Family Care, Family Care Partnership, and PACE: Cost Share Cap for Medicaid Eligibility Group B Plus
Cost share, also known as post-eligibility treatment of income, is a monthly amount that some members of Family Care, Family Care Partnership, and PACE (Program of All-Inclusive Care for the Elderly) may have to pay towards their home and community-based services (HCBS).
- Members eligible for long-term care programs under Medicaid Group B or B Plus may have to pay a cost share for HCBS services.
- Group A members do not pay a cost share for HCBS services.
Wisconsin Department of Health Services (DHS) calculates the cost share cap each year. This is the most a member will have to pay out-of-pocket for cost share. We use the average costs for HCBS waiver services to set the cost share cap.
2024 cost share cap
$3,347.75 is the cost share cap for 2024.
This is the most money MCOs can collect for HCBS waiver services from members. Keep in mind:
- Members must live in the community.
- The cap does not apply to members living in, or likely to be living in, a nursing home or hospital for 30 days or more. A member in a nursing home may have to pay more than the cost share cap to the MCO for their care.
Who to contact for help
Email one of these groups:
- Questions about Group B Plus eligibility—Email the Bureau of Programs and Policy at dhsdmsltc@dhs.wisconsin.gov.
- Questions about fiscal impact—Email the Bureau of Rate Setting at DHSLTCFiscalOversight@dhs.wisconsin.gov.