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CMS rules that Wisconsin must Reimburse Individuals Affected by Family Care Cap

On July 22 the federal Center for Medicare and Medicaid Services (CMS) wrote to Wisconsin DHS saying that Wisconsin’s recent cap on Family Care and IRIS programs was a violation of the state’s agreement with the federal government. People who were “improperly placed on a waiting list” can seek reimbursement from the state. The ruling is significant and is the result of back and forth communication between the state and CMS since December 2011.
The letter states:
“The CMS understands that between July 1, 2011 and April 3, 2012 the State instituted an enrollment cap on long term care programs, including Family Care. During this time CMS is aware that eligible individuals in entitlement counties were on waiting lists, both during the period of the enrollment cap and after the State indicated that the enrollment cap had been lifted. The State’s denial of services to these individuals violates the terms of the State’s approved §1915(c) waivers associated with this concurrent §1915(b) waiver. Therefore, if such individuals appeal to the State from service or eligibility denials, the State should reimburse the individuals improperly placed on a waiting list for any health care costs incurred while on the waiting list.”