COP High Cost Request Instructions and Form

COP High Cost (COP HC) one-time funding is unspent state-wide COP funds from the previous calendar year. The fund was created primarily to provide one-time funding to assist counties in serving persons with above average costs who have exceptional one-time service needs.

COP HC funds are used for exceptional expenses such as the purchase of specialized training for providers, start-up costs for developing needed services, home modifications, and/or the purchase of medical equipment or other specially adapted equipment. This funding source is not used for routine costs of care. It is a funding of last resort and therefore other funding possibilities must be explored before the use of COP HC. Examples of other resources: Medicaid, Medicare, DVR, private insurance, trust fund, no- or low-interest loans, or funding made available by charitable organizations.

Criteria for Submission

Priorities for funding requests:

  1. Very expensive one-time needs or completely unexpected happenings or emergencies.
    • For an individual to remain in their home, extensive/expensive home modifications are necessary.
    • For someone to function as independently as possible, expensive non-MA allowable medical or other specially adapted equipment is necessary.
    • Essential expensive equipment unexpectedly needs to be replaced.
    • Someone’s condition deteriorates unexpectedly resulting in a sudden increase in costs.
    • A caregiver dies or is suddenly unable to continue resulting in a sudden increase in costs.
    • Home catastrophes occur such as tornado damage and furnace or septic system failures.
  2. Help for people who are moving from nursing homes with necessary start-up costs if they need to set up new households in the community. Much of this funding may be for non-waiver allowable items.

Limitations and Rules:

  1. Developmental Disabilities managers will determine when COP HC will be used for exceptional expense requests.
  2. The minimum request for an individual item or project should be $1,000 per individual item or project.
  3. Funds may only be used for individuals who are participants in one of the Waiver Programs (CIP 1A, CIP 1B, CIP II, BIW, or CLTS) or COP.
  4. Documentation of MA denial for MA allowable items and estimates with separate materials and labor charges may be submitted with request form.

Procedure

  1. A support broker is given approval for an exceptional expense request and COP HC will be used to fund the item or project.
  2. The support broker will complete a COP HC Request Form and other necessary documentation.
  3. The form and all necessary documentation will need to be completed and submitted within of approval.

Form

Request one-time COP funding using the most recent version of the Exceptional Expense request form available from the DHS Forms Library at: www.dhs.wisconsin.gov/forms1/F2/F21353.docx.