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ADRC Professionals: Concerns With My Program

Wisconsin’s long-term care programs aim to serve older adults and adults with disabilities. Programs include Family Care, IRIS (Include, Respect, I-Self Direct), Partnership, and PACE (Program of All-Inclusive Care for the Elderly).

You should have a good experience with your program. If you are unhappy with your experience, you have the right to say something. You have the right to know how to file a grievance or appeal.

Each program must give you information about how to file a grievance or appeal. Your program also is not allowed to treat you differently if you file a grievance or appeal.

At any time you can contact the aging and disability resource center (ADRC) or Tribal aging and disability resource specialist (ADRS) to learn about your options to transfer to a different program, managed care organization (MCO), IRIS consultant agency (ICA), or fiscal employer agent (FEA) or disenroll from your current long-term care program.

Terms to know

  • Grievance: This is a formal way to say that you are not satisfied with your managed care organization, IRIS consultant agency, or fiscal employer agent. You can file a grievance at any time for any concern except an adverse benefit determination, which follows an appeal process.
  • Adverse benefit determination: This is a denial of services or payments. Your services may stop or be reduced.
  • Notice of action: This is a formal letter from your MCO or ICA about an adverse benefit determination.
  • Appeal: This is a formal process to have your notice of action reviewed at a state fair hearing. You must file an appeal within 60 days of the date on the notice of action. When you request an appeal, you can often request a continuation of services. This means your services will continue until the appeal process is complete.

Note: For IRIS, if a payment is denied, you will not get a written notice. There also is no appeal process. You may contact your fiscal employer agent or file a grievance.

How to get help if you have a concern

Your long-term care program is there to help you set up the supports and services you need. If you are concerned your needs are not being met, follow these steps:

  1. Talk to your main contact. Let your care team (for Family Care, Partnership, or PACE), IRIS consultant agency, or IRIS fiscal employer agent know about your concerns. They may be able to fix them without going through the formal complaint process.
  2. File a grievance. You may file a grievance on your own, or you can seek help from others. Friends, family, or advocates may help you complete the process. If you have questions about who can help you, ask your program or contact your local ADRC.
  3. File an appeal for a state fair hearing. You can request a state fair hearing if you do not agree with the result of your grievance. You can also file an appeal in response to an adverse benefit determination. A state fair hearing is in front of a state administrative law judge. They ask you questions and get information to make a decision about your concern. If you are enrolled in IRIS, only you or your legal representative can file an appeal.

Where to find more help

MetaStar

The Wisconsin Department of Health Services (DHS) contracts with MetaStar to manage an appeal and grievance hotline. MetaStar helps with grievances and tries to find an agreement that works for both you and the program. They also try to help sort out appeals so they do not have to go to a state fair hearing.

Contact:

  • DHS Grievances c/o MetaStar 2909 Landmark Place, Madison, WI 53713
  • Hotline: 888-203-8338
  • Fax: 608-274-8340

Ombudsman

An ombudsman is an independent advocate or helper. Their services are free. They answer questions about grievances and appeals. An ombudsman can tell you about your rights and help you advocate for yourself.

ADRC or Tribal ADRS

The ADRC or Tribal ADRS can provide you with your options to transfer to another program, MCO, ICA, or FEA, or to disenroll. You can find your local ADRC or Tribal ADRS contact information at FindMyADRC.org.

Glossary

 
Last revised August 17, 2026