MedicaidCoverageMedium impact
Special Medicaid eligibility programs for Medicare recipients, What�s new on the Medicaid Web site, Family Care available to people not on Medicaid, Commonly asked Family Care questions
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Jul 1, 2000
We identified it
Jun 20, 2026
Summary
Wisconsin is expanding eligibility for five special Medicaid programs for Medicare recipients (QMB Only, SLMB, QI-1, QDWI, QI-2) and extending Family Care long-term care services to non-Medicaid eligible individuals starting July 1, 2000. Providers must verify eligibility at every visit using the AVR system and obtain CMO authorization before providing Family Care services.
Action Required
By July 1, 2000: Billing team must verify all Medicare patient eligibility using the AVR system at every visit, listening to the full response message for coverage limitations. For Family Care members not on Medicaid in Fond du Lac, La Crosse, Portage, and Milwaukee counties, use EVS to verify eligibility (managed care codes 58 or 59) and contact the CMO for prior authorization before providing any long-term care services. Update billing workflows to recognize that Family Care only covers long-term care services, not acute or primary care.