In 2022, the Wisconsin Department of Health Services (DHS) was informed of the potential purchases of two managed care organizations (MCOs) that currently provide Medicaid long-term care services. That means new companies will purchase their assets and begin managing their Medicaid programs.
- Molina Health Care, Inc., is buying My Choice Wisconsin.
- iCare (a wholly owned subsidiary of Humana, Inc.,) bought Inclusa, Inc., on June 1, 2023.
DHS certifies MCOs and health maintenance organizations (HMOs) serving Wisconsin’s Medicaid members. The new companies must prove they can meet all contract and program requirements and provide quality services to members. The certification process requires the organizations to submit information about case management transition, provider contracts, governance and organizational structure, records, marketing and communications, and finances. Organizations must also complete a three-year work plan. MCOs and HMOs undergo annual certification to serve Medicaid members. DHS works collaboratively with organizations during the certification process, which includes filing a three-year work plan (Excel) and demonstrating compliance with the DHS certification checklist (PDF).
Molina Health Care, Inc., plans to purchase My Choice Wisconsin.
- My Choice Wisconsin operates a MCO and a licensed HMO that contracts with DHS for the following Medicaid programs:
- Molina is a DHS-certified HMO for BadgerCare Plus and SSI Medicaid
Molina Health Care, Inc., submitted certification documentation to DHS. Now it is working with the Office of the Commissioner of Insurance (OCI). After OCI completes its review, DHS will finalize its decision whether to approve certification and reassign the contract.
iCare (a wholly owned subsidiary of Humana, Inc.,) finalized its purchase of Inclusa, Inc., on June 1, 2023.
After completing reviews and certifications, iCare, finalized their plans to purchase Inclusa effective June 1, 2023. As a result, the contract reassignment from Inclusa will take place. The program will continue routine operations under the name Inclusa. Members' care plans, care managers, and providers will not change because of the acquisition. Members do not need to take action to continue with their current care plan should expect written notification about the acquisition.
Review the DHS presentation (PDF) from the Wisconsin Long Term Care Advisory Council meeting on March 2, 2023.
FAQs about these acquisitions
Members would continue to get the same quality services that they have come to expect. All MCOs and HMOs must meet Wisconsin Medicaid’s quality standards and take part in quality improvement initiatives to be certified by DHS.
No. DHS does not anticipate any reductions in the available networks of providers.
All MCOs and HMOs must meet Wisconsin’s provider network standards. To successfully complete annual certification, MCOs and HMOs must show they can keep or develop a robust network of providers to meet member needs.
Members would still have a choice of MCOs or HMOs.
Every MCO in Wisconsin has a contract with DHS. Each contract has the same rules and requirements, regardless of whether the contract is with a for-profit or a nonprofit agency.
All MCOs must meet DHS’s quality expectations and contractual obligations.
Molina and iCare/Humana may eventually change the brand names of My Choice Wisconsin and Inclusa.
You will continue to be enrolled in your program. Your benefits and the providers you have access to will not change.
The care team will continue to manage your care; however, you may eventually notice a change in the brand name and payor information for services.
If you would like to discuss your enrollment options or change your MCO, please talk to your local tribal Aging and Disability Resource Specialist (ADRS) or visit your local Aging and Disability Resource Center (ADRC).
DHS has a dedicated team of quality and oversight specialists. MCOs must complete performance improvement projects annually and meet all DHS quality expectations.
Read more about projects DHS is working on to address the caregiver worker shortage.
DHS reviews all MCOs’ provider networks annually. Provider networks must be robust enough to meet all member care needs.
Any assets owned by Inclusa will be sold to iCare/Humana. Any assets owned by My Choice Wisconsin will be sold to Molina. Certain assets may be specifically excluded through legal paperwork written as part of the acquisition process.
The DHS-MCO contract, Article XVI, lists the steps an MCO must take to end a contract.
The MCO must work with DHS to develop an approved transition plan. MCOs must continue operations until all members have been transitioned to another MCO or program of their choice.
DHS pays MCOs a set fee each month for each member they serve. This is called capitation.
Rates are set annually based on claims, levels of care, target group, geographic adjustments, administrative costs, by contracted actuaries and approved by the Centers for Medicare & Medicaid Services (CMS).
Each MCO negotiates rates with providers in their network.
DHS is developing a minimum fee schedule for adult family homes, residential care apartment complexes, community based residential facilities, and supportive home care.
Please review your program handbook or contact the MCO’s member rights specialist for details on appeal rights and procedures.
Yes, an organization can operate both an MCO and an IRIS contractor.
DHS is revising contract language to create new protections for MCO members and IRIS participants.
You must visit your local tribal Aging and Disability Resource Specialist (ADRS) or local Aging and Disability Resource Center (ADRC) if you are considering changing your program enrollment.
Acquisitions are private business decisions. DHS does not have the legal power to stop an acquisition.
DHS does due diligence to collect information that MCOs meet specific requirements to serve members in our programs. This process is called certification. Certification includes a review of policies and procedures, financial information, marketing, and more.
If the asset purchases are completed, Wisconsin Medicaid’s HMO Service Areas and Wisconsin Medicaid Long-Term Care’s Geographic Service Regions will remain the same. At least two MCOs would continue to serve each region to make sure all members can choose who they get care from.
- HMO Service Areas
- Family Care Geographic Service Regions (PDF)
- Family Care Partnership/PACE Geographic Service Regions (PDF)
- IRIS Contract Geographic Service Regions (PDF)
Provide your feedback
During the certification process DHS held online public forums and received feedback about these acquisition proposals. Review the presentation slides in English (PDF), Hmong (PDF), and Spanish (PDF).
- Email your feedback to email@example.com
- Mail your feedback to:
PO Box 309
1 West Wilson, Room 518
Madison, WI 53701-0309
- Contact Humana at MTaylor108@humana.com or call Mark Taylor at 317-753-0345
- Contact Molina at firstname.lastname@example.org or call Karen Felstead at 414-323-5104