, they would not financially qualify for the Long-Term Care program and do not want to privately pay for someone to come in and help. What can I do?
- There are Family Caregiver Support Programs that may be able to alleviate some of the caregiving stress you are feeling. These are short-term and limited programs that offers help to caregivers. Call the ADRC to discuss your options.
I don’t think I am ready to get enrolled in the Long-Term Care Program…
- That’s okay! This is a completely voluntary program, and will be here for you if you decide you would like it. We can take a closer look at other options you are more comfortable with while you explore all of your options.