DHS Announces New Accountability Measures for Medicaid Providers to Ensure Families Receive Critical, Effective Post-Birth Care Services

The Wisconsin Department of Health Services (DHS) is announcing new accountability measures aimed at preventing fraud and improving health outcomes for child care coordination, a Medicaid post-birth benefit created under state law to address health disparities in southeastern Wisconsin. Child care coordination and prenatal care coordination (PNCC) provide prenatal and post-birth services to support vulnerable families at high risk of a negative health outcome—a critical program designed to improve infant and maternal health and reduce infant and maternal mortality.

The sweeping effort comes as the DHS Office of the Inspector General (OIG) has reviewed and investigated multiple instances of suspected fraud of child care coordination services by providers and has taken action to implement provider enrollment terminations and suspensions. OIG has issued referrals to the Wisconsin Department of Justice Medicaid Fraud Control Unit on 20 different Medicaid providers engaging in suspected fraudulent activity that resulted in the provider being paid for false claims.

DHS is taking several actions announced today to provide additional education and training to providers and increase billing reviews to identify and investigate incidents of fraud, including:

• Conducting a comprehensive review of all enrolled providers currently certified to offer these services.
• Providing additional education to providers about what services are allowable under the benefit.
• Implementing a 100% payment integrity review for all child care coordination claims.
• Eliminating automatic certification for new PNCC agencies to provide child care coordination benefits while DHS fully reviews the child care coordination benefit to ensure it is addressing maternal and child health disparities in southeastern Wisconsin.
• Requesting authority from CMS to only enroll new PNCC providers who do not have major indicators of fraud and who will only provide PNCC services.

“Wisconsin's disparities in maternal and infant health outcomes are preventable and unjust. The child care coordination benefit is a unique opportunity to leverage Medicaid to improve maternal and infant health outcomes in Wisconsin, and it’s important women and children in Wisconsin receive the services and resources they need to live healthy lives,” said DHS Secretary-designee Kirsten Johnson. “Through the diligent work of our Office of the Inspector General, we have worked to identify and hold accountable bad actors to ensure Wisconsin women and children receive the services they need and deserve for which Medicaid has been billed. Reducing infant and maternal health disparities is a top priority at the Wisconsin Department of Health Services, and a critical part of that work is increasing enforcement and preventing fraud to ensure women and children receive the services they need while supporting community providers. The actions we are taking today are important steps toward our goal of promoting positive health outcomes for mothers and children.”

The child care coordination benefit was created to provide post-birth care plan development and care coordination from the time a child is born until they turn seven in Milwaukee County or two in the City of Racine. When families receive child care coordination services, providers first work with them to do an assessment of their needs, which includes discussion of topics like child development, nutrition, child safety, home and money management, and parenting skill support. Providers and families then work together to develop a plan to connect the family to resources and support for the areas where they’ve identified needs. They then meet regularly to monitor how the plan is working and make adjustments.

Importantly, the actions DHS is taking are focused on providers and not on members. Medicaid members receiving child care coordination benefits will continue to receive these benefits and additional Medicaid members will be able to receive this benefit in the future if they are eligible for it. DHS will work with partners to ensure members understand what services they should be receiving. Any member receiving child care coordination services who has questions can call member services at 800-362-3002. Anyone who suspects fraud, waste, or abuse of public funds can contact OIG through the fraud hotline at 877-865-3432 or use the DHS fraud reporting webpage.

Earlier this year, DHS released two new reports on birth outcomes that continue to shed light on how to best reduce and address significant disparities in infant deaths across Wisconsin. Governor Evers has launched multiple efforts to address infant mortality throughout his administration. In his 2019-2021 biennial budget, Governor Evers introduced the “Healthy Women, Healthy Babies” initiative, which aimed to improve access to preventive care, support healthier pregnancies and births, and address racial disparities in maternal and child health. The initiative included increased funding for the Women’s Health Block Grant and access to family planning services and cancer screenings. The Governor’s 2021-2023 biennial budget again recommended annual funding for grants to address those most affected by infant and maternal mortality. Similar proposals were stripped from the Governor’s 2023-2025 biennial budget. Governor Evers has also called for extending Medicaid eligibility to 12 months for mothers following the birth of a baby. Extending postpartum coverage would improve continuity of care and reduce disparities in postpartum follow-up care for chronic conditions associated with mortality rates.

As part of its comprehensive approach to addressing infant mortality, DHS has funded numerous partners across the state to address these issues. Recently, $16 million in federal funding was dedicated to maternal and child health equity initiatives intended to combat maternal and infant deaths. Work is underway to address food security, educate around safe sleep, provide breastfeeding support, and train additional doulas. DHS also established a Maternal and Infant Mortality Prevention Unit, which is focused on partnering with communities across the state to improve birth outcomes and the health of people who may become pregnant. Included are efforts to fund maternal and child health equity initiatives intended to combat maternal and infant mortality at the community and systems-level and improve the health of all families across Wisconsin.

Learn more about Wisconsin’s maternal and infant mortality prevention efforts.