Wisconsin Medicaid Rate Reform Project

Wisconsin is facing a $6.6 billion budget deficit for the 2009-11 biennium, the biennial budget (2009 Act 28) requires the ForwardHealth/Medicaid program to identify $625 million ($208 million GPR) in savings over the 09-11 biennium.

In addition, difficult economic times have caused an increase in the demand for Medicaid services in Wisconsin. This demand exceeds current funding. As a result, an additional $100 million GPR in savings is needed to support the increase in the Medicaid caseload.

These financial issues pose difficult challenges for the Department of Health Services; however, the Department views these challenges as opportunities to review the Medicaid program and identify ideas to achieve real reform in how the state provides and pays for health care. 

The Medicaid Rate Reform Project is a comprehensive examination of how Wisconsin Medicaid purchases health care outcomes and identifies areas where reform can improve the health care of Wisconsin's citizens and achieve savings.

As part of the the Rate Reform Project the Department is requesting reform ideas from: health care professionals, administrators, stakeholders, and the general public through adhoc advisory committees and an online survey. As ideas are collected, DHS evaluates the ideas and prepares a final “package” which is then reviewed and approved by the the Governor and the Legislature. The final, approved package is then implemented by DHS. Implementation of the ideas in the package can take months, weeks, or even years, depending on the complexities of the idea. Rate Reform is DHS’ process for continuous quality improvement and program reform. As such, the State will continually collect ideas and recommendations for reform.

The links below provide additional information for each round of rate reform, including a brief description about each round and any associated materials.

• Rate Reform Round 1: Began April 2009, Implementation In Progress
• Rate Reform Round 2: Began January 2010, Implementation in Progress
• Rate Reform Round 3: Began October 2010.
• Medicaid Health Care Efficiencies: Began March 2011, Package Under Development. 

Last Revised: March 28, 2011