State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
Most BadgerCare Plus members who are eligible for BadgerCare Plus and reside in a BadgerCare Plus HMO service area must enroll in an HMO.
Members may choose their own HMO or work with the HMO Enrollment Specialist to choose the best one for their needs. They may choose at any time during the enrollment process. All eligible members of the member’s family must choose the same HMO. However, individuals within a family may be eligible for an exemption from enrollment.
This is the enrollment process:
Exemptions: A member may qualify for an exemption from HMO enrollment if he or she meets certain criteria, such as a chronic illness, high-risk third trimester pregnancy, or continuity of care concerns, etc.
If the member believes he or she has a valid reason for exemption, he or she should call the HMO Enrollment Specialist at 1-800-291-2002. The number is also in the enrollment materials he or she receives.
Members who lose BadgerCare Plus eligibility, but become eligible again may be automatically re-enrolled in their previous HMO.
If the member’s eligibility is re-established after a Restrictive Re-enrollment Period ( RRP ), he or she will be automatically re-enrolled in the previous HMO, unless the HMO is no longer accepting reassignments.
After six months, or if the HMO is no longer accepting reassignments or has exceeded its enrollment level, he or she will receive an enrollment packet, and the enrollment process will start over.
Note: | The policies in this section also apply to members whose BadgerCare Plus is suspended due to incarceration but they regain full BadgerCare Plus eligibility once they are released from jail or prison. |
Members are automatically disenrolled from the HMO program if:
Members can be disenrolled by the HMO’s request if they need an experimental transplant. HMO disenrollment is not automatic in this situation.
Members who move out of the HMO service area receive a new packet showing the HMO(s) available in the new area and the enrollment process begins again. If no HMO covers the member’s new area, he or she remains fee-for-service.
Members with questions about their rights as HMO members may call 1-800-760-0001 or write:
HMO Ombudsman
P.O. Box 6470
Madison, WI 53791-9823
This page last updated in Release Number: 20-04
Release Date: 11/23/2020
Effective Date: 10/24/2020
The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.
Publication Number: P-10171