Wisconsin Medicaid pays for in-home personal care and related services through 3 programs, including the Family Care and the IRIS (Include, Respect, I Self-Direct). Wisconsin DHS runs Family Care (managed long-term care through MCOs), Family Care Partnership, IRIS (self-directed) and CLTS; My Choice Wisconsin, a Family Care MCO, is under DHS corrective action. Sandata is the DHS-provided EVV system and alternate systems are allowed. Confirm CLTS age range and eligibility with Wisconsin DHS.
Yes. Wisconsin Medicaid and BadgerCare Plus fee-for-service and the BadgerCare Plus and Medicaid SSI HMOs pay for personal care services, which are subject to EVV.
Which Wisconsin waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Family Care
Population
Wisconsin adults 18+ who are frail elders or adults with a disability, Medicaid-eligible, functionally eligible on the Long-Term Care Functional Screen, with a long-term care condition expected to last more than 90 days.
Services covered
supportive home care
personal care
respite care
adult day care
home-delivered meals
daily living skills training
personal emergency response system
training services for unpaid caregivers
transportation
Billing format
Members enroll in a managed care organization (paid monthly per member by DHS) that authorizes and pays providers; personal care and supportive home care require EVV (Sandata or an alternate system).
Wisconsin adults 18+ who are older adults or adults with a disability, enrolled in Medicaid, functionally eligible, and living in a qualifying setting.
Services covered
respite
support broker
assistive technology
self-directed personal care and supportive home care
Billing format
Self-directed budget with an IRIS consultant agency and a fiscal employer agent; personal care and supportive home care require EVV.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
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