Improving Access to Medicare and Medicaid Coverage: Information for Partners and Providers
The Wisconsin Department of Health Services (DHS) is improving how Medicare and Medicaid health care coverage works together to provide a better experience for people with disabilities and older adults. To make these improvements, we will:
- Gather input from people who use both Medicare and Medicaid coverage.
- Gather input from the partners and providers who help people access and use both Medicare and Medicaid coverage.
- Find ways to make it easier for people to access and use both Medicare and Medicaid coverage.
- Identify areas for improvement and find ways to make it easier for people to access and use both Medicare and Medicaid coverage.
- Prepare for changes from the federal Centers for Medicare & Medicaid Services (CMS) related to who can enroll.
- Develop and implement a strategic plan to make D-SNP coverage easier to understand, access, and keep for those who need it.
Timeline and phases
Phase 1: Gathering input (September–December 2024)
We looked at Medicare and Medicaid coverage in Wisconsin and how well they work together to provide a better experience for people with disabilities and older adults. We also considered the upcoming D-SNP plan and enrollment restrictions finalized by CMS. To gather input, we held one-on-one meetings, joined large group discussions, and sent surveys to:
- People who have both Medicare and Medicaid
- Health insurance plans
- Health care providers
- State Health Insurance Assistance Program (SHIP) counselors
- Aging and disability resource centers (ADRCs)
- Tribal aging and disability resource specialists (Tribal ADRS)
Surveys and discussions
We asked people who have both Medicare and Medicaid coverage to share their thoughts about:
- What they need most out of their coverage
- What resources were helpful when enrolling
- Problems they have when trying to get care
This survey is closed.
We asked health care providers and those who work for health insurance plans to share their thoughts about Medicare and Medicaid coverage.
This survey is closed.
We asked the following professionals to share their thoughts about Medicare and Medicaid coverage:
- SHIP counselors
- ADRC staff
- Tribal ADRS
This survey is closed.
We talked with multiple groups across the state who deliver or manage Medicare and Medicaid services or support people with both Medicare and Medicaid coverage.
| Group | Date | Associated materials |
|---|---|---|
| Monthly Managed Care Contractor Forum | August 8, 2024 | N/A |
| Medicare Advantage and SHIP Roundtable | August 22, 2024 | N/A |
| FIDE SNP Expansion | August 29, 2024 | N/A |
| Medicaid Advisory Committee | August 9, 2024 | N/A |
| Wisconsin Long Term Care Advisory Council (WLTCAC) | September 10, 2024 | September 10, 2024, WLTCAC Meeting Handouts (PDF) (see page 199) |
Phase 2: Planning for improvements (January–April 2025)
Once we understood how Medicare and Medicaid health care coverage was working for people in Wisconsin, we set out to find ways to improve this system. That meant creating a plan to improve D-SNP Medicare and Medicaid coverage by doing things like making it easier for members of these plans to:
- Find doctors who take their insurance
- Get the most out of their benefits
- Get help coordinating their health care
Our technical assistance partners, ATI Advisory and Speire Healthcare Strategies, created a report with findings and recommendations for Wisconsin. It’s based on ideas and input we heard throughout this project.
Phase 3: Making improvements
Using the report from step 2 as a foundation, DHS will work with partners across the state to decide how to make it easier for people with disabilities and older adults to access and keep Medicare and Medicaid coverage. DHS will reach out to partners like health care providers, health insurance plans, SHIP counselors, ADRCs, Tribal ADRS, Medicaid and Medicare members, and others with opportunities to learn and get involved.
More about Medicare and Medicaid coverage
When someone has both Medicare and Medicaid health care coverage, they can choose a Dual Eligible Special Needs Plan (D-SNP) for their Medicare coverage.
D-SNPs are Medicare Advantage plans for people who also have Medicaid benefits. D-SNPs:
- Are available for people who are eligible for both Medicare and Medicaid (dual eligible).
- Have a contract with the state’s Medicaid agency (in Wisconsin, that’s DHS).
- Use care plans that identify and address each person’s unique needs.
- Coordinate the person’s Medicare and Medicaid benefits to pay for necessary health care services.
There are two types of D-SNPs in Wisconsin:
- Highly Integrated Special Needs Plans (HIDE SNPs)
- Fully Integrated Special Needs Plans (FIDE SNPs)
This project aims to improve both of them.
Most D-SNPs in Wisconsin are HIDE SNP plans. HIDE SNPs are available to people who have Medicare and Medicaid for their health insurance.
HIDE plan organizations may also offer Medicaid plans, so a dual eligible person could get both Medicare and Medicaid coverage from one organization.
FIDE SNPs are available to people who have both Medicare and Medicaid and need long term care services from a nursing home, or the equivalent type of care provided in the community.
For this reason, FIDE SNPs offer coverage through one organization for the person’s Medicare and Medicaid health care services and their long-term care services and supports. In Wisconsin, FIDE SNP plans are available through Family Care Partnership.
Stay up to date
- Email DHSDMSHMO@dhs.wi.gov with questions.
- Check this page regularly for updates.