Wisconsin Family Care Transportation: How to Get Rides from the Managed Care Organizations (2027)

Most Wisconsin Medicaid rides go through one statewide NEMT manager, but the state’s long-term care members are the exception. In Family Care, Family Care Partnership, and PACE, each managed care organization (MCO) buys its members’ rides itself, from medical trips to rides to jobs and day programs. That makes six MCOs to approach, each with its own contract and rates, and three of them send at least some rides through one broker. This guide covers how they buy. For SMV licensing, vehicle inspections, and the statewide NEMT program, start with the Wisconsin NEMT guide.

How Family Care rides work

Family Care serves older adults and adults with physical, intellectual, or developmental disabilities who need long-term care. As of August 1, 2026, DHS counted 55,835 Family Care members, 3,158 in Family Care Partnership, and 552 in PACE. Partnership and PACE add medical care to the long-term care benefit.

These members sit outside the statewide NEMT program. ForwardHealth’s NEMT handbook says Family Care, Family Care Partnership, and PACE members have their NEMT coordinated by their MCO. The 2026 DHS contract with the MCOs (effective January 1, 2026) puts three kinds of rides in the benefit package:

• Medicaid medical transportation as defined in Wis. Admin. Code DHS 107.23, excluding ambulance. These are the trips the NEMT manager would handle for other members, including specialized medical vehicle (SMV) trips.
• Community transportation. Rides that let a member reach waiver services, a job, and other community services, activities, and resources in the care plan. It can be a ride, a ticket, or a fare card. Family, neighbors, friends, or community agencies who can give the ride free are used first.
• Other transportation. Medical rides for a member who self-directs them with a budget. These members are not limited to the MCO’s network, need no prior authorization if the budget covers the trip, and the MCO must verify an SMV provider’s credentials.

The member’s interdisciplinary care team decides which rides to authorize. iCare, for example, says its care teams usually authorize transportation for a period that matches the care plan, such as six months. Under the contract, the MCO must give you the authorization before the service starts, or a verbal one followed by written confirmation when that is not practical.

Which MCOs buy rides where

DHS’s key contacts list (June 2026) names six MCOs and the counties each serves. Three of them send rides through MTM Health. Inclusa ended its own transportation contracts at midnight on March 31, 2026, and MTM began serving its members April 1, 2026, so iCare and Inclusa share one model. Anthem’s Family Care provider manual supplement (January 2026) lists MTM for non-emergency transportation. The other three take ride companies directly.

MCO	Programs, members August 1, 2026	How ride companies join
Anthem	Family Care, 104	Its manual lists MTM Health for non-emergency rides; ask Anthem about community rides
Community Care, Inc.	Family Care 15,290; Partnership 381; PACE 552	Transportation application to its provider management team
iCare	Partnership, 1,566	Through MTM Health
Inclusa	Family Care, 16,606	Through MTM Health, since April 1, 2026
Lakeland Care, Inc.	Family Care, 7,769	Online application, when its network needs more providers
My Choice Wisconsin	Family Care 16,066; Partnership 1,211	Online application from its Joining Our Network page

The map keeps changing. In October 2025, DHS announced its intent to award new contracts in geographic service region 2 (16 western and southwestern counties) and region 7 (Milwaukee County), and enrollment for new or expanding MCOs was set to begin March 1, 2026. Anthem joined Family Care there, and Inclusa entered Milwaukee County. On July 14, 2026, DHS issued award letters for seven southeastern counties starting in 2027: Kenosha, Ozaukee, Racine, Sheboygan, Walworth, Washington, and Waukesha. Anthem joins Family Care in all seven, Inclusa enters Kenosha and Racine, and UnitedHealthcare joins Partnership in all seven. DHS cannot sign those contracts until any protests are resolved, and the Partnership changes depend on CMS approval and may slip past 2027. My Choice Wisconsin says it will be called Molina Healthcare starting January 1, 2027.

For MTM’s process, see MTM Health in Wisconsin. Inclusa sends interested companies to providerswi@mtm-inc.net, and MTM handles credentialing. iCare says MTM runs this work apart from the statewide NEMT program, with its own provider requirements and payment process, so ask about the Inclusa and iCare network by name.

Step 1: Enroll with Wisconsin Medicaid

Every Family Care ride company needs a Wisconsin Medicaid ID first. The 2026 contract lets MCOs use only providers enrolled through DHS’s centralized enrollment system with a valid Medicaid ID for the service, except mass transit systems. DHS’s December 2025 update told providers that if enrollment was not approved by March 31, 2026, they could not be paid for dates of service from April 1, 2026, and their MCO contracts would be cancelled. Community Care now requires a Medicaid number for each service and location.

