Family Care, Family Care Partnership, and PACE (Program of All-Inclusive Care for the Elderly) include both home and community-based services (HCBS) waiver and state plan services. Cost share only applies to HCBS waiver services, not to state plan services. The Wisconsin Department of Health Services calculates the average payment for HCBS waiver services for the upcoming year to use as the cost share cap.
Cost share cap amount
Effective January 1, 2020, the maximum amount of cost share that managed care organizations may collect for Group B Plus members in Family Care, Family Care Partnership, and PACE is $2,837.00.
The cost share cap is the maximum amount a managed care organization may collect from a member residing in the community. The cap does not apply to members residing in, or likely to be residing in, a nursing home or hospital for 30 or more days. These members are subject to Medicaid institutional rules for patient liability.