Medicaid → State Stories of Medicaid Coverage → Wisconsin
Wisconsin’s State Story of Medicaid Coverage
Overview
The Wisconsin Department of Health Services (DHS) Chronic Disease Prevention Program (WI CDPP) and the Division of Medicaid Services (DMS) have been working together for several years to prepare for Medicaid coverage for the National Diabetes Prevention Program (National DPP) lifestyle change program. By participating in technical assistance opportunities, developing a managed care organization (MCO) pilot project, and creating a partner network, Wisconsin is putting important infrastructure in place as it pursues statewide Medicaid coverage for the program.
Wisconsin is also the first states to implement the National DPP lifestyle change program in state correctional facilities, through the Wisconsin Department of Corrections (DOC). To learn more, see the Engaging Correctional Facilities page of the Coverage Toolkit.
Establishing Coverage
The WI CDPP and DMS have a shared vision for working toward Medicaid coverage for the National DPP lifestyle change program in Wisconsin and are pursuing options to secure authority and funding to offer sustainable coverage. WI CDPP views Medicaid coverage for the National DPP lifestyle change program as an important steppingstone for increasing overall health education and prevention resources for Wisconsin communities. The following describes some of the work that has prepared Wisconsin to pursue Medicaid coverage for the program.
Public Health and Medicaid Collaboration in Wisconsin
Participating in Building the Case for Medicaid Coverage Technical Assistance
WI CDPP and DMS have been meeting since spring 2021 to discuss diabetes and prediabetes education coverage in Wisconsin. In 2022-23, CDPP and DMS participated in the CDC-funded and NACDD-led Building the Case for Medicaid Coverage technical assistance opportunity, which focused on developing partnerships between public health and Medicaid in pursuit of coverage for the National DPP lifestyle change program. Involvement in this initiative supported CDPP and DMS staff in furthering their collaborative relationship, expanded DMS knowledge of the National DPP lifestyle change program, and increased their capacity to provide guidance and technical assistance related to coverage within their state.
As part of this opportunity, CDPP and DMS developed the following joint vision statement: “The Division of Medicaid Services (DMS) will continue to work with the Division of Public Health (DPH) to explore National DPP requirements. DMS and DPH will continue to meet regularly. DMS will continue to evaluate and address possible [National] DPP coverage. Moving forward DMS anticipates implementation would require additional authority, budget, and resources. DPH included continued work toward National DPP coverage by Medicaid in both Diabetes Action Plan (DAP) to state legislature and CDC-RFA-DP-23-0020 (2320) workplan.”
Developing a State-Supported MCO Pilot and Infrastructure for Statewide Coverage
State-Supported Managed Care Pilot
In 2023, WI CDPP began participating in the CDC-funded and NACDD-led Medicaid Beneficiary Enrollment Project (MBEP), in partnership with DMS and the YMCA of Metropolitan Milwaukee (Y-MKE). Y-MKE is a CDC-recognized organization serving the state’s largest metropolitan area in Wisconsin, and it serves as the lead organization for an umbrella hub arrangement with several affiliates in the state. The Wisconsin team’s MBEP project goal is to leverage grant funds to develop a state-supported MCO pilot project that addresses both National DPP lifestyle change program enrollment and implementation of a health-related social needs (HRSN) screening tool for Medicaid beneficiaries aged 18 and older. The project is also leading work to expand Medicaid MCO contracts for the National DPP lifestyle change program and explore statewide mechanisms for Medicaid coverage for the program. For additional information on other state-supported MCO or value-based care pilots, see the Medicaid Coverage Landscape and the Engaging MCOs to Attain Coverage pages of the Coverage Toolkit.
Systems Building
WI CDPP, in partnership with Welld Health, has established a pathway for CDC-recognized organizations to contract with payers called the Lifestyle and Prevention Benefits Network (LPBN). The Y-MKE umbrella hub is part of the LPBN, and as of late 2023 has established two contracts for the National DPP lifestyle change program and the Medicare Diabetes Prevention Program (MDPP): Group Health Collaborative and Common Ground Healthcare Cooperative. Through these contracts, the Y-MKE UHA has successfully received MDPP-approved claims payments.
Y-MKE systems currently integrate with the 2-1-1 Community Connect services that link YMCA members and National DPP lifestyle change program/MDPP participants to community resources. To build on this work, Y-MKE is partnering with service organizations that can address SDOH needs and implement SDOH screening, referral, and closed loop feedback processes. Y-MKE secured a grant through Advancing Healthier Wisconsin Endowment Fund to build a PRAPARE tool screening module in Welld Health to conduct HRSN screening for the Medicaid population. A robust evaluation of this system, including cost of delivery and health care savings, will also be used to inform coverage options for the state.
Finally, Y-MKE is working with MCO(s), the Wisconsin Statewide Health Information Network (WISHIN), Wisconsin Health Information Organization (WHIO), and WillBridge (a public benefit corporation) on a broader initiative to establish a robust data and referral sharing network for the state of Wisconsin. The resulting data and referral sharing network will be leveraged to identify potential participants, establish referral pathways, and enroll participants in the National DPP lifestyle change program.
Program Features Unique to Wisconsin
Fostering Relationships with Program Champions
CDPP has intentionally sought out subject matter experts around the state to further the conversation related to diabetes prevention and coverage of the National DPP lifestyle change program. To this end, CDPP has established a contractual relationship with a family practice physician and subject matter expert in insurance, including Medicaid. In his work with the state, he serves as a trusted messenger who can share key information about diabetes prevention with health plans.
Covering the Program in Correctional Facilities
In addition to seeking Medicaid coverage for the National DPP lifestyle change program, Wisconsin has become the first state to successfully implement the National DPP lifestyle change program in three state correctional facilities through the Wisconsin Department of Corrections (DOC). Through this effort, the Wisconsin DOC has been awarded full CDC-recognition status as a National DPP lifestyle change program provider and has trained 19 sergeants and recreational therapists to become Lifestyle Coaches. For more information on Wisconsin’s implementation of the National DPP lifestyle change program in a correctional setting, see the white paper titled, “Implementing the National DPP Lifestyle Change Program in Correctional Settings” and the Engaging Correctional Facilities page of the Coverage Toolkit.
Creating a Partner Network
“A partner network is a group of organizations and representatives from different communities that team up to advance a common goal or vision. In the context of type 2 diabetes prevention, partners leverage each other’s expertise and reach to maximize their capacity and capabilities. Wisconsin participated in the CDC-funded and NACDD-led Bright Spots Initiative to create a partner network for the National DPP lifestyle change program, with CDPP serving as the “backbone organization.” For more information on the Bright Spots Initiative and Wisconsin’s participation, see the Partner Networks page of the Coverage Toolkit.
Lessons Learned
- Seek a relationship with your state’s Medicaid office from the very beginning so that work toward National DPP coverage is a true partnership and everyone’s interests or needs are addressed.
- Securing Medicaid coverage is a slow process. The first step, identifying and receiving approval for a provider type, is difficult because each state identifies providers differently. If a state is on a biennial budget cycle, this can slow the process even further.
- Enlist and deploy champions strategically. As mentioned above, CDPP intentionally sought input from influential partners in the state who could communicate to specific groups about the benefits of covering the program. These champions can serve as liaisons between DHS divisions as well as with the health insurance industry.
