The Medicaid Program Nobody Understands

“Nobody Taught Me How to Read My Own Budget" — The Hard Truths of Self-Direction

Real talk this week — Medicaid funding uncertainty, the caregiver workforce shift that never recovered after COVID, and why so many families have never even seen their own self-direction budget. We also get into the language gap that blindsides families when kids age into adult long-term care, where HIPAA ends and confidentiality begins, and why self-determination might be the more important word nobody's using. Oh, and we found a job post that might be the best in the industry. Lego lovers, stay tuned. Whether you're a caregiver, guardian, support broker, or just trying to figure out the system… pull up a chair. New episodes weekly. Learn more at communityhorizonsllc.com. [http://www.communityhorizonsllc.com.]

What Is a Support Broker? The Wild West of Self-Direction Explained

If you've ever had to explain what a support broker is to someone at a doctor's appointment, you already know this episode. This week, we're talking about what we actually do and why "broker" is such a weird word for it. We get into the hiring process, what it looks like to help someone write a job post that sounds like them, the interviews that go great and the ones that absolutely do not, and why setting boundaries early saves everyone a headache later. We also talk about the changes coming to the IRIS program and why that conversation hit differently this week. If you're currently in IRIS, read your 2026 waiver manual and ask your consultant how this affects you. Plus, caregivers who show up high, members who accidentally almost let someone move in, a guy who asks every single candidate to help him bury a body, and why payroll is actually the most relaxing part of this job. This one's for anyone working in self-direction, thinking about it, or just trying to figure out why their caregiver situation keeps falling apart. Also for the care managers who've been wondering what we actually do all day. It's a full one.

The Medicaid Program Nobody Understands

We're Cindy and Jamie — both healthcare burnouts who somehow ended up building something better. In this episode, we're starting at the beginning: what self-direction actually is, why almost nobody understands it, and how we ended up here after years of 24/7 on-call chaos. We also get into the IRIS waiver changes coming in 2026 that could pull the safety net out from under thousands of Wisconsin participants (and nobody's talking about it yet). If you've never heard of self-direction, start here. New episodes weekly. Learn more at communityhorizonsllc.com. Follow us on Facebook: www.facebook.com/communityhorizons [http://www.facebook.com/communityhorizons]