ForwardHealth’s provider type pages, as of October 2026, give three routes for transportation:

• Common carrier or mass transit. An organization that meets Wis. Stat. chapter 194 (common carriers), 85.20, or 85.23.
• Specialized transport. An individual or organization that meets Wis. Stat. 85.21 or 85.22 and Wis. Admin. Code DHS 61.45.
• Specialized medical vehicle. An SMV provider enrolled under DHS 105.39 adds the waiver transportation services to its existing enrollment.

The first two are limited risk at enrollment and revalidation, carry no application fee, and use the waiver provider agreement, form F-00180C. DHS runs a criminal and caregiver background check for individuals and sole proprietors. SMV enrollment is a separate, high-risk enrollment with a fee and a provisional period that includes an audit, which the Wisconsin guide covers. Whichever route you take, add the service named “Transportation (non-emergency medical and community)” for Family Care, Partnership, and PACE, and “Transportation (community)” if you want IRIS work.

Your enrollment takes effect on the date DHS receives your completed application with every required document, so it cannot be backdated. You revalidate every three years. For help, ForwardHealth Provider Services answers at 800-947-9627, Monday to Friday, 7 a.m. to 6 p.m. Central; say “LTC Waiver” at the prompt.

Step 2: Get into each MCO’s network

Enrollment makes you eligible. It does not give you trips. The 2026 contract says an MCO is not required to contract with more providers than its members need, may pay different rates to different providers, and must give you written notice of the reason when it declines you.

DHS’s network adequacy standard, P-02542 (April 2024), sets one provider per 150 members for community and other transportation, and the same ratio for medical transportation. DHS reviews each MCO’s network every year and after big changes, such as a 25 percent swing in members or a 5 percent drop in providers. When it finds a network inadequate, the MCO must contract with more providers or pay out-of-network providers. Ask each MCO which of its counties are short of ride providers.

Each direct-contract MCO asks for something different:

• Community Care. Its transportation application (revised May 15, 2025) requires at least two drivers and two similarly equipped vehicles. You send the application, an attestation form, your Wisconsin Medicaid approval letters for each service and location, a W-9, and your licenses. You also need a certificate of insurance naming Community Care as certificate holder: general and professional liability at $500,000 and $1,000,000 limits, workers’ compensation and employer’s liability, and auto. A vehicle chart lists each VIN, plate, ramp, lift, or cot, and who inspects each van on which day, and you sign that the listed vehicles meet DHS 105.39 and 107.23. Community Care reviews its network needs first and keeps your application on file if it has no current need. Its provider hotline is 866-937-2783, option 2.
• Lakeland Care. You apply online and its contracting team contacts you within three business days. Once your documents are in and rates are agreed, it issues a service provider contract within five business days. It asks for licenses, insurance and any bonding, a provider agreement form, and attestation letters on background checks, debarment, training, and civil rights compliance. It adds providers only when capacity in the service category shows a need, and you agree to its contracted rate negotiated with similar providers.
• My Choice Wisconsin. You must be enrolled with Wisconsin Medicaid where applicable, meet home and community-based settings rules where applicable, and hold the licenses the service needs. You apply online from its Joining Our Network page.

For how health plan contracting works in other states, see how to contract with Medicaid health plans.

What MCO contracts ask of drivers and vans

The contract’s provider rules depend on what kind of company you are:

• Taxis and common carriers comply with Wis. Stat. chapter 194.
• Specialized transportation agencies comply with Wis. Stat. 85.21, 85.22, or 85.215, as they apply, and chapter Trans 301 on human service vehicles.
• Individual drivers need a Department of Transportation operator’s license, liability insurance, and a vehicle in good repair with all operating and safety systems working.
• Public transit and ride-hailing companies follow Wis. Stat. 85.20 or hold a transportation network company license under SPS 440.415.

If you contract with a county under its specialized transportation program, Wis. Stat. 85.21 adds driver rules. Each human service vehicle driver needs a valid license for that vehicle and passenger restraint training within the previous 24 months. Before hire, you get a state criminal history search and the driver’s operating record, and you pull a new operating record at least every four years. Drivers must also meet the school bus endorsement standards in s. 343.12(7) and (8). A driver with a school bus endorsement issued or renewed in the last four years is exempt from those standards and the pre-hire checks.

