Medicaid

Covering Wisconsin's Low-Income & Disabled Residents

Nearly 80% of adults and children enrolled in Wisconsin’s BadgerCare Plus and SSI Medicaid programs receive health care coverage through a public-private partnership between the state and health plans. Another 55,000 older adults and adults with disabilities receive long-term care services through health plans that serve the Family Care and Family Care Partnership programs. Association members’ participation in Medicaid contributes to robust health plan options for low-income and disabled Wisconsinites, regardless of the county in which they live.

Health plans participating in Medicaid managed care programs - like BadgerCare Plus, SSI, Family Care, and Family Care Partnership - are paid a fixed monthly fee, known as a capitation rate, based on expected costs. Health plans assume the financial risk above the capitation rate and are held accountable for patient outcomes through quality metrics, which limits the state’s financial obligations while creating an incentive to control costs through better health care.

Rulemaking for the Medicaid Program

As the Department of Health Services (DHS) develops rules governing the Medicaid program, the Association provides feedback on behalf of member health plans. See below for recent Association comments on key aspects of the Medicaid program.