7/27/2019 Transitionplan Initial

1/1

1

2

3

4

5

6

7

8

9

10

1112

13

14

15

16

17

18

19

20

21

2223

24

25

2627

28

29

30

31

32

33

34

35

36

37

38

39

40

4142

43

44

45

46

47

48

49

50

51

52

53

54

55

5657

58

59

60

61

62

63

64

65

66

67

A B C D E F G H I J K L M N O

Template for Transition - Initial Plan

County Name:

Consortia Name:

(County fills in Start Date)

Start Date: Oct-08

(County fills in actual current waiver and wait list enrollment)

Current Waiver Wait List Data Run-date:

People People

COR - FE -

CIP 1B - PD -

CIP 1A - DD -

BIW - -

CIP II -

COP W -

CLTS -

-

(Consortium/County/ADRC consult with MCO to establish enrollment targets)

Waivers

DHFS expects rollovers to be completed in first six months

Month Month Month Month Month Month Month Month Month Month Month Month Month Month

1 2 3 4 5 6 7 8 9 10 11 12 13 14

COR - - - - - - - - - - - - - -

CIP 1B - - - - - - - - - - - - - -

CIP 1A - - - - - - - - - - - - - -

BIW - - - - - - - - - - - - - -

CIP 11 - - - - - - - - - - - - - -

COP W - - - - - - - - - - - - - -

CLTS - - - - - - - - - - - - - -

Subtotal Rollovers - - - - - - - - - - - - - -

WaitlistDHS allows 1/36 of wait list number to be enrolled in each of the first 36 months

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Month 13 Month 14 M

FE - - - - - - - - - - - - - -

PD - - - - - - - - - - - - - -

DD - - - - - - - - - - - - - -

Subtotal Wait List - - - - - - - - - - - - - -

Institutional Relocations

Individuals relocating from nursing homes and ICFs-MR may enroll immediately in managed long-term care. These individuals may skip the wait list.

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Month 13 Month 14 M

Nursing Home Relocations - - - - - - - - - - - - - -

ICF-MR Relocations - - - - - - - - - - - - - -State Center Relocations - - - - - - - - - - - - - -

Subtotal Relocations - - - - - - - - - - - - - -

Total Enrollment

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Month 13 Month 14 M

- - - - - - - - - - - - - -

Revised: 4/21/09, R. Hotynski (revised to auto-populate waitlist from over 24 mos to over 36 mos)

Enrollment Plan

Current Waiver and Wait List Individuals

Estimated Transition Start Date