State of Wisconsin Department of Health Services

Release 24-03 November 15, 2024

15.2 Apply for Benefits: Applicant

After submitting an application for health care using Apply for Benefits (AFB), the person can choose an HMO preference if there is a household member who may be eligible for BadgerCare Plus or SSI Medicaid. 

Note	When the person chooses an HMO, or chooses to have an HMO selected for them, they are not enrolled in an HMO at that time.  Only after their application is processed and they are found eligible for BadgerCare Plus or SSI Medicaid can they be enrolled in an HMO they chose earlier.

15.2.1 Apply for Benefits Home

On the Apply for Benefits Home screen, a to-do list will display. 

Click the Choose your HMO tab to expand and get to the HMO section. 

15.2.2 Choose an HMO

Applicants can choose a preferred HMO before they are approved for health care. The HMOs available to choose depends on whether they are expected to go into BadgerCare Plus or SSI Medicaid. 

15.2.2.1 Choose a BadgerCare Plus HMO

This screen displays when the applicant is expected to enter BadgerCare Plus. The names of household members that may be eligible for BadgerCare Plus will display. 

Note	All members in the household enrolled in BadgerCare Plus must be enrolled in the same HMO.

Choose an HMO (or two) by selecting one of the following options:

• Yes
• No, please select for me
• Skip this step

Note	Applicants can click Try our Compare HMOs tool to get to the Compare HMOs screen for useful information on choosing an HMO (see Section 15.3.1.2 Compare HMOs).

15.2.2.1.1 Choose an SSI Medicaid HMO

This screen displays when the applicant is expected to enter SSI-Related Medicaid. The names of household members that may be eligible for this program will display. 

Note	If there is more than one member in the household enrolled in SSI-Related Medicaid, these members can enroll in the same HMO or in different HMOs.

Choose an HMO (or two) by selecting one of the following options:

• Yes
• No, please select for me
• Skip this step

Note	Applicants can click Try our Compare HMOs tool to get to the Compare HMOs screen for useful information on choosing an HMO (see Section 15.3.1.2 Compare HMOs).

15.2.2.2 Yes

After choosing Yes, select the radio button for an HMO.

If more than one HMO is available and the applicant wants to make a second choice, click Choose a second HMO and select the radio button for that second HMO choice. 

 
Applicants will only see HMOs in their primary service area (and not HMOs in the extended service area).

Applicants who have only one HMO plan available in their service area can select that HMO or select Fee for Service coverage (which allows a person to choose any doctor or clinic that accepts BadgerCare Plus or SSI Medicaid and is open to new patients). 

Click Next to get to the Review your HMO choices screen.

15.2.2.3 Skip this step

After choosing Skip this step, the following pop-up window displays:

• Click Choose an HMO to return to the Choose an HMO screen.
• Click Skip this step to get to the Review your HMO choices screen.

15.2.3 Review your HMO Choice 

On the Review your HMO choice screen, review the choices(s) made by the applicant, the choice made for them automatically, or no choice made by the applicant. 

15.2.3.1 HMO Choice Made by or for the Applicant 

On this screen, review the HMO plan choice(s) for the applicant and people in the household who would be enrolled in the plan if their health care is approved.

15.2.3.2 No HMO Choice Made by the Applicant 

On this screen is the statement, "We will select one for you." The member will recieve a letter with the HMO selected for them.  

15.2.4 Changing an HMO Choice

People can see the status of their application from their ACCESS homepage or the Results page. They can change their choice of HMO, but only when the application is in a Submitted status (which means the Income Maintenance agency has not yet processed it). 
To update an HMO choice, the applicant can either: 

• Click Manage your HMO choice on the ACCESS homepage.
• Click Update Choices on the Manage your HMO screen  

Note	After the health care application is processed, a member can change their HMO enrollment in Check My Benefits (see Section 15.3.1.1 Change HMO) or by calling an HMO enrollment specialist at 1-800-291-2002.

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Notice: The content within this guide is the responsibility of the State of Wisconsin's Department of Health Services (DHS) and the Department of Workforce Development (DWD).

Publication Number: P-16101