Medicaid: What Humana and Molina 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.
Members served by My Choice Wisconsin or Inclusa should have received a letter about the acquisition.
What to know
- Members’ care plans, care managers, and providers will not change.
- Individuals remain enrolled and do not need to take action to continue their care plans.
- If a member receives a Medicaid renewal packet, they should complete and return it right away.
Before the acquisition, DHS and the Office of the Commissioner of Insurance (OCI) required Molina Health Care, Inc., and iCare to complete a review and certification process to prove they can meet contract and program requirements. This process ensures the organizations provide quality services to members.
Managed care organizations (MCOs) and health maintenance organizations (HMOs) serving Wisconsin Medicaid members complete certification with DHS annually. They must show provider contracts and their governance and organizational structure. Business activities, like finance and marketing and communications, are also reviewed.
DHS works collaboratively with organizations during the certification process, which includes filing a three-year work plan (Excel) and complying with the DHS certification checklist (PDF).
Frequently asked questions about these acquisitions
Regardless of internal changes, like who owns the company, the MCOs that work with Wisconsin’s Family Care program must provide the care and services members need.
All MCOs must meet Wisconsin Medicaid’s quality standards and take part in quality improvement initiatives to be certified by DHS.
Members do not need to do anything special to continue their benefits. They will continue to be enrolled in their program unless they request a change. The benefits and the providers they have access to will not change.
The member’s care team will continue to manage their care plan. The phone numbers used to contact the MCO and the care team will remain the same. Eventually members may notice a change in the brand name.
Beginning on July 1, 2024, members of the My Choice Wisconsin HMO will be identified as Molina members. This change is for members of BadgerCare Plus and SSI Medicaid. This change is not for Family Care or Family Care Partnership members in the My Choice Wisconsin MCO.
However, everyone is having to renew their participation in Wisconsin’s Medicaid programs this year. If members haven’t already done their renewal, they should watch for a packet in the mail. When they get that Medicaid renewal packet, it’s important that they do that renewal right away to make sure they can stay enrolled in their program.
Every MCO in Wisconsin has a contract with DHS. Each contract has the same rules and requirements, regardless of whether the contract is with a for-profit or a nonprofit agency.
All MCOs must meet DHS’s quality expectations and contractual obligations.
Members still have a choice of MCOs or HMOs.
Members should discuss their enrollment options or other changes with their MCO. They should consult with either their local tribal Aging and Disability Resource Specialist (ADRS) or their local Aging and Disability Resource Center (ADRC).
Members can also review external quality reports and score cards for each MCO posted by DHS.
DHS has a dedicated team of quality and oversight specialists working to ensure that all MCOs meet Wisconsin’s provider network standards. These specialists are in frequent communication with MCOs and participate in monthly oversight meetings.
MCOs must complete performance improvement projects annually and meet all DHS quality expectations.
DHS also contracts with MetaStar (a private company) to provide an annual quality review of MCOs. The review looks at whether the MCOs are complying with federal standards, makes sure they met their performance measures and did performance improvement projects and assesses their information systems capabilities. Metastar also does case management reviews to look at health care quality. DHS gets a report on their results so it can see what they found. Those quality review reports are available on the DHS website.
Molina and iCare/Humana may eventually change the brand names of My Choice Wisconsin and Inclusa.
Beginning on July 1, 2024, members of the My Choice Wisconsin HMO will be identified as Molina members. This change is for members of BadgerCare Plus and SSI Medicaid. This change is not for Family Care or Family Care Partnership members in the My Choice Wisconsin MCO.
Any assets owned by Inclusa transferred to iCare/Humana. Any assets owned by My Choice Wisconsin transferred to Molina. Legal paperwork written as part of the acquisition process determined how each organizations’ assets were handled.
Yes, an organization can operate both as an MCO and an IRIS contractor.
Members considering changing their program enrollment should visit their local tribal Aging and Disability Resource Specialist (ADRS) or local Aging and Disability Resource Center (ADRC).
Acquisitions are private business decisions. DHS does not have the legal power to stop an acquisition.
DHS does due diligence to collect information that MCOs meet specific requirements to serve members in our programs. This process is called certification. Certification includes a review of policies and procedures, financial information, marketing, and more.
The DHS-MCO contract, Article XVI, lists the steps an MCO must take to end a contract.
The MCO must work with DHS to develop an approved transition plan. MCOs must continue operations until all members have been transitioned to another MCO or program of their choice.
The acquisition has no impact on the MCO’s provider network. The MCO’s provider network requirements remain the same and are reviewed annually.
DHS reviews all MCOs’ provider networks annually. Provider networks must be robust enough to meet all member care needs.
Read more about projects DHS is working on to address the caregiver worker shortage.
DHS pays MCOs a set fee each month for each member they serve. This is called capitation.
Rates are set annually based on claims, levels of care, target group, geographic adjustments, administrative costs, by contracted actuaries and approved by the Centers for Medicare & Medicaid Services (CMS).
Each MCO negotiates rates with providers in their network.
DHS is developing a minimum fee schedule for adult family homes, residential care apartment complexes, community based residential facilities, and supportive home care.
We recommend members start by talking to their care team as they may best understand the specific needs and circumstances of the member.
Members may also leave a voicemail message at the Family Care, Family Care Partnership, and PACE general inquiry line at DHS at 855-885-0287.
If members need additional assistance, they can also contact the ombuds at the Board on Aging & Long Term Care or Disability Rights Wisconsin. Ombuds are people who are there to help members and advocate on their behalf to make sure any concerns or issues they have are being addressed.
- If the member is 18-59 years old, contact Disability Rights Wisconsin at 800-928-8878.
- If the member is 60 or older, contact the Wisconsin Board on Aging and Long-Term Care at 800-815-0015.
Service areas
Wisconsin Medicaid’s HMO service areas and the geographic service regions for long-term care remain the same after the acquisitions. At least two MCOs continue to serve each region, ensuring that members have a choice in their care.