Wisconsin

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Managed LTSS Programs 

Wisconsin has two MLTSS programs. Wisconsin Family Care (under §1915(b) and §1915(c)) provides LTSS to adults under age 65 with physical disabilities, adults under age 65 with intellectual/developmental disabilities, and adults of age 65 and older. HCBS waiver services are only available to members who are a nursing home level of care, and primary, acute, and prescription drugs services are excluded from capitation rate. Enrollment is voluntary (choice of Family Care, Family Care Partnership, PACE, or IRIS depending on what is offered in the county and individual’s functional level of care) with opt in. The program covers 57 counties in the state (out of 72 counties). Effective April 3, 2012, temporary caps on enrollment in the Family Care or IRIS programs were lifted. More information on Family Care is available here and here. (Source: dhs.wisconsin.gov)

Wisconsin Family Care Partnership (FC-P) (under §1932(a) and §1915(c)) provides Medicare cost-sharing, behavioral health (not covered by Medicare), prescription drugs (not covered by Medicare), LTSS (HCBS and institutional), and other services including case management, dental, hospital, hospice, and therapies. Groups enrolled are adults under age 65 with physical disabilities, adults under age 65 with developmental disabilities, and frail adults of age 65 and older. Enrollment is voluntary with opt in. The program covers 19 counties in the state (out of 72 counties). (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012; State Program website)
Waiver Application
NASUAD & n4a presentation (4/5/2011)

Governor Scott Walker’s budget proposal includes a plan to expand Wisconsin’s Family Care program to incorporate acute and primary care health services and community-based long-term supports by Jan. 1, 2017, at which point all other long-term care programs would be discontinued.  The IRIS program, which benefits 11,000 adults with LTC needs, would be among the state’s discontinued LTC programs.  Additionally, Walker has proposed cutting $14 million in funding to the Family Care program over the next two years. Changes to the Family Care program and cuts to the personal care program could save the state $33 million over the next two years.  (Source:  Twincities.com, 3/1/2015)

The Wisconsin Department of Health Services (DHS) released a concept paper outlining forthcoming changes, as mandated under the State’s 2017 State Budget Act, to the Family Care and IRIS (Include, Respect, I Self-direct) programs.  Family Care is the state’s MLTSS program, and IRIS allows self-direction of LTSS services. Family Care/IRIS 2.0, as the changes have been labeled, will integrate acute, behavioral, and LTSS for 55,000 Medicaid enrollees across the state through contracts with integrated health agencies (IHAs).

  • Populations covered: adults with physical disabilities, adults with intellectual/developmental disabilities, and elderly individual. Dual eligibles may enroll in Family Care/IRIS 2.0 or may choose to remain enrolled in the Family Partnership program.
  • Areas served: the concept paper proposes splitting the state into three regions, each of which will be served by three IHAs. 

Payment structure: IHAs managing care for Family Care/IRIS 2.0 beneficiaries will be paid a monthly capitated payment. (Source: Concept Paper 3/2016) 

The Wisconsin Department of Health Services (DHS) recently projected that switching to statewide, managed long-term services and supports—which would be handled by Integrated Health Agencies (IHAs)—would save the state $300 million over six years. Family Care/IRIS 2.0, as the program will be called, would manage care for 55,000 Wisconsin Medicaid enrollees. This, among other changes, are detailed in a concept paper DHS released in March 2016. (Source: Concept Paper 3/2016; WI DHS 4/25/2016) 

On June 9, 2016, the Secretary of the Wisconsin Department of Health Services (DHS) formally notified the state Joint Finance Committee that DHS is withdrawing its concept plan for changes to Family Care/IRIS 2.0, which includes a statewide MLTSS program. The plan faced resistance from some advocates and lawmakers in the state. Although DHS did not offer a specific timeline for future reforms moving forward, DHS remains committed to working toward better integrated and coordinated care. (Source: Wisconsin Health News 6/10/2016)

On September 19, 2016, the Wisconsin Department of Health Services (DHS) released a request for proposals (RFP) for MCOS interested in participating in the state’s MLTSS program, referred to as Family Care and Family Care Partnership Programs. Proposals are due by November 9, 2016, at 2:00pm Central Time. (Source: WI.gov 9/19/2016)

On January 23, 2017, the Wisconsin Department of Health Services (DHS) released the three MCOs selected to provide MLTSS in the Northern expansion counties in the state. The three MCOs are:

  • Community Link, Inc.;
  • Lakeland Care, Inc.; and
  • Care Wisconsin.

