The Department of Health Services is working closely with the Centers for Medicare and Medicaid Services (CMS) on a waiver to provide all childless adults under 100% FPL with Medicaid for the first time in the state’s history. This bolstering of the state’s safety net will provide nearly 100,000 Wisconsin residents who live in poverty with health care under the state’s Standard Medicaid benefit. In March 2013, then Secretary-Elect, Kitty Rhoades, gave testimony to the Joint Committee on Finance in which she stated that as part of her responsible management of the Medicaid program, she will include medical homes as a model to reform service delivery for Medicaid beneficiaries The Wisconsin Department of Health Services's State Plan Amendment (SPA) for their Section 2703 Heatlh Home program, named Behavioral Health Integrated Care (BHIC) was approved initially for patients with HIV/AIDS and children in foster care. The BHIC health home will focus on preventive services, wellness, and chronic and acute care for both behavioral and physical health needs. The BHIC will provide additional care coordination and care management resources and access to dental services for the eligible population.
Funded by the Children's Hospital of Wisconsin and the Wisconsin Department of Health Services, Division of Public Health, Children and Youth with Special Health Care Needs Program, the Wisconsin Statewide Medical Home Initiative (WiSMHI) works to promote the concepts of medical home for primary care clinicians, families, and service providers throughout the state. Training, technical assistance and resources are provided to support medical home implementation with a focus in the areas of early identification of developmental concerns in the primary care practice and coordination of care and services including those for youth with special health care needs.
Dual Eligible | 2703 SPA | CPC | CPC+ | PCMH QHP | PCMH Legislation | Private Payer |
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Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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AAMC Project CORE: Coordinating Optimal Referral Experiences- Wisconsin | Grant | California, Iowa, New Hampshire, Virginia, Wisconsin | CMS Health Care Innovation Award (Round 2) | |
Behavioral Health Integrated Care (BHIC) Health Homes | Medicaid | Langlade, Lincoln, and Marathon counties | ACA Section 2703 Health Homes | |
Bellin-Thedacare Healthcare Partners - CMS Pioneer ACO | Medicare | Northeast Wisconsin | CMS Pioneer ACO | |
Care4Kids | Medicaid | Kenosha, Racine, Waukesha, Ozaukee, Washington, Milwaukee counties | ||
CMS Health Care Innovation Award - Children's Hospital and Health System, Inc | Grant | Southeastern Wisconsin | CMS Health Care Innovation Award (Round 1) | |
CMS State Innovation Model (SIM) Design Award - Wisconsin | Grant | Statewide | CMS State Innovation Model (SIM) | |
Wisconsin Collaborative for Health Care Quality | Grant | Statewide | Aligning Forces for Quality |
Program Name | Payer Type | Coverage Area | Parent Program | Outcomes |
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Enhanced Personal Health Care Program - Wisconsin | Commercial | Northeast and Southeast Wisconsin | Anthem - Enhanced Personal Health Care | |
Humana medical home program - Prevea Clinic | Commercial | Green Bay | Humana Medical Home Program |