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Family Care, Family Care Partnership, and PACE: Information for Members and Potential Members

You’re the Medicaid expert Wisconsin needs

Nobody knows Medicaid better than those who use it every day. That’s why we are forming a new group of people with current or past experience with Medicaid, and we want you to join! The Medicaid Member Experience Council (MMEC) will talk about how Medicaid is working, and how it can be improved. You can help build a better future for health care in Wisconsin by joining in and speaking up.

Learn more about MMEC and apply by May 12.

This page has details about programs for older adults and people with disabilities:

Where to start

If you want to apply for Family Care, Partnership, or PACE, contact your local aging and disability resource center (ADRC). ADRCs serve the public and offer resources. They also help with issues that affect older adults, people with disabilities, and their families. ADRCs make it easy to learn about public benefits and other programs.

Contact my ADRC

Managed care organizations (MCOs)

An MCO helps program members get the services they need. Members work with the ADRC to choose the MCO they want to use. To help, we have MCO scorecards. These are tools that score MCOs for each program. You can find:

  • Contact details.
  • A link to the MCO’s provider directory.
  • The number of MCO staff per member.
  • Staff turnover rates.
  • Star ratings for how happy other members are with the MCO.
  • Star ratings for how well the MCO follows state quality standards.

What Molina and Humana acquisitions mean to members

Molina Health Care, Inc., and iCare (a wholly owned subsidiary of Humana, Inc.) have completed acquisitions of two other providers.

  • My Choice Wisconsin was acquired by Molina on Sept. 1, 2023.
  • Inclusa, Inc., was acquired by iCare on June 1, 2023.

My Choice Wisconsin and Inclusa will continue routine operations, and the Wisconsin Department of Health Services (DHS) will track the organizations' efforts to ensure a smooth transition for members and providers. 

Learn more about the acquisitions.

Grievances and appeals

You have the right to file a grievance (also called a complaint). You can also file an appeal if you don’t agree with a decision.

Grievance

To file a grievance, you can either:

  • Contact your care manager or member rights specialist at your MCO.
  • Write about your concern and send it to your MCO.

If you do not agree with the decision your MCO made, you can ask DHS to review the decision. DHS oversees MCOs. To request a DHS review, either:

You cannot ask for a DHS review until your MCO decides on your grievance.

Appeal

The first step in the appeals process is filing an appeal with your MCO. To file an appeal, you can either:

If you do not agree with your MCO’s decision, you can ask for a state fair hearing. This is with the Wisconsin Division of Hearings and Appeals. To ask for a state hearing, you can either:

Division of Hearings and Appeals
Family Care and Partnership Request for a Fair Hearing
PO Box 7875
Madison, WI 53707-7875

Make sure to include:

  • Your name.
  • Your mailing address.
  • A brief description of the problem.
  • The name of your MCO.
  • Your signature.

Use the Voluntary Withdrawal form (PDF) if you change your mind about your hearing.

Ombud services

An Ombud is an independent advocate or helper. They answer questions about grievances and appeals. They can tell you about your rights. Anyone receiving Family Care, Partnership, or PACE services can get free help from an Ombud. The organization to contact depends on your age.

Other resources

People who get services for a developmental disability, mental health, or substance abuse have rights under Wisconsin law:

Learn more on the Client Rights Office web page.

Related topics

Glossary

 
Last revised January 13, 2025