Lakeland Care’s transportation addendum (updated May 1, 2025, approved by DHS July 25, 2025) shows how one MCO turns that into contract terms:

• Background checks under DHS 12 for all staff and household members 18 or older: a Background Information Disclosure (F-82064), a Wisconsin Department of Justice record check, a Caregiver Registry search, and any license check.
• Driver files. Verify each driver’s license and driving record, and add every driver to your auto liability policy.
• Training within the first six months, or sooner when needed to work safely, meeting DMV standards for transportation.
• Individual or volunteer drivers show liability insurance, a valid license, and a W-9, and give written assurance that the vehicle’s lights, ventilation, brakes, and tires are sound.
• SMV providers who bill SMV codes keep a current SMV certification through ForwardHealth and follow DHS 105.39 and DHS 107.23.
• Service rules. A 15-minute window for scheduled pickups and drop-offs, 24 hours’ notice when you cannot give an authorized trip, and a backup plan. Report member incidents to the care team within one business day and formal complaints within 48 hours. Keep a written no-show policy.

For training programs that satisfy rules like these, see NEMT driver training.

How Family Care trips are billed and paid

Each MCO sets its own rates in its contract. DHS’s minimum fee schedule for adult home and community-based services, in effect since October 1, 2024, covers supportive home care and residential care, not transportation. So your rate is whatever you negotiate.

Lakeland Care’s addendum shows the units an MCO uses. It authorizes rides by trip, by mile, or by route:

• Trip. Pickup to drop-off, including dispatch and escort from origin to destination. Medical trips bill under codes 107.10 (trip) and 107.11 (mile) with modifier RD. Rides to activities, such as supported employment or day services, bill under 107.20 and 107.21 with modifier RI. SMV providers bill the standard SMV codes, such as A0130 and S0209, with their trip and discharge modifiers.
• Mile. Loaded miles count from the first mile, by the shortest direct route. For unloaded miles from your home base to the pickup, Lakeland covers the shortest, most direct route. An empty trip back to base is not paid unless your rate chart says so.
• Route. A set rate between fixed points, with two hours of waiting included and no separate mileage.
• Wait time. Only with prior authorization, up to six hours per member, and only when you cannot run other trips meanwhile. The driver must stay at the site.
• No-shows. A no-show fee is considered only if your rate chart lists one.

The 2026 contract sets how fast MCOs pay. Unless you agreed to later payment, the MCO must pay or deny 90 percent of clean claims within 30 days of receipt, 99 percent within 90 days, and all of them within 180 days. For My Choice Wisconsin and Lakeland Care, WPS processes claims as third-party administrator. It says claims must use the Tax ID you enrolled with DHS and contracted with the MCO, or they are denied. Payments from the MCO are your full pay: with narrow exceptions, the contract bars you from billing members for covered or non-covered services.

You keep enrollment documents and the personnel files of everyone who gives direct care for 10 years from the end of the contract period or the completion of any audit. Lakeland Care may also ask for transport logs, odometer readings, and proof of enough cash reserves to serve members for 30 days without payment.

When a claim is denied

Appeal to the MCO first. Send a separate letter or form marked “appeal” within 60 calendar days of the payment or denial notice, with your name, the date of service, billing date, rejection date, and why the claim deserves another look. The MCO must answer in writing within 45 days. If it does not, or you disagree, you have 60 days to appeal to DHS by fax to 608-266-5629, or by mail to Provider Appeals Investigator, Division of Medicaid Services, 201 E. Washington Ave., Room B300, P.O. Box 309, Madison, WI 53703-0309. DHS decides within 45 days of receiving all comments, and the MCO pays within 45 days of a decision in your favor. The denied claim appeal guide covers how to build the file.

IRIS rides

IRIS is Wisconsin’s self-directed long-term care waiver. Participants pick their own providers within a budget instead of joining an MCO. The IRIS Service Definition Manual (March 2026) defines community transportation as rides to waiver services, a job, or community services, activities, or resources in the participant’s plan. It says the cost is reimbursed in line with the IRS federal mileage rate and written into the plan.

To be chosen and paid, you must be enrolled with Wisconsin Medicaid and active. The manual lists mass transit, taxis and common motor carriers, specialized transportation providers under Trans 301 and Wis. Stat. 85.21, 85.22, or 85.215, transportation network companies, and individual participant-hired workers with a license and auto insurance. Qualifications are verified before service and every year after. An IRIS consultant agency authorizes the service, and the participant’s fiscal employer agent pays you. The codes are S0215 (miles), T2003 (trip), T2001 (attendant trip or pass), and T2004 (pass), each with modifier RI.

Two limits matter. The waiver pays only when the ride is not available through the Medicaid state plan, Medicare, or another responsible source, or free to the public. Participants aged 18 to 21 get these rides through the state plan. Medical rides for IRIS participants go through the statewide NEMT program, not the waiver. For waiver rides in other states, see the waiver transportation guide, and for the PACE side of long-term care, see PACE transportation contracts.