Family Care, Partnership, and PACE: What's New!

COVID-19 Updates

We are committed to protecting the health and safety of our members and participants during the COVID-19 pandemic. To stay informed about the latest program updates, limitations to in-person contacts, general COVID-19 resources, and more:

For data on COVID-19 in Medicaid home and community-based services settings, please visit the Medicaid Adult Home and Community-Based Services: COVID-19 Data page.

Request for Public Comments

Wisconsin Medicaid Home and Community-Based Services Heightened Scrutiny

The Wisconsin Department of Health Services (DHS) is opening a 30-day public comment period on its findings about home and community-based service long-term care settings that were identified for heightened scrutiny review. Review is needed to determine if these settings are truly home and community-based and not institutional. This public comment period is in accordance with federal requirements.

DHS operates several home and community-based services long-term care programs under federal authority from the Centers for Medicare & Medicaid Services (CMS). Medicaid waiver funding for these programs can only be used to support people living in community-based settings and cannot be used to support someone who is living in an institution. Review is needed for settings that are located within another facility that provides inpatient treatment (like a skilled nursing facility), on the grounds of a public institution (like an inpatient facility that is financed and operated by a county, state, municipality, or other unit of government), or because of other factors that may lead to isolating some people from the broader community.

DHS has conducted a heightened scrutiny review process and determined there is enough evidence to show CMS that these settings are not institutional in nature and that they meet CMS compliance requirements. The evidence from the heightened scrutiny review is documented in "evidentiary summaries."

Public comment is an opportunity to support or rebut information DHS obtained from its heightened scrutiny reviews of facility-submitted documentation and onsite visits. If you would like to submit comments on DHS review of these settings, the public comment period offers you the opportunity to do so.

View the evidentiary summaries and submit your comments by March 24, 2021. There are a few ways you can submit your comments:

Division of Medicaid Services
Bureau of Programs and Policy
Attn: Heightened Scrutiny Review
PO Box 309
Madison, WI 53701-0309

To request a paper copy of the evidentiary packages, call 877-498-9525.

Scorecards

The Scorecards are a tool members can use to help them choose a managed care organization. Each managed care organization is represented in the scorecard by star ratings evaluating how well the organization performs across a variety of factors, including consumer satisfaction and compliance with state standards. You can find the Scorecards on the Consumer Information page.

Enrollment Statistics

Enrollment Report: October 2020

Electronic Visit Verification

In response to the federal 21st Century Cures Act, the Wisconsin Department of Health Services (DHS) is required to implement Electronic Visit Verification (EVV) for Medicaid-covered personal care services and home health services. DHS has created a dedicated webpage where providers can view all current EVV information. Providers are encouraged to visit the webpage frequently.

Last Revised: February 23, 2021