Medicaid agency: DHS
Wisconsin Medicaid, branded BadgerCare Plus, is administered by the Department of Health Services (DHS) via its ForwardHealth provider and member portal; Wisconsin has not adopted the ACA Medicaid expansion. Instead, its BadgerCare Reform Section 1115 demonstration, effective October 29, 2024 through December 31, 2029, covers childless adults with incomes up to 100% of the federal poverty level, extends eligibility to former foster care youth from other states through age 26, and authorizes residential and inpatient substance use disorder treatment in institutions for mental disease (IMD); a pending amendment submitted to CMS in December 2024 would add IMD coverage for inpatient stays for adults with serious mental illness or serious emotional disturbance. SeniorCare, a separate Section 1115 demonstration covering prescription drugs for adults 65 and older with incomes up to 200% of the federal poverty level, runs through December 31, 2028, and a separate Postpartum Coverage 1115 application has been pending at CMS since 2022; BadgerCare Plus already covers 12 months of postpartum care directly under the state plan. Wisconsin's new Medicaid work requirement, part of the federal One Big Beautiful Bill Act, takes effect for new applicants on January 1, 2027 and for most current members at their next renewal starting March 2027; affected adults must complete 80 hours of work, school, or volunteering, or have at least $580 in monthly income, unless exempt, with members who have a Social Security Administration disability determination exempted automatically, and Wisconsin has joined the multistate litigation challenging the CMS rule implementing the federal work-requirements mandate. DHS's own current rosters list 13 BadgerCare Plus HMOs and five Family Care managed care organizations as of June 2026, a more current count than CMS's own enrollment data.
Per CMS's 2024 managed care enrollment data (the most recent year CMS has published for Wisconsin), BadgerCare Plus, the primary managed care program for families, children, and childless adults, was delivered through 13 regionally organized HMOs covering 839,627 members statewide. SSI-related Medicaid members are served through the same regional network, tracked by CMS as a separate program line: nine of the 13 BadgerCare Plus plans (all but Chorus Community Health Plans, Dean Health Plan, Group Health Cooperative of South Central Wisconsin, and MercyCare Health Plans) also carried SSI Medicaid enrollment in 2024, covering 52,936 members.
Long-term services and supports run through their own managed care programs rather than through the BadgerCare Plus HMOs. Family Care (a capitated MLTSS-only PIHP model) and Family Care Partnership (which combines LTSS with primary and acute care in a single capitated MCO) together cover older adults and adults with physical, intellectual, or developmental disabilities. IRIS (Include, Respect, I Self-Direct), a 1915(c) waiver, is the fee-for-service, self-directed alternative to Family Care; IRIS currently operates through multiple fiscal employer agents, and DHS announced a notice of intent in January 2026 to consolidate onto a single fiscal employer agent, Public Partnerships LLC, with current participants set to begin transferring no earlier than 2027. A separate Program of All-Inclusive Care for the Elderly (PACE), operated only by Community Care, Inc., serves Kenosha, Milwaukee, Racine, and Waukesha counties; CareSource, an Ohio-based nonprofit health plan, holds the controlling interest in Community Care's PACE program specifically.
Partially integrated into managed care
Behavioral health is largely integrated into the BadgerCare Plus HMOs alongside physical health rather than carved out statewide. One county-level exception: WrapAround Milwaukee, a Milwaukee County-administered program operating under separate 1915(a) authority, carves out behavioral health for children and youth with severe emotional disturbance in that county (413 members in CMS's 2024 data) outside the standard HMO structure.
Carved in
Dental care is a covered BadgerCare Plus specialty benefit, delivered as part of the standard benefit package with no dedicated statewide dental administrator or carve-out vendor.
Pharmacy is carved out of managed care statewide; claims are billed fee-for-service directly to Wisconsin Medicaid regardless of a member's HMO enrollment, including for members in the Pharmacy Services Lock-In Program.
MTM is Wisconsin's current statewide non-emergency medical transportation broker. DHS announced a notice of intent in May 2026 to select Verida, Inc. as MTM's successor, though no transition timeframe has been set and members continue to schedule rides with MTM in the meantime.
Gainwell Technologies operates ForwardHealth interChange as Wisconsin's Medicaid Management Information System fiscal agent, including claims processing and prior authorization on the ForwardHealth Portal. DHS has not published a current contract-through-date for this role.
95 agency updates tracked for Wisconsin. Available with Pro.
See them with ProWisconsin Watch reports that gubernatorial candidates Tom Tiffany (R) and David Crowley (D) have released competing plans to address rising health care costs, a top concern among Wisconsin voters. Crowley proposes opening BadgerCare enrollment to any household, with income-based premiums, targeted subsidies for small businesses and gig workers, and expanded coverage for dental, vision and mental health. Tiffany's plan focuses on price transparency requirements for hospitals and insurers, direct-pay subscription models for primary care, and increased oversight of pharmacy benefit managers. The piece also notes that federal Medicaid work requirements under the One Big Beautiful Bill Act are set to take effect in 2027 and will apply to childless adult BadgerCare members.
Wisconsin's gubernatorial candidates, Democrat David Crowley and Republican Tom Tiffany, have released competing healthcare affordability plans ahead of the 2026 election. Crowley proposes opening BadgerCare (Wisconsin's Medicaid program) to any household, with income-based premiums, subsidies for small businesses and gig workers, and expanded coverage for dental, vision and mental health. Tiffany's plan focuses on price transparency requirements for hospitals and insurers, a direct-pay subscription model for primary care, and increased oversight of pharmacy benefit managers. The debate comes as a Forward Analytics report shows Wisconsin hospital prices among the highest in the nation, with hospital costs up 274 percent since 2000 versus 90 percent income growth, and as federal Medicaid work requirements for childless adult BadgerCare members are set to begin in 2027.
The HHS Office of Inspector General reports that Wisconsin may have improperly claimed $455 million in federal Medicaid reimbursement for its school-based services program. The finding affects the state Medicaid agency and school districts that bill Medicaid for services delivered to eligible students, as OIG's audit identifies claims that did not meet federal reimbursement requirements. The report does not specify a comment deadline but signals likely recoupment action and corrective-action requirements from CMS. The audit underscores recurring compliance risk in state school-based Medicaid billing programs nationally.
Bread of Healing Clinic, which provides free and low-cost care to Milwaukee residents, is preparing for an increase in uninsured patients following changes to Medicaid eligibility. The clinic is asking the community for additional support to handle the anticipated demand. No specific timeline or dollar figures are given in the report, but the clinic frames the shift as a direct consequence of recent Medicaid policy changes affecting coverage access.
A federal judge ruled Sept. 21 that the Trump administration's 2025 rule requiring immigration status checks for users of federally funded adult education, Head Start, and community health centers violated notice-and-comment requirements. The rule would have barred undocumented immigrants and several legal-status categories, including TPS holders and U visa applicants, from these programs, reversing a three-decade interpretation that such safety-net services were open to all regardless of immigration status. Wisconsin and 20 other states had sued to block the rule, arguing it would force states to restructure social safety nets and render them inaccessible to vulnerable residents. The ruling permanently blocks enforcement of this version of the rule, though federal agencies could reissue it after proper notice and comment.
17 active waivers tracked for Wisconsin. Available with Pro.
See them with Pro7 active solicitations tracked for Wisconsin. Available with Pro.
See them with Pro29 managed care contracts tracked for Wisconsin. Available with Pro.
See them with Pro2 bills tracked for Wisconsin. Available with Pro.
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