The Wisconsin Department of Health Services (DHS) is collaborating with three sites in different areas of the state to pilot a new model to treat eligible BadgerCare Plus and Medicaid members who have substance use disorders and at least one other health condition.
The new benefit these sites are providing is called the Integrated Recovery Support Services benefit. It will not only support services to treat members’ substance use disorders (SUDs) but also care for the other physical and behavioral health issues that challenge their efforts in recovery. The benefit coordinates access to mental health treatment, primary care, and a range of other supports that may be needed.
The pilot uses a hub and spoke health home approach to help provide eligible members the new Integrated Recovery Support Services benefit.
- A health home is not a building or a place. It’s a program that can help manage and coordinate the different kinds of care a person needs.
- In Wisconsin’s pilot, different providers will work together to address the member’s needs. The lead agency, or hub, provides access to specialized SUD treatment and supports, including assessment, medication-assisted treatment, behavioral health care, and help with other life circumstances.
- The spokes are community partners that work with the hub sites to provide additional support services and care management. The spokes also help people reconnect with their own self-defined support system.
As a pilot program, the Integrated Recovery Support services benefit is available to a limited number of eligible BadgerCare and Medicaid members who have access to one of the pilot regions. The pilot sites collect and report outcome data, which DHS will use to decide whether to expand the benefit to serve more members in more parts of the state.
Inclusion and respect
People with substance use disorders have historically experienced health disparities due to bias and exclusion, including systemic racism. Wisconsin's Integrated Recovery Support Services benefit uses culturally respectful approaches to enhance substance use disorder treatment and address each person’s unique needs.
The Integrated Recovery Support Services benefit uses person-centered treatment planning to help members get and stay healthy. Learn more about person-centered planning.
Pilot sites and locations
The three hub sites, chosen from a field of 17 applicants from across the state, will pilot the new benefit in three different regions. The sites represent one rural site, one tribal site, and one urban site selected deliberately to help Wisconsin understand how this care coordination model will work in a variety of contexts, to inform a future statewide approach.
- The Family Health Center (FHC) of Marshfield, Inc., a federally qualified health center, will provide services through the FHC Minocqua Alcohol and Drug Recovery Center for Forest, Iron, Oneida, Price, and Vilas Counties, as well as the Forest County Potawatomi, the Lac du Flambeau Band of Lake Superior Chippewa, and the Sokaogon Chippewa Tribal Nations.
- The Oneida Nation Behavioral Health Center, a federally qualified health center, will provide services to any federally enrolled Native American in the Oneida Nation, and Brown and Outagamie Counties.
- Wisconsin Community Services, Inc., a non-profit community based organization, will provide services in Milwaukee County.
Program eligibility and services
Who is eligible?
Because it is a pilot program, enrollment is limited to members who have access to one of the pilot regions. With a referral, a Medicaid-eligible youth or adult who has such access is eligible to participate in the program if they have a substance use disorder and at least one other health condition. Enrollment in this benefit is voluntary.
How can I be referred to the program?
The goal of the program is to facilitate a seamless transition into services from wherever a person’s treatment begins, such as a hospital, emergency room, clinic, health center, county program, correctional facility, or other treatment setting.
Once you are referred from one of those locations, you will be connected to a hub site. From there you will have access to timely, local follow-up services to promote your recovery and wellness.
What kinds of services will be provided under this benefit?
- Comprehensive Care Management: Identifying members for treatment, conducting initial assessments, and creating individualized care plans with the member.
- Care Coordination: Implementing the plan of care through connections, referrals, coordination, and follow-up across treatment settings and providers.
- Health Promotion: Encouraging activities that empower the member to pursue healthy behaviors and self-manage their physical, behavioral, and SUD conditions.
- Comprehensive Transitional Care: Streamlining movement from one treatment setting to another, between levels of care, and between health care providers.
- Individual and Family Support: Advocating on the member’s behalf and engaging their social support network.
- Referral to Community and Social Support Services: Connecting the member to medical, behavioral, educational, community, and social support services to support their ongoing recovery.
In January 2018, Executive Order #274 (PDF) created the Commission on Substance Abuse Treatment Delivery (CSAT) to research hub-and-spoke delivery models for opioid use disorder. CSAT issued a report later that year outlining evidence in support of the hub-and-spoke model.
CSAT recommended that Wisconsin adopt a hub-and-spoke model similar to Vermont’s, which had helped increase treatment capacity for opioid use disorder to the highest level in the United States. Wisconsin’s model builds on that approach by coordinating care for all substance use disorders.
This approach aims to address some of the biggest challenges facing Wisconsin’s SUD treatment system. Goals include improving access to specialty treatment in rural areas; integrating services between SUD treatment providers and other health care professionals; and promoting patient engagement through the entire care process.