Public Notice: Medicaid Personal Care Reimbursement Increase

Public Notice

Department of Health Services

Medicaid Personal Care Reimbursement Increase Authorized by 2021 Wisconsin Act 58

The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and s. 49.471 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 in effect.

The Department is proposing changes to the fee-for-service Medical Assistance (MA) maximum fee rates for personal care services pursuant to changes mandated in 2021 Wisconsin Act 58, the 2021–2023 biennial state budget. The changes would be effective January 1, 2023.

The impacted services and the changes being implemented are listed below:

The hourly rate for personal care services (Healthcare Common Procedure Coding System code T1019: Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment [code may not be used to identify services provided by home health aide or certified nurse assistant]) will increase to $5.86 per interval which equates to $23.44 per hour.

The change to Medicaid, BadgerCare, and BadgerCare Plus is projected to result in increased annual expenditures of $38,400,000 all funds (AF), composed of $24,300,000 federal match (FED) and $14,100,000 state funds/general purpose revenue (GPR), effective January 1, 2023 – December 31, 2023.

Copies of Changes

Copies of the state plan change may be obtained free of charge by calling or writing as follows:

Mail: Bailey Dvorak

Bureau of Benefits Policy Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

Phone: [phone]

Fax: [phone]

Attention: Bailey Dvorak

E-Mail: [e-mail]

Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.

Written Comments

Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e‑mail, or regular mail to the Division of Medicaid Services as described above. All written comments will be reviewed and considered.

The written comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed change based on comments received.