Gettysburg, Pa, Aug. 13, 2019 (GLOBE NEWSWIRE) — OPEN MINDS has released an updated suite of Medicaid market intelligence resources on the state of Wisconsin. The resources include an analysis of the Wisconsin’s Medicaid system, Medicaid managed care vendor contracts, and additional state-specific information
Wisconsin has three managed care programs under the umbrella of ForwardHealth that serve specific subsets of the Medicaid population:
- BadgerCare Plus: Wisconsin’s BadgerCare Plus managed care program provides Medicaid services to parent/caretaker relatives, childless adults with income below 100% of the FPL, and children. There are 15 BadgerCare Plus health plans that operate on a county-by-county basis. Enrollment is mandatory in service areas in which there are two or more health plans, and in rural areas where there is one health plan; if there is only one health plan in a non-rural area, enrollment is optional. The health plans are responsible for providing personalized and coordinated care through a care manager. The program specific contracts are available here for download:
- Anthem BCBS
- Children’s Community Health Plan
- Dean Health Plan, Inc.
- Group Health Cooperative of Eau Claire
- Group Health Cooperative of SC WI
- Independent Care – iCare
- Mercy Care Insurance Company
- Managed Health Services
- Molina Healthcare of Wisconsin
- Network Health Plan
- Physicians Plus Insurance Company
- Security Health Plan of Wisconsin, Inc.
- Trilogy Health Insurance
- UHC Community Plan
- Medicaid EBD (SSI) Managed Care: The state describes the Medicaid SSI program as mandatory managed care; however, the program is effectively optional. Persons with chronic conditions, high-risk pregnancies, or continuity of care issues may request exemption from enrollment. As of October 2018, only 24% of the elderly, blind, and disabled population was enrolled. Individuals in the Wisconsin Medicaid SSI managed care program receive all state plan services through one of eight health plans. The program specific contracts are available here for download:
Note: In counties with two or more participating health plans, all eligible, non-exempt individuals are automatically enrolled in a health plan if they do not choose one. Individuals may opt-out in favor of the FFS program after 60 days. Enrollment in counties with one health plan is on an opt-in basis.The health plans are responsible for providing personalized and coordinated care through a care manager. Health plans are responsible for ensuring enrollees have a Health Needs Assessment Screening within 60 days of enrollment to develop a Comprehensive Care Plan within 30 days of the screening. Wisconsin Interdisciplinary Care Teams (WICT) are available to provide member-centered care management for members with the highest needs.
- Family Care: Family Care is a voluntary program that provides MLTSS to dual eligibles and Medicaid EBD individuals ages 18 years and over. Family Care plans operate as prepaid inpatient health plans (PIHPs) because they provide a limited set of benefits on a capitated basis. Plans are available on a regional basis.The plans provide all home- and community-based waiver services, as well as some state plan benefits related to long-term care. All other services are provided on an FFS basis. There are six participating plans, and individuals have a choice of plan in their region. The program specific contracts are available here for download:
The state also operates the Family Care Partnership Program, an integrated health and long-term care program for frail elderly and people with disabilities. The Partnership Program consists of three health plans located in different geographical regions of Wisconsin:
In 2018, the state set a threshold that 10% of BadgerCare Plus and Medicaid SSI payments be in alternative payment arrangements. Health plans must report on the percentage of payments in these models, but there is no penalty for missing the target.
- The state’s alternative payment model program goals are aligned with Learning Action Network (LAN)’s goals to move “payments away from fee for service (FFS) and into APMs that reduce the total cost of care (TCOC) and improve the quality of care.”
- Additionally, the state applies a 2.5% withhold to the BadgerCare Plus and Medicaid SSI capitation rates, which is returned based on performance on quality measures
Additionally, the OPEN MINDS team has four in-depth profiles of the Wisconsin state health system:
- Wisconsin Health Care System Landscape: An OPEN MINDS State Profile, which provides information on each state’s largest health plans, Medicaid expansion policy, health insurance marketplace plans, demographics, population health insurance coverage by payer, and more.
- Wisconsin Medicaid System: An OPEN MINDS State Profile, which provides a detailed exploration of each state’s Medicaid financing system, including a review of the managed care financing systems, largest health plans by enrollment, key players in the state Medicaid department, and plans for future system changes and contract reprocurements.
- Wisconsin Behavioral Health System State Profile Report, which provides a comprehensive listing of behavioral health benefits in the state, care coordination programs related to behavioral health, and behavioral health subcontractors for health plans.
- Wisconsin Medicaid/Medicare Dual Eligible System: An OPEN MINDS State Profile, which provides an overview of each state’s dual eligible financing system, as well as the largest Medicare health plans serving dual eligibles and details on new initiatives involving the dual eligible population.
The Wisconsin suite of state profiles is now available now for the Elite OPEN MINDS Circle members. In addition, the OPEN MINDS team has a wealth of additional Wisconsin-specific resources. A monthly OPEN MINDS market intelligence update is available to all health and human services executives. To sign up, OPEN MINDS Circle members should set their email preferences under the My Account Settings.
All of these resources, and more, are available as part of an OPEN MINDS Circle Elite membership. Membership includes unlimited organizational access to all OPEN MINDS content and databases, plus executive education events, and other exclusive Elite member benefits. Learn more about becoming an Elite OPEN MINDS Circle member online at www.openminds.com/elite.
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OPEN MINDS is an award-winning information source, executive education provider, and business solutions firm specializing in the domains of health and human services serving consumers with chronic conditions and complex support needs. For thirty years, we’ve been pioneers for change – helping organizations implement the transformational business practices they need to succeed in an evolving market with new reimbursement, competition, policies, and regulations.
OPEN MINDS is powered by a national team of experienced executives and subject matter experts with specific expertise and experience in nine key market areas – mental health, addictions, chronic conditions, autism and intellectual/developmental disabilities, long-term care, children’s services, social services, juvenile justice, and corrections health care. Our mission is to improve the quality of care for consumers with complex support needs by improving the effectiveness of those serving them – provider organizations, payer and insurance organizations, government agencies, pharmaceutical organizations, and technology firms. Learn more at www.openminds.com.
Sarah C. Threnhauser OPEN MINDS 717-334-1329 [email protected]