Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 03, 2020
Under contract with the state of Wisconsin, Oneida Nation of Wisconsin can administer the state’s Community Options Program Waiver (COP-W). This waiver broadens the range of home- and community-based services (HCBS) that Medicaid covers.
In 2018, Oneida Nation renamed its COP-W program to Oneida Nation Family Care.
The program provides culturally appropriate long-term care to help elders and adults with disabilities live as independently as possible.
A successful tribal-state partnership
Oneida Nation’s program provides an example of successful approaches for working with your state to provide LTSS under a Medicaid waiver.
- Gathering data. Oneida Nation did a feasibility study to determine how many clients it might serve and see if the program would be financially sustainable.
- Establishing a working relationship. Through a joint committee, Oneida Nation and the state developed an agreement under which the state treats the tribe as a county, enabling Oneida Nation to administer the waiver.
- Explaining the benefits of partnership. Oneida Nation showed the state how much money it could save through tribal administration of the waiver. Oneida Nation explained the 100% Federal Medical Assistance Percentage (FMAP) reimbursement option, under which the state can receive full reimbursement for qualifying services provided to Medicaid-eligible AI/AN patients.
Services provided directly
Oneida Nation Family Care serves between 20 and 24 people each month.
Job coaching for the developmentally disabled
Physical therapy
Respite care
Skilled nursing care (up to once per week)
Traditional healing (when possible)
Services to help patients navigate processes
Case management
Help completing the Medicaid application
Help determining which services a patient is eligible for
Services the program refers to contracted providers
Medical equipment
Personal care services, such as help bathing or getting dressed
Skilled nursing care (for people who need it more than once a week)
Occupational therapy
Speech therapy
Transportation
Eligibility
Oneida Nation Family Care provides services to people who are eligible for care under the Medicaid HCBS 1915(c) waiver.
Funding
Prior to 2007, Oneida Nation's COP-W was partly funded by the state (42%), with the majority of support coming from federal Medicaid funds (58%).
In 2007, Oneida Nation successfully petitioned to include waiver services included under its contract with IHS. This change resulted in the following benefits:
- all costs go to the federal government, rather than being shared by the federal government and the state
- the program’s enrollment cap was removed
Resources
- Watch a short video on LTSS provided through the Oneida Community Health Center.
- Learn more about working with your state.
- Read more about 100% FMAP.
- Read about White Earth Long-Term Care Consultation, another successful tribal LTSS program.
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