My Choice Wisconsin

What My Choice Wisconsin does

My Choice Wisconsin is a Wisconsin-based Managed Care Organization (MCO) and Health Maintenance Organization (HMO) that contracts with Wisconsin Medicaid and the federal Medicare program to deliver long-term care, health services, and dual-eligible coverage. Originally founded in 2000 (previously known as Care Wisconsin following an internal merger), the company is now a subsidiary of Molina Healthcare Inc. (NYSE: MOH) following a 2025 operational integration that combined MCW and Molina systems.

The organization runs three core programs: Family Care, a Medicaid-funded program coordinating home and community-based long-term care for frail elders and adults with intellectual, physical, or developmental disabilities; Partnership, a PACE-style program for members with higher care needs that integrates medical, behavioral, and long-term care services with Medicare drug coverage; and Medicare Dual Advantage, an HMO Special Needs Plan for individuals eligible for both Medicare and Medicaid. Each member is supported by a dedicated care team consisting of a Care Manager and a Registered Nurse, with access to self-directed supports (the ability to hire one's own caregivers), employment support, and supplemental benefits including dental, vision, hearing, and Over-the-Counter allowances administered through NationsBenefits. Quality performance is validated by annual HEDIS compliance audits, External Quality Review by Metastar, Inc., and a 4-out-of-5 CMS Star Rating achieved in plan year 2023.

The underlying technology platform is a healthcare managed-care stack rather than a software product: care coordination systems, Electronic Visit Verification (EVV) for Medicaid-covered personal care services, provider network management tools, and integrations with TriZetto (Cognizant) for claims processing, EnvisionRx for pharmacy benefit administration, NationsBenefits for OTC benefits, ForwardHealth for Wisconsin Medicaid enrollment, and CAQH ProView for provider credentialing. A new web-based Provider Network Management Portal (ProviderTrak) is scheduled to launch in July 2026. Revenue is generated through capitation payments from Wisconsin Medicaid and CMS for covered lives; member outreach runs through Aging and Disability Resource Centers (ADRCs), community advocacy partners, and a statewide network of 90+ hospitals, 1,900+ primary care providers, and nearly 10,000 facility locations across 34 to 44 Wisconsin counties depending on the program.

Name

My Choice Wisconsin

Legal name

My Choice Wisconsin

Website

https://mychoicewi.org

Company type

Private

Founded year

2000

Operating status

Operating

Headcount range

11–50 employees

Short description

My Choice Wisconsin is a Wisconsin-based Managed Care Organization and HMO, now part of Molina Healthcare, delivering Medicaid-funded Family Care, Partnership, and Medicare Dual Advantage programs to frail elders, adults with disabilities, and dual-eligible members across up to 44 Wisconsin counties.

Ownership category

akta.pro rank

Product category

Managed Care Services (Medicaid and Medicare)

NAICS

HMO Medical Centers (621491), Services for the Elderly and Persons with Disabilities (624120), Nursing and Residential Care Facilities (623)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Medicaid Managed Care HMOs (HLAEAMAI)

akta.pro secondary industry

Benefits, Insurance & Long-Term Care Planning Navigation (Medicare/Medicaid/LTC) (HLADALAI)

Keywords

• Medicaid managed care
• Medicare Advantage plans
• Long-term care coordination
• Dual-eligible health plans
• Home and community-based services

Headquarters

HQ city

Milwaukee

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure

Revenue model

1. Government Healthcare Programs: My Choice Wisconsin operates as a Managed Care Organization (MCO) receiving capitated payments from Wisconsin Medicaid and Medicare programs to provide long-term care and health services to eligible members including frail elders, adults with disabilities, and dual-eligible beneficiaries.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels5 records

Core offering

My Choice Wisconsin is a Managed Care Organization and HMO that operates three government-funded programs in Wisconsin: Family Care (Medicaid long-term care coordination for frail elders and adults with disabilities), Partnership (a PACE-style program for higher-need members coordinating medical, health, and long-term care with Medicare drug coverage), and Medicare Dual Advantage (an HMO SNP plan for dual-eligible beneficiaries providing coordinated healthcare with supplemental benefits and no premiums). The organization receives capitated payments from Wisconsin Medicaid and Medicare to deliver care plans managed by dedicated Care Managers and Registered Nurses, supported by self-directed supports, an extensive provider network across 90+ hospitals and roughly 10,000 facility locations, and integrated pharmacy and supplemental benefits.

Product overview

My Choice Wisconsin is a Managed Care Organization (MCO) and Health Maintenance Organization (HMO) offering three core programs: Family Care (Medicaid-funded long-term care for frail elders and adults with disabilities), Partnership (PACE-style program with higher care needs including Medicare drug coverage), and Medicare Dual Advantage (HMO SNP for dual-eligible individuals). The organization is part of Molina Healthcare and operates across Wisconsin counties. Core programs include Self-Directed Supports (allowing members to hire their own caregivers), Employment Support, Care Team coordination, and pharmacy services. Medicare Dual Advantage and Partnership include supplemental benefits such as dental, vision, hearing, and Over-the-Counter allowances managed through NationsBenefits.

