Information for Members and Potential Members of Family Care, Partnership, and PACE

Assistance and information

Your local aging and disability resource center (ADRC) is the best place to start. ADRCs are service centers that provide a place for the public to get accurate, unbiased information on all aspects of life related to aging or living with a disability. These centers are friendly, welcoming places anyone can contact to receive information and assistance regarding not only the public benefits that may be available, but all of the programs and services available throughout the area.

Find an aging and disability resource center in your area.

Managed Care Organization (MCO) scorecard

The scorecards are a tool you can use to help you choose a managed care organization (MCO). Each MCO is represented in the scorecard by star ratings evaluating how well the MCO performs across a variety of factors, including consumer satisfaction and compliance with state standards. The scorecard also provides MCO staff characteristics like turnover rate and staff to member ratios. You can find more information, like contact information and a link to each MCO's provider directory, in the MCO scorecard. Contact your ADRC to discuss the options available to you in your county.

Resources available for help

How do I file a grievance or appeal?

If you want to file a grievance or appeal, you must start with your managed care organization.

To file a grievance, you can:

  • Contact your care manager or a member rights specialist at your managed care organization.
  • Write your concern down and send it to your managed care organization.

To file an appeal, you can:

What if I don't agree with the decision made about my grievance?

If your managed care organization makes a decision about your grievance that you do not agree with, you can ask DHS to review the managed care organization's decision. DHS is the agency that oversees managed care organizations.

To request a DHS review:

What if I don't agree with the decision made about my appeal?

If your managed care organization's Grievance and Appeal Committee makes a decision about your appeal that you do not agree with, you can ask for a state fair hearing of the decision with the Wisconsin Division of Hearings and Appeals.

To file a request a state fair hearing, you can:

  • Submit a Fair Hearing Request form
  • Send a written request to the following address. Include your name, mailing address, a brief description of the problem, the name of your managed care organization, and your signature.
    • Division of Hearings and Appeals
      Family Care and Partnership Request for a Fair Hearing
      PO Box 7875
      Madison, WI 53707-7875
  • Fair Hearing Voluntary Withdrawal for, DHA-17 (PDF) - If you want to withdraw your request for a hearing.

Other grievance and appeals resources

If you are receiving services for mental illness, a developmental disability, or substance abuse, or have been protectively placed under Wis. Stat. ch. DHS 55, along with your rights under Wis. Admin. Code ch. DHS 10, you also have rights under Wisconsin patient rights laws and rules (Wis. Stat. § 51.61 and Wis. Admin. Code ch. DHS 94). You also have the right to use the DHS 94 grievance procedure, along with or in lieu of any other grievance process you may have access to. For more information on these rights, refer to the Office of Client Rights.

Last Revised: March 18, 2020