MedicaidAdministrativeHigh impact
Managed Care Organization Changes Affecting Members in Western Wisconsin
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Jan 1, 2013
We identified it
Jun 20, 2026
Summary
Community Health Partnership will no longer provide managed care services in five western Wisconsin counties effective January 1, 2013, replaced by Southwest Family Care Alliance for Family Care services only. Family Care Partnership is discontinued in these counties, with affected members choosing between Family Care through the new MCO or fee-for-service Medicaid including IRIS waiver services.
Action Required
Immediately: Billing team must verify member enrollment status on each date of service for patients in Chippewa, Dunn, Eau Claire, Pierce, and Saint Croix counties using Wisconsin's Enrollment Verification System. Update billing workflows to submit claims directly to Wisconsin Medicaid for fee-for-service reimbursement of acute and primary care services for Family Care members and all services for IRIS members. Staff must check ForwardHealth Portal for enrollment verification procedures.