Medicaid: Direct Care Workforce Funding 2024 Payment Adjustments
In 2022, some providers were paid too much or too little in direct care workforce funding than they should have due to an error made by two of the MCOs DHS relies on to confirm data used to calculate the payments.
What to know
- Due to MCO errors, some providers received more funds or less funds from the Direct Care Workforce Initiative than they should have in 2022.
- MyChoice Wisconsin underpaid or never paid approximately 600 providers. These providers will receive checks to recover the funds they should have received.
- Lakeland Care, Inc., overpaid almost 500 providers. These providers won't need to repay DHS—but their payments in 2024 will be reduced.
- Other providers who were underpaid or overpaid as a result of the error will see payment adjustments in December 2024.
- DHS has put measures in place to find mistakes like this in the future and prevent this from happening again.
MyChoice Wisconsin underpayment
In October 2024, MyChoice Wisconsin discovered a group of their providers who:
- Received less direct care workforce funding than they should have
- Did not receive any direct care workforce funding, even though they should have
Underpaid providers will receive a check in October for the amount they should have received, along with a letter explaining the situation.
Because these providers were underpaid or never paid, all other providers were overpaid as a result. Adjustments will be made to December payments for the overpaid providers and documented on their statements. Providers will not need to take any additional action regarding their payments.
Lakeland Care, Inc., overpayment
In 2022, Lakeland Care, Inc., made a mistake that caused almost 500 providers to receive more direct care workforce funding than they should have.
Overpaid providers will get reduced 2024 payments
Providers who were overpaid in 2022 will not have to send repayments back to DHS. Instead, DHS will reduce 2024 payments to these providers. That means they'll get less in payments than they may have in previous years.
The reductions will be spread across three payments in 2024.
First and second reductions
Lakeland will reduce payments sent in July 2024 for both the 2022 reallocation and the second payment for calendar year 2023 to those providers that were overpaid.
Third reduction
The first payment for calendar year 2024 dates of service, arriving in December 2024, will also be reduced.
Adjusting funds across three payments is meant to lessen the impact on the overpaid providers.
Underpaid providers will get additional payments in 2024
Providers who were underpaid in 2022 will get additional funds paid in three extra checks in 2024.
First and second extra payments
MCOs will send the first two additional checks at the same time as they send the 2022 reallocation and the second payment for calendar year 2023, starting in late June and finishing by mid-July.
Third extra payment
MCOs will send the third and final additional check in December at the same time as the first direct care workforce payment for calendar year 2024.
Underpaid providers will get a letter describing the additional payments they'll get and why.
Questions and answers
No. Providers will not need to repay money to DHS. Instead, funding will be withheld from three payments in 2024.
Additional payments for underpaid providers come from the money withheld from the payments to overpaid providers. Each time money is withheld, it will be sent to those who were originally underpaid, based on data about services provided in 2022.
Yes. Underpaid providers getting additional dollars must spend them according to direct care workforce funding rules. Common uses might include bonuses, paid time off, wage increases, and payroll taxes.
Normal payment amounts will resume with the second payment for the calendar year 2024, which will be sent in June 2025.
Underpaid providers getting additional payments in 2024 should not factor those extra dollars into future expected payments. They are one-time adjustments.
After discovering Lakeland’s error, DHS' fiscal team acted to put additional measures in place to identify large variations in data for each MCO. If such a discrepancy is discovered in the future, DHS will request additional information from the MCO to discover and address such errors before payments are made.