In 2022, almost 500 providers received more direct care workforce funding (DCWF) than they should have. Lakeland Care, Inc., one of the managed care organizations (MCOs) the Wisconsin Department of Health Services (DHS) relies on to confirm data used to calculate the payments, made a mistake that caused this.

These providers won’t need to repay DHS—but their payments in 2024 will be reduced. The reductions will be spread across the three payments in 2024 to lessen the overall impact. Additionally, because the DCWF is a set amount of money, other providers were underpaid in 2022. They will get three additional checks in 2024.

If you contracted with Lakeland in 2022 and received DCWF funds, you can expect to be in the overpaid category. However, if you also contracted with other MCOs during that time, you may also have been underpaid as well. Please read on for details regarding the payment adjustments for both categories.

Overpaid Providers

Lakeland will reduce payments sent in July 2024 for both the 2022 reallocation and the second payment for calendar year 2023 to those providers that were overpaid.

The first payment for calendar year 2024 dates of service, arriving in December 2024, will also be reduced.

Underpaid Providers

Providers who were underpaid in 2022 will get additional funds paid in three extra checks in 2024:

MCOs will send the first two additional checks at the same time as they send the 2022 reallocation and the second payment for calendar year 2023, starting in late June and finishing by mid-July. MCOs will send the third and final additional check in December at the same time as the first direct care workforce payment for calendar year 2024.

Underpaid providers will get a letter describing the additional payments they’ll get and why.

Normal payment amounts will resume with the second payment for the calendar year 2024, which will be sent in June 2025.

Underpaid providers getting additional payments in 2024 should not factor those extra dollars into future expected payments. They are one-time adjustments.

DHS has put measures in place to find mistakes like this in the future and prevent this from happening again.

Due to CMS regulations for directed payment programs, there is not an approved alternative way to fix this error. WHCA/WiCAL spoke with DHS officials to confirm there were not any more palatable methods to address this. DHS created a webpage with additional details regarding the payment adjustments and provider should be hearing from MCOs in the near future about the adjusted payments.

Please contact Kate Dickson with questions.