Improving Access to Medicare and Medicaid Coverage
The Wisconsin Department of Health Services (DHS) is working on improving how Medicare and Medicaid health care coverage works together to provide a better experience for people with disabilities and older adults. When you have Medicare and Medicaid, you can choose to get a Dual Eligible Special Needs Plan (D-SNP) for your Medicare coverage. D-SNPs are designed for people who have Medicaid.
To make these improvements, we will:
- Gather input from people who use both Medicare and Medicaid coverage.
- Gather input from the partners and providers who help people access and use both Medicare and Medicaid coverage.
- Identify areas for improvement and find ways to make it easier for people to access and use both Medicare and Medicaid coverage.
- Develop and implement a strategic plan to make D-SNP coverage easier to understand, access, and keep for those who need it.
For partners and providers
Visit the Improving Access to Medicare and Medicaid Coverage: Information for Partners and Providers page for details geared toward:
- Health insurance plans or providers
- SHIP counselors
- ADRC staff or Tribal ADRS
How this work will get done
1. Gathering input (completed December 2024)
We looked at Medicare and Medicaid coverage in Wisconsin and how well they work together. We also considered the upcoming D-SNP plan and enrollment restrictions finalized by the federal Centers for Medicare and Medicaid Services (CMS). We want to provide a better experience for people with disabilities and older adults. To gather input, we held one-on-one meetings, joined large group discussions, and sent surveys to:
- People who have both Medicare and Medicaid
- Health insurance plans
- Health care providers
- State Health Insurance Assistance Program (SHIP) counselors
- Aging and disability resource centers (ADRCs)
- Tribal aging and disability resource specialists (Tribal ADRS)
2. Planning for improvements (completed April 2025)
Once we understood how Medicare and Medicaid health care coverage is working for people in Wisconsin, we set out to find ways to improve this system. That meant creating a plan to improve Medicare and Medicaid coverage, such as making it easier to:
- Find doctors who take your insurance
- Get the most out of your benefits
- Get help coordinating your health care
Our technical assistance partners, ATI Advisory and Speire Healthcare Strategies, created a report with findings and recommendations for Wisconsin. It’s based on ideas and input we heard throughout this project.
3. Making improvements
Using the report from step 2 as a foundation, DHS will work with partners across the state to decide how to make it easier for people with disabilities and older adults to access and keep D-SNP Medicare and Medicaid coverage.
More about Medicare and Medicaid coverage
When someone has both Medicare and Medicaid health care coverage, they can choose a Dual Eligible Special Needs Plan (D-SNP) for their Medicare coverage.
D-SNPs are Medicare Advantage plans for people who also have Medicaid benefits. D-SNPs:
- Are available for people who are eligible for both Medicare and Medicaid (dual eligible).
- Have a contract with the state’s Medicaid agency (in Wisconsin, that’s DHS).
- Use care plans that identify and address each person’s unique needs.
- Coordinate the person’s Medicare and Medicaid benefits to pay for necessary health care services.
There are two types of D-SNPs in Wisconsin:
- Highly Integrated Special Needs Plans (HIDE SNPs)
- Fully Integrated Special Needs Plans (FIDE SNPs)
This project aims to improve both of them.
Most D-SNPs in Wisconsin are HIDE SNP plans. HIDE SNPs are available to people who have Medicare and Medicaid for their health insurance.
HIDE plan organizations may also offer Medicaid plans, so a dual eligible person could get both Medicare and Medicaid coverage from one organization.
FIDE SNPs are available to people who have both Medicare and Medicaid and need long term care services from a nursing home, or the equivalent type of care provided in the community.
For this reason, FIDE SNPs offer coverage through one organization for the person’s Medicare and Medicaid health care services and their long-term care services and supports. In Wisconsin, FIDE SNP plans are available through Family Care Partnership.
Stay up to date
- Email DHSDMSHMO@dhs.wi.gov with questions.
- Check this page regularly for updates.