Department of Health Services
(Foster Care Medical Home)
The State of Wisconsin provides access to health care for low-income and medically needy persons under the authority of Title XIX of the Federal Social Security Act and sections 49.43 to 49.47 and 49.688, Wisconsin Statutes. The Wisconsin Department of Health Services administers this program, which is called Medical Assistance or Medicaid (MA). In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss. 49.471
, and 49.67
of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.
Children in foster care paid for under Title IV-E of the Social Security Act are categorically eligible for Medical Assistance. Wisconsin also provides MA coverage for children who are not Title IV-E eligible who reside in foster care. Coverage for youths in foster care is available through a youth's completion of high school or up to the age of 18, whichever period is longer. Wisconsin provides MA coverage to youths up to age 19 under BadgerCare and Healthy Start.
Section 1937 of the Social Security Act provided authority for States to provide for medical assistance to one or more groups of Medicaid-eligible individuals, specified by the State in an approved state plan amendment, through enrollment in coverage that provides benchmark or benchmark-equivalent health care benefit coverage. Wisconsin did so, effective February 1, 2008. The current groups who receive benefits under Wisconsin's benchmark plan are pregnant women and infants with incomes between 200 and 300% of the Federal income poverty line, as well as newborns who are born to women with family incomes between 200 and 300% of the Federal income poverty line. As required under federal law, Early and Periodic Screening & Diagnostic Treatment Benefit (EPSDT) services are to be provided to individuals under 21 years of age as an additional benefit under section 1937 of the Act.
In addition to this public notice, Wisconsin's tribes will be consulted at a meeting of the Tribal Health Directors at a date to be determined this quarter.
Proposed Changes - Enhanced Services for Children in Out-of-Home Care
Currently, there are approximately 6,000 children in foster care placements who receive Medicaid services in Wisconsin. Many of the foster care children need specialty care and are receiving that care on a fee-for-service basis under Medicaid. As a result, coordinated care may be limited among providers, and may not address the specific needs of children in foster care. The Departments of Health Services and Children and Families are creating a coordinated care benefit based on a medical home concept for children in foster care that provides an individualized treatment plan for each child that addresses the child's trauma-related needs, delivers treatment services that are evidence-based and will result in improved behavioral, mental, and physical health for the child and a safer, more stable family setting for the child.
• The primary care provider and care team will assure that each child receives a complete trauma-informed health assessment, and an individual treatment plan, including evidence-based mental health interventions.
• Benefits will be provided based upon the BadgerCare Plus standard Plan, with added unique features to support children in foster care placements. Benefits will include: care coordination, hospitalizations, physicians visits, dental services, laboratory and x-ray services, prescription drugs, behavioral and mental health services, health and well-child screening services, immunizations and urgent and emergency care.
• The child will be eligible to continue to receive care coordination and services through this medical home model for 12 months after a child reunifies with his/her birth family, or moves to an adoptive family or relative guardian to assure continuity of care and treatment, provided they are still eligible for Medicaid after the child's permanency plan is achieved.
• The initiative will begin in Kenosha, Milwaukee, Ozaukee, Racine, Washington and Waukesha counties and will include approximately 2,500 eligible children.
• Qualified health care providers for the medical home must be organized as an integrated health system with demonstrated capacity in trauma-informed care, evidence-based treatment, and must demonstrate that they have qualified physicians, nurse practitioners and other supportive staff, an adequate network of qualified providers for medical, dental and behavioral health services and the ability to contract with providers outside their network to ensure a full range of services for urgent care and other services to ensure continuity of care for the child.
• The Department of Health Services and the Department of Children and Families will set forth key performance-based measures related to health care and child outcomes that are based upon national standards within the Child Welfare and Medicaid programs.
The change in services is projected to decrease expenditures by $300,000 GPR annually. The effective date of this change will be January 1, 2012.
Copies of Proposed Changes
A copy of the proposed Medicaid program changes may be obtained free of charge by calling or writing as follows:
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53707-0309
Written comments are welcome. Written comments on the changes may be sent by FAX, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is (608) 261-7792. The e-mail address is: Alfred.Matano@dhs.wisconsin.gov
Regular mail can be sent to the above address.
The written comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 472 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin.