July 13, 2001

Department of Health and Family Services
Division of Children and Family Services
Division of Health Care Financing



Area Administrators/Assistant Area Administrators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Section Chiefs
Tribal Chairpersons/Human Services Facilitators


Susan N. Dreyfus
Division of Children and Family Services


Peggy Bartels
Division of Health Care Financing


New Medicaid Reimbursement for TCM Provided to Non VI-E Eligible Children in Out-of-Home Care


In 1998, the Department of Health and Family Services submitted two Medicaid (MA) State Plan amendments to the federal government to establish Targeted Case Management (TCM) for children in out-of-home care as an MA covered service for children in all 72 Wisconsin counties. These plan amendments did not differentiate between TCM provided to children in out-of-home care who were IV-E eligible or non-IV-E eligible. The federal government approved the state’s plan amendments in
March 2001. However, the federal approval narrowed the scope of MA reimbursable TCM activities and created ambiguity concerning the reimbursability of TCM for children in out-of-home care who are IV-E eligible.

Therefore, the Department has decided to pursue utilizing the new federal approval to claim federal MA/TCM funding for non-IV-E eligible children in the Child Welfare System. We are in the process of sorting out the federal requirements concerning the MA TCM claim for IV-E eligible children but did not want to delay the state’s ability to begin claiming additional federal reimbursement for the non-IV-E children.

The Department will adjust the Random Moment Time Study (RMTS), which is currently used as the basis for claiming Title IV-E funds, and use it to claim MA TCM reimbursement for the target group of non-IV-E eligible children. By using the RMTS approach rather than the fee-for-service, the State will be able to claim without requiring billing of individual services.

To avoid double billing against federal funds, Wisconsin Medicaid will not reimburse case management providers for case management services provided to children in substitute care after July, 2001, on a fee-for-service basis whether the provider is a county agency or a private vendor contracting with the county. The Department will be issuing instructions through both the Medicaid Provider Update and the DCFS Numbered Memo. As of July 1, 2001, case management services to non-IV-E eligible kids in substitute care will be reimbursed only through the RMTS mechanism.



Area Administrator


William Fiss
Deputy Administrator
(608) 266-3728

The Department of Children and Families, protecting children, strengthening families, building communities.