The expansion will enable the state to reduce wait lists for services and foster independence for beneficiaries. (DHS Announcement 1/23/2017) 

On February 22, 2017, The Wisconsin Department of Health Services (DHS) released request for proposals for interested MCOs to manage care delivery for select Geographic Service Regions (GSRs) under the Family Care and Family Care Partnership programs. Both programs serve frail elders and adults with physical, intellectual, or developmental disabilities Family Care is an LTSS- only program while, Family Care Partnership provides comprehensive acute and LTSS programs for dual eligible through Medicare Special Needs Plans.. This round of proposals would have covered Family Care GSRs 2, 3, 11, and 12, and Family Care Partnership GSRs 3, 11, and 12. Proposals were due by April 13, 2017. However, a few weeks later, DHS cancelled the RFP for these GSRs, and announced that they would be issuing two separate RFPs in the coming weeks instead.

On March 23, 2017, DHS released the separate RFPs—one covering  GSRs  2, 3, and 11, and the other for GSR 12—for the Family Care and Family Care Partnership programs. MCO proposals for GSRs 2, 3, and 11 are due April 27, 2017, and proposals for GSR 12 are due May 11, 2017/ (Source: Solicitation Announcement 2/22/2017; Link to RFPs 3/23/2017)

On July 7, 2017, the Wisconsin Department of Health Services (DHS) announced the MCOs selected to cover services under an expansion of the state’s two MLTSS programs – Family Care and Include, Respect, I Self Direct (IRIS) – into Dane County Wisconsin. The MCOs selected are Care Wisconsin, and My Choice Family Care. The transition to MLTSS in Dane County will commence during the first quarter of 2018. (Source: Press Release 7/6/2017)

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

Wisconsin’s proposed demonstration, Virtual PACE, will include all people who are full dual eligible members over the age of 18 residing in a Nursing Home (NH) on a long-term basis and receiving Medicaid services via the fee-for-service system at the time of enrollment. On January 1, 2013, Wisconsin will implement Virtual PACE in the Southeastern region, and then statewide in 2015. The demonstration will use a capitated payment model. (Source: Demonstration Proposal)
State website on the demonstration

Wisconsin Department of Health Services (DHS) submitted a revised draft Memorandum of Understanding (MOU) to CMS on August 12, 2013. This state drafted version reflects the design proposal of Wisconsin’s Integrated Demonstration, with updates from versions previously submitted to CMS. While CMS considers the proposed MOU, DHS is working to leverage the innovative ideas and investments in building more integrated systems by applying the “lessons learned” to current Wisconsin-administered Medicaid programs while awaiting CMS’ response. (Source: State website on the demonstration)
DHS letter to CMS (8/12/2013)
DHS Memorandum of Understanding (revised draft) (8/12/2013)

On November 22, 2013, CMS informed Wisconsin DHS it was unable to approve the state’s MOU as currently proposed. In response, the state withdrew from the Demonstration to Integrate Care for Dual Eligible Individuals on December 19, 2013. (Source: Kaiser Family Foundation Duals Demonstration Proposal Status Map, March 2014; NSCLC Dual Eligible State Profiles website, March 2014)
CMS Letter to Wisconsin DHS (11/22/2013)
State Demonstration Withdrawal Letter (12/19/2013)

Section 1915(i) HCBS State Plan Option

As of May 2014, CMS has approved the state’s §1915(i) HCBS State Plan Amendment; and the state is currently participating in the HCBS State Plan Option. (Source: Kaiser HCBS State Plan Option website, 5/2014)

Section 1915(k) Community First Choice Option

The state is planning to participate in the Community First Choice Option in FY 2014. (Source: Kaiser Community First Choice website, 5/2014)

Health Homes

In October 2012, CMS approved the state’s Health Homes State Plan Amendment targeting Medicaid and BadgerCare Plus members with a diagnosis of HIV/AIDS who have at least one other diagnosed chronic condition or who are at risk of developing another chronic condition. (Source: Approved Health Homes State Plan Amendment, 10/1/2012)

As of June 2014, Wisconsin has officially submitted to CMS a second proposed Health Home SPA. CMS has not yet approved the state’s second Health Home SPA. (Source: CMS Health Home Proposal Status website, 6/2014; Kaiser Health Home website, 6/2014)