Wisconsin Brain Injury, Medicaid Long-Term Care, and Appeal Help: Official Starting Points

Use this page if you live in Wisconsin and need brain injury information, disability long-term care, or help responding to a Medicaid service decision.

ABI Resources provides care services in Connecticut. This Wisconsin page is public educational information and does not mean ABI Resources provides services in Wisconsin. Wisconsin programs and managed care organizations make their own decisions.

Start here

1. Keep the decision notice and envelope.

2. Circle the appeal deadline and the date a change would begin.

3. Contact your care manager or member rights specialist.

4. Ask whether informal resolution is available without giving up appeal rights.

5. Ask what must be filed with the managed care organization and what can go to a state fair hearing.

6. Save proof of submission.

Official Wisconsin brain injury information

Wisconsin Department of Health Services publishes a traumatic brain injury information page with signs, prevention information, and state resources.

• Wisconsin DHS traumatic brain injury information

• Wisconsin DHS guide to approved TBI care units

A person who may have a recent brain injury should seek qualified medical care. The resource page does not replace an individual medical evaluation.

Medicaid long-term care starting point

Wisconsin Family Care is a Medicaid long-term care program for older adults and adults with disabilities. Aging and Disability Resource Centers help people learn about options and begin the eligibility process.

• Wisconsin Family Care

• How to apply for Family Care, Partnership, or PACE

Ask the Aging and Disability Resource Center which programs operate where you live, what functional and financial steps apply, and what written notice will be issued.

If services are denied, reduced, or stopped

Wisconsin explains that a managed care organization must send a notice of adverse benefit determination when it stops, denies, or reduces services. The state’s current instructions say a member can appeal through the managed care organization and may later request a state fair hearing.

• File an appeal with a Wisconsin managed care organization

• Family Care member help, grievances, and appeals

The state currently states that an MCO appeal generally must be filed within 60 days of the notice mailing date. It also explains that filing by the effective date may matter if you want services to continue during the appeal. Read the notice and act promptly.

Ask for communication support

Tell the plan or agency what makes the process accessible: more time to process spoken information, written summaries, a support person, an interpreter, large print, email copies, or remote participation. Ask that the accommodation request and response be documented.

What to record

• Program and MCO name.

• Care manager and member rights specialist.

• Service requested, current service, and proposed change.

• Notice date, effective date, and filing deadline.

• Health and safety consequences of a delay.

• Confirmation number or delivery proof for each submission.

More help from ABI Resources

• Brain Injury and Disability Help in Every State

• Medicaid Service Problems, Appeals, Complaints, and Federal Oversight

• Medicaid Service Problem Documentation Worksheet

Reviewed September 19, 2026. Verify current instructions on the linked government pages and your own notice. This page is general information, not legal or medical advice. Call 911 for an emergency or 988 for suicide or crisis support.