Wisconsin Department of Health Services in Partnership with ATI Advisory

Wisconsin has a long history of promoting integrated care for people who are dually eligible for Medicare and Medicaid. The state has several different Medicaid managed care programs in which dual eligible individuals can enroll, including Family Care, SSI Medicaid, and Family Care Partnership. Family Care plans offer institutional long-term care, home and community-based services (HCBS), and outpatient behavioral health. SSI Medicaid plans offer primary and acute care, state plan HCBS, and behavioral health. Each SSI Medicaid plan is required to offer a dual eligible special needs plan (D-SNP) that is designated as a highly integrated D-SNP (HIDE SNP). Family Care Partnership plans are aligned with D-SNPs that are designated as fully integrated D-SNPs (FIDE SNPs). While HIDE SNPs are available statewide and currently enroll more than 89,000 full-benefit dual eligible individuals, FIDE SNPs are available in a limited number of counties and enroll approximately 2,400 full-benefit dual eligible individuals. The state’s project under Advancing Medicare and Medicaid Integration focuses on increasing access to its FIDE SNP program.

Project Goals

With support from Arnold Ventures, Wisconsin is working with ATI Advisory, in partnership with Speire Healthcare Strategies, to examine options and develop a strategic plan for expanding access to the FIDE SNP program throughout the state and increase enrollment in these health plans.

Project Approach

To achieve its objectives, Wisconsin and ATI Advisory have undertaken a 12-month, two-phase effort that includes:

1. Conducting landscape analyses to better understand Wisconsin’s dual eligible population. The analyses consist of multiple workstreams to:

• Identify utilization and coverage patterns among the state’s dual eligible population;
• Review Wisconsin’s Medicaid waiver authority to determine if updates are needed to its current program;
• Examine the potential impacts of the CY2025 Medicare Advantage and Part D Final Rule provisions related to dual eligible populations and D-SNPs;
• Evaluate managed care plan procurement requirements and state statute related to long-term care programs; and
• Interview current and former Wisconsin policymakers to better understand the context of the state policy decisions for programs that cover dual eligible individuals.

These efforts will include outreach and engagement with health plans, enrollees, advocates, and other key partners to identify dual eligible individuals’ preferences and goals for accessing care, as well as better understand the concerns and challenges faced by dual eligible individuals when navigating care and services.

2. Developing a strategic plan to identify options to expand FIDE SNPs. Wisconsin and its collaborators will use landscape analyses and partner engagement findings to inform the development of a strategic plan that outlines the best options for Wisconsin to expand FIDE SNPs statewide and enroll additional members. The team will also conduct a series of workgroup meetings with state staff to support the implementation of policy decisions needed to expand the FIDE SNP program.

Support for Other States

Many states are in the same position as Wisconsin — they know they want to improve care for their dual eligible populations by providing fully-integrated programs, but face resource gaps that prevent them from moving forward. Arnold Ventures launched Advancing Medicare & Medicaid Integration to support states and help fill those resource gaps. Learn more about funding opportunities.