Children may be functionally eligible for the CLTS program automatically if they meet certain age and diagnosis requirements. In this case, the petitioner was a five-year-old with autism whose was determined functionally ineligible after an updated functional screen. Noting the Department policy that children under six with an autism diagnosis are automatically considered at the institutional level of care, ALJ Brian Schneider concluded the screen was mistaken.
This decision was published with support from the Wisconsin chapter of the National Academy of Elder Law Attorneys and Krause Financial.
Preliminary Recitals
Pursuant to a petition filed November 3, 2025, under Wis. Admin. Code, §HA 3.03(1), to review a decision by the Crawford County Dept. of Human Services to discontinue the Children’s Long-Term Support Program (CLTS), a hearing was held on December 18, 2025, by telephone.
The issue for determination is whether petitioner meets a level of care for CLTS eligibility.
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
201 E. Washington Ave.
Madison, WI 53703
By: Shauna Strandlie
Crawford County Dept. of Human Services
225 N Beaumont Rd., Suite 326
Prairie du Chien, WI 53821
ADMINISTRATIVE LAW JUDGE:
Brian C. Schneider
Division of Hearings and Appeals
Findings of Fact
- Petitioner is a five-year-old resident of Crawford County.
- Until the action at issue in this appeal, the respondent was eligible for CLTS based upon meeting a functional screen finding of institutional need under the developmental disability (DD) target group. See 8/12/24 CLTS Functional Screen, which was done when petitioner was in 4K at school. Petitioner’s diagnosis is autism spectrum, and in the 2024 screen it was noted that he had an Individualized Education Program (IEP).
- In September, 2025, an annual reassessment was completed with a new functional screen done on September 29. That assessment noted that petitioner’s primary diagnosis is Autism or Autism Spectrum. It noted that petitioner has an IEP, but specifically for occupational and speech therapy. The screen noted that petitioner does not have problem behaviors at school, that he has some problem with communication in that he does not follow certain two-step directions, and that he has deficits in a number of social competency/self-direction areas (similar to the finding in 2024).
- The Functional screen was run, and petitioner was found to no longer meet the CLTS level of care. A notice of denial of CLTS was sent dated October 23, 2025. This appeal was filed. Benefits were not ordered to be continued.
Discussion
The CLTS program started on January 1, 2004 after the federal Department of Health and Human Services informed the state department that federal MA funding would no longer be available for in-home autism services. The department utilizes a Medicaid Home and Community-Based Services Waiver Manual for the CLTS Waiver Program (“the Manual”), just updated in December, 2025. It is found on-line at https://www.dhs.wisconsin.gov/publications/p02256.pdf.
The Manual provides that an individual must meet several eligibility criteria for these programs, one of which is level of care. Manual, §2.2. In addition, the child must be part of a waiver target group. Those groups include children with developmental disabilities, those with physical disabilities, and those with mental health disabilities. Manual, §2.3.
Petitioner was eligible for CLTS under the DD level of care. To meet the DD level of care, the child must (1) have a diagnosis of a cognitive disability or related condition, (2) must demonstrate substantial functional limitations, and (3) need active treatment. Manual, §2.3.1.
Institutional Levels of Care: Children’s Long-Term Support Programs in Wisconsin is a document found on-line at www.dhs.wisconsin.gov/publications/p03027.pdf. It is dated May, 2022, and it includes written descriptions of the levels of care upon which the functional screen instructions are based. A web page describing the Wisconsin Functional Screen, updated September 30, 2025, includes a link to the site. See www.dhs.wisconsin.gov/functionalscreen/index.htm#childrens. Importantly to this decision, I discovered this statement in the first paragraph of the DD level of care discussion on page 4 of the Level of Care Document: “Children under age 6 with an eligible diagnosis will automatically meet an institutional level of care on the Functional Screen and be eligible for the CLTS Program.” Autism Spectrum Disorder is one of the eligible diagnoses. Id., page 5.
I have no explanation of why the functional screen determination found that petitioner did not meet the DD level of care. However, the statement in the Department’s own Level of Care policy document that a child under age six with an autism diagnosis meets the DD level of care is sufficient proof to me that the functional screen result was erroneous. I thus will order that petitioner remain eligible for CLTS under the DD level of care. Next year when he is six the result might change, and it might also be worth reviewing the mental health level as well. However, for this year he remains eligible.
Conclusions of Law
Petitioner remains eligible for CLTS under the DD level of care because he is under six years old with a diagnosis listed as a cognitive impairment.
THEREFORE, it is
Ordered
That the matter be remanded to the agency with instructions to restore petitioner’s CLTS eligibility with the finding that he meets the DD level of care, if he continues to meet all other eligibility criteria. The agency shall do so within 10 days of this decision.
[Request for a rehearing and appeal to court instructions omitted.]
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