Family Care program
Family Care is Wisconsin’s long-term-care Medicaid program that helps eligible older adults and adults with disabilities live safely and independently in their homes and communities.
Family Care overview
Administered by the Wisconsin Department of Health Services (DHS) through Anthem and other managed care organizations (MCOs), Family Care provides coordinated home and community-based services (HCBS) tailored to each member’s needs and goals.
Residents of Wisconsin aged 65 or older and adults with physical or developmental disabilities may be eligible for participation based on Medicaid financial eligibility criteria, with consideration of income, asset limits, and functional eligibility standards. Interested individuals can begin the process by contacting their local Aging and Disability Resource Center (ADRC). ADRCs provide information about eligibility and program options, and they help facilitate enrollment into Family Care.
As a provider with Anthem's Family Care network, you will work closely with our Care Coordinators to support in the development of each individual's Member-Centered Plan (MCP). The MCP is the foundation for all service authorizations. The MCP is developed collaboratively with the members, their care team, and others the members choose to involve. It identifies the members' goals, preferences, and assessed needs, as well as outlines the support and services necessary to achieve those outcomes.
The Family Care program provides a comprehensive range of long-term services and support designed to help members live as independently as possible in their homes and communities.
Covered services include a broad array of health, personal, and supportive care options that address members’ daily living needs, safety, and overall well-being. The scope of services is guided by each person's Member-Centered Plan (MCP) and authorized by Anthem based on the member’s assessed needs and program eligibility.
For a complete description of covered services, including service definitions and provider requirements, refer to:
- The Wisconsin Administrative Code DHS 10.41 and related Family Care statutes
- The Anthem Family Care Scope of Services Reference Guide, which outlines detailed service descriptions and coverage parameters
Claims and billing
Providers should use Availity Essentials to submit claims, check the status of claims, or appeal a claim decision. For more information on using Availity Essentials to submit claims and other information, use your provider manual or visit our Claims submissions and disputes page.
Family Care requires EVV for personal care and supportive home care services, as well as Home Health services. For a detailed list of Family Care services which require EVV for Family Care, visit WI EVV Service Codes.
Within Care Central, providers can:
- Access authorizations in real time for covered services
- Submit claims directly and securely
- Check claim status
- Use a consolidated dashboard for member-specific service data and authorization history
Anthem will use the prior year’s Housing and Urban Development (HUD) Fair Market Rent (FMR) amounts, based on residential type by county, plus the prior calendar year’s maximum Supplemental Nutrition Assistance Allocation for one person, in determining the room and board payment to the residential facility:
- Efficiency rate — owner-occupied adult family home
- One-bedroom rate — corporate adult family home and community-based residential facility
- Two-bedroom rate — residential-age apartment complex
Provider enrollment and contracting
To contract with Anthem for Family Care, a provider must:
- Be enrolled with Wisconsin Department of Health Services and have a valid Wisconsin Medicaid ID by enrolling on the ForwardHealth Portal
- Complete Anthem's Family Care Application and Anthem's Family Care Compliance Attestation Form
- Submit application packet and attestation form to Anthem following instructions detailed in the application coversheet
Credentialing, certification, and compliance
All providers wishing to enroll with Anthem must access the application by joining our network.
Are you interested in becoming a certified one- or two-bed Adult Family Home (AFH) provider? As a certified AFH provider, you will offer a supportive, homelike environment that helps people live more independently while receiving the personalized care they need.
Anthem partners with providers who deliver member-centered care to seniors and adults with physical, intellectual, or developmental disabilities across Wisconsin. Each home in our network works closely with our care and certification teams to promote healthy, independent living — while ensuring safety, dignity, and quality of life.
All of Anthem’s AFH providers follow the Wisconsin Medicaid Standards for Certified 1-2 Bed Adult Family Homes.
To start the certification, email us at wi-ltssproviderrelations@anthem.com. Our team will guide you through certification.
For additional information on what may be considered a reportable incident, review the Family Care Provider Manual Supplement.
To report an incident, download the Incident Report Form and follow the reporting instructions on the form.
If you have questions about what constitutes a reportable incident or how to submit the form, contact Anthem’s Family Care Provider Relations.
Email Anthem’s Family Care Provider Relations team
Email: wi-ltssproviderrelations@anthem.com
For more information on reporting requirements, compliance, and credentialing, access your provider manual.
Provider Services information
Please contact Provider Services to verify eligibility or refer a member for services.
Anthem’s LTSS dedicated Provider Relations team is responsible for fostering and maintaining strong partnerships with providers who deliver essential services participating in the Family Care programs. The team serves as a primary point of contact for providers, offering support and guidance to ensure they meet regulatory and contractual requirements.
To contact a member of the LTSS Provider Relations team, visit the LTSS Provider Relations Map to identify your dedicated representative or email us directly at wi-ltssproviderrelations@anthem.com.
For a full list of our available forms, visit the Forms page. If you need to submit a form electronically (such as a precertification request), use our trusted partner, Availity Essentials.
For additional help with understanding Family Care member eligibility, member concerns, provider requirements, and other available resources, reach out to our Provider Services team:
Provider Services
Call: 855-558-1443
For additional help with understanding Medicaid Member Eligibility, reach out to the Wisconsin Department of Health (DHS) via phone or email.
Wisconsin Department of Health (DHS)
Call: 800-362-3002
Email: dhsfcwebmail@wisconsin.gov
If you need to file a member grievance or appeal, refer to your provider manual for instructional guidance.
Please review our selection of materials to learn more about Family Care. Providers can use training materials and educational opportunities featured in our Training Academy or access the Family Care provider manual and other provider manuals by visiting our Policies, guidelines and manuals page.
Documents
Consumer Guide: Resources for Caregivers
For additional Family Care and LTSS updates, visit Provider News.