Medicaid: Managed Care Quality Strategy
The Wisconsin Department of Health Services (DHS) plans to measure and improve the quality of care for Medicaid members in the Wisconsin Medicaid Managed Care Quality Strategy 2025-2027 (Quality Strategy).
Below is information about the Quality Strategy as well as the timeline for public comment and submission.
What is the Wisconsin Medicaid Managed Care Quality Strategy?
The Wisconsin Medicaid Managed Care Quality Strategy (Quality Strategy) will help DHS understand how well certain health plans are working for Medicaid members and how to make them better. DHS developed this draft strategy using feedback from groups it works with, the latest data, and information from the Centers for Medicare & Medicaid Services (CMS).
The Quality Strategy includes these managed care programs:
- BadgerCare Plus and Medicaid Supplemental Security Income (SSI)
- Family Care and Family Care Partnership
- Care4Kids
The Quality Strategy meets the federal requirements of 42 C.F.R. § 438.340(a) and 42 C.F.R. § 457.1240(e) that require state Medicaid and Community Health Improvement Plan (CHIP) managed care programs to assess and improve the quality of healthcare and services managed care plans provide.
The Quality Strategy sets a three-year vision for the Division of Medicaid Services to achieve its quality goals for managed care programs and is intended to evolve over time.
Timeline
September 11, 2024 | Tribal consultation
September 23, 2024 | Tribal notice
September 23 - October 25, 2024 | Public comment period
December TBD, 2024 | Final Quality Strategy submitted to CMS