Personal care services are services that help with medically necessary daily activities so that a person can stay in his or her home. Examples of personal care services are bathing, eating, and toileting.
Wisconsin Medicaid and BadgerCare Plus cover personal care services that are:
- Medically necessary.
- Authorized through an independent assessment.
- Authorized by a Medicaid-enrolled doctor.
- Detailed in a plan of care.
- Provided by a Medicaid-enrolled personal care provider according to program policies.
Beginning June 1, 2017, Liberty Healthcare (Liberty) will conduct independent assessments for personal care services provided on a fee-for-service basis to BadgerCare Plus and Wisconsin Medicaid members. (Fee-for-service means that a person’s doctor is paid for each type of service he or she provides. Sometimes fee-for-service personal care services are also called “medical assistance personal care” or “personal care card services.”) Liberty will also get a doctor’s order for the personal care services and authorize the personal care services.
Liberty will provide these services at no charge to members or providers. Liberty will not oversee, manage, or provide personal care services. Medicaid-enrolled personal care providers will continue to provide personal care services to members.
Members Affected by the Independent Assessment Process
The following members will be affected by the independent assessment process if they get their personal care services on a fee-for-service basis:
- Members of BadgerCare Plus
- Members of Wisconsin Medicaid
- Participants in IRIS (Include, Respect, I Self-Direct) who do not self-direct their personal care services
- Members of Wraparound Milwaukee
- Members of the Children Come First program
Members Not Affected by the Independent Assessment Process
The following members will not be affected by the independent assessment process because they do not get their personal care services on a fee-for-service basis:
- BadgerCare Plus or Wisconsin Medicaid members who are enrolled in a state-contracted HMO (this includes a BadgerCare Plus or Medicaid Supplemental Security Income managed care organization)
- Members of Care4Kids
- Members of Family Care
- Members of Family Care Partnership
- Members of the Program for All-Inclusive Care for the Elderly (PACE)
- Participants in IRIS who self-direct their personal care services
Members Not Eligible for Personal Care Services
BadgerCare Plus or Wisconsin Medicaid members are not eligible to have their personal care services covered by Wisconsin Medicaid or BadgerCare Plus if they are in one of the following:
- A nursing home
- A community-based residential facility with more than 20 beds
- A hospital
You can get more information about Liberty and the independent assessment process on Liberty’s website or by calling Liberty at 1-855-947-2742.
The New Approval Process for Personal Care Services handout (P-01774) also has more information about the independent assessment process.