Differentiator

Problem solved

Functional benefit

Brands

• Family Care: A Medicaid-funded program helping frail elders and adults with disabilities coordinate their home and community-based long-term care needs.
• Partnership
• Medicare Dual Advantage

Products and services

• Family Care Medicaid-funded managed care program helping frail elders (65+) and adults (18+) with intellectual, physical, or developmental disabilities coordinate their home and community-based long-term care needs through dedicated care teams, self-directed supports, employment support, and care planning.
• Family Care Partnership (Partnership) PACE-style integrated program for frail elders and adults with disabilities who have higher care needs, coordinating their medical, health, and long-term care services along with Medicare drug coverage through dedicated care teams and an extensive provider network.
• Medicare Dual Advantage HMO SNP Medicare Advantage plan for individuals who qualify for both Medicaid and Medicare, offering coordinated healthcare with no monthly premiums or deductibles plus supplemental benefits including prescription medications, dental, vision, hearing, OTC allowance, PERS, Silver&Fit fitness, and readmission-prevention meal services.

Quantifiable outcome

• 4 out of 5 stars in CMS Medicare Star Ratings (2023)
• +1 more outcomes

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration9 records

Feature2 records

Partnerships

Ten partnerships are on record, tiered minor and core.

• Best BuddiesminorStrategic or Co-development PartnerAdvocacy organization partnership providing opportunities for people with intellectual and developmental disabilities through friendship, employment, and leadership development programs.
• GiGi's PlayhouseminorStrategic or Co-development PartnerDown syndrome achievement center partnership providing educational, therapeutic, and career preparation programs for individuals with Down syndrome.
• Association for the Rights of Citizens with handicaps (ARCh)minorStrategic or Co-development PartnerAdvocacy organization partnership focused on promoting rights and independence for individuals with disabilities.
• The Arc WisconsinminorStrategic or Co-development PartnerState chapter of national advocacy organization working to promote and protect the rights of people with intellectual and developmental disabilities.
• Wisconsin BPDDminorStrategic or Co-development PartnerWisconsin Board for People with Developmental Disabilities partnership supporting self-advocacy and inclusion.
• DSAminorStrategic or Co-development PartnerDown syndrome advocacy organization partnership providing resources and support for individuals with Down syndrome and their families.
• Molina HealthcarecoreStrategic or Co-development PartnerParent company relationship. My Choice Wisconsin is now part of Molina Healthcare Inc. Medicaid SSI and BadgerCare Plus services transitioned to Molina in 2025. Medicare Dual Advantage products combined onto MCW systems.
• EnvisionRxcoreTechnology or IntegrationPharmacy benefit management partnership providing pharmacy directory locator services and prescription drug coverage administration for Partnership and Medicare Dual Advantage members.
• NationsBenefitscoreTechnology or IntegrationOver-the-counter benefits administration partnership providing OTC card and catalog services for Medicare Dual Advantage and Partnership members.
• Cognizant (TriZetto)coreTechnology or IntegrationClaims processing platform partnership providing electronic claims submission portal and electronic funds transfer capabilities for providers.

Scale indicators7 records

Recent moves7 records

Expansion highlights4 records

Direct peers

• Molina Healthcare: Parent company (NYSE: MOH) and the most direct comparable as a national Medicaid managed care operator. MCW is a Wisconsin subsidiary of Molina following the 2025 integration.
• Chorus Community Health Plans: Wisconsin-based nonprofit MCO offering BadgerCare Plus, Medicaid SSI, and Medicare Advantage plans. Direct competitor for the same Wisconsin Medicaid and dual-eligible populations MCW serves.
• Network Health: Wisconsin-based health plan owned by Froedtert Health offering Medicare Advantage and Medicaid plans in eastern Wisconsin. Competes with MCW for dual-eligible and Medicaid members in the Milwaukee metro.
• Security Health Plan: Wisconsin-based HMO offering Medicare Advantage and Medicaid plans. Regional peer competing for dual-eligible beneficiaries across central and western Wisconsin.
• iCare (Independent Care Health Plan): Wisconsin-based MCO specializing in Medicaid SSI and BadgerCare Plus members, particularly those with complex needs. Direct competitor in the same Wisconsin Medicaid SSI market that MCW transitioned to Molina.

Broad incumbents

• Centene Corporation: One of the largest U.S. Medicaid managed care operators (NYSE: CNC), operating multiple state Medicaid plans including Wisconsin. Broad incumbent competing for the same dual-eligible and Medicaid populations at a national scale.
• Elevance Health (Anthem): National managed care company (NYSE: ELV) operating Blue Cross plans including in Wisconsin with Medicare Advantage and dual-eligible Special Needs Plans. Large incumbent with overlapping products and broader portfolio.
• Humana: National leader in Medicare Advantage (NYSE: HUM) with Dual-Eligible Special Needs Plans (D-SNPs). Comparable in dual-eligible focus but at a national scale across a much broader portfolio.
• UnitedHealth Group (Optum): Largest U.S. health insurer (NYSE: UNH) operating Medicare Advantage plans including D-SNPs nationwide. Provides broad competitive context for the dual-eligible SNP segment MCW serves.

Emerging players

• CareSource: Nonprofit Medicaid-focused MCO operating across multiple states with a strong dual-eligible focus. Comparable in mission and product mix, though not currently a major Wisconsin presence.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/molina-healthcare
• Xx.com/MyChoiceWI

Compliance6 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about My Choice Wisconsin