Programs and Services

The Division provides access to health care for low income and medically needy persons.  It also provides health care information to assist consumers in decisions on health care providers and health care plans.

Medicaid.  Pays for health related services to low-income and medically needy persons.  These include services provided by nursing homes; and fee-for-service and managed care health care providers.

Health Care Systems and Operations.  Implements, operates and monitors program operations, systems, procedures and contracts.  Coordinates payment for services with other funding sources and recovers payments from the estates of recipients, where appropriate.

Health Care Eligibility Determination.  Develops and implements eligibility policies for the Division’s health care programs, works with counties and tribes to determine eligibility, and provides outreach to citizens about value of health care services and the eligibility rules.

Health Care Program Integrity.  Develops and implements prior authorization guidelines, performs audits of service providers, and develops quality control measures and standards.

Fee-for-Service Health Care Benefits.  Develops reimbursement rates for direct medical and policy services and programs.  Manages the entire Medicaid budget.  Oversees Medicaid statutory changes, administrative rule updates, and federal state plan changes.  Reviews and audits nursing home costs.

Managed Health Care.  Develops and administers all Medicaid Managed Care Programs for Medicaid recipients, AFDC-related and BadgerCare low-income families with children, disabled children and adults and low-income elderly.

Disability Determination Services.  Provides disability and blindness eligibility determinations under contract with the Social Security Administration for individuals who apply for Supplemental Security Income, Medicaid or Social Security Disability benefits.

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Last Revised: October 22, 2014