43.4 Core Plan Application

43.4.1 How to Apply 43.4.2 Processing Fee

43.4.2.3 Medicaid Certified Provider Processing Fee Policy

43.4.2.4 Community Based Organization Payment Options for the Processing Fee

43.4.2.6 Processing Fee as a Medical Expense

43.4.1 How to Apply

BadgerCare Plus Core Plan applications can be submitted online, in person, or by phone. To enroll in the BadgerCare Plus Core Plan, applicants will be asked to complete these steps:

Complete the request online at access.wisconsin.gov , by phone or in person.
Take a short survey about their health,
Pay a $60 non-refundable processing fee, and
Mail or fax proof of income and other information provided to:

Milwaukee County:

MDPU

PO Box 05676

Milwaukee WI 53205

Fax: 1-888-409-1979

Balance of State:

CDPU

PO Box 5234

Janesville, WI 53547-5234

Fax: 1-855-293-1822

NOTE: This PO Box is only for verification and other correspondence. Application fees should be sent to:

DHS

PO Box 93735

Milwaukee, WI 53293-0735

There is no mail-in application option for Core Plan applicants.

43.4.2 Processing Fee

A non-refundable processing fee is required before an application for the Core Plan can be processed, unless the fee is waived because the applicant /member is homeless or a tribal member. The applicant/member has 30 calendar days from the day the initial or renewal request for Core Plan is submitted to pay the fee. If the fee is not paid within 30 calendar days, the application will be withdrawn and will not be processed. Unmarried individuals residing together will each have their own application (1 fee per application required), married couples should apply on the same application (1 fee required). If a partial payment is submitted, the remaining amount must be paid by the 30th calendar day after the application was submitted or the application will be withdrawn. The partial fee payment will not be refunded. The processing fee will be applied to the payment of a Core member’s premiums if the member has a household income over 133% of the FPL and is thus required to pay premiums as a condition of eligibility. The current fee amount for all Core Plan applications is $60.

43.4.2.1 Waiver of Processing Fee

Homeless

The processing fee is waived for applicants who meet the federal Housing and Urban Development (HUD) definition of homeless:

A homeless individual lacks a fixed, regular, and adequate nighttime residence; and s/he has a primary nighttime residence that is:

- A publicly supervised or privately operated shelter designed to provide temporary living accommodations (including welfare hotels, congregate shelter and transitional housing for the mentally ill);
- An institution that provides a temporary residence for individuals intended to be institutionalized or an inpatient facility for mental health and/or substance abuse; or
- A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.

Tribal Members

The processing fee is waived for tribal members, the son or daughter of a tribal member, the grandson or granddaughter of a tribal member, or anyone otherwise eligible to receive Indian Health Services.

43.4.2.2 Methods of Payment

The processing fee may be paid by:

Credit card via ACCESS
Electronic check via ACCESS
Sending, check, credit card information, or money order to the DHS lockbox with an appropriate payment slip.

Checks and money orders should be mailed to the lockbox at:

DHS

P.O. Box 93735

Milwaukee, WI 53293-0735

NOTE: THIS P.O. BOX IS ACTUALLY A LOCKBOX. IT IS ONLY FOR PROCESSING FEES. VERIFICATION AND OTHER CORRESPONDENCE SHOULD BE SENT TO:

Milwaukee County:

MDPU

PO Box 05676

Milwaukee WI 53205

Fax: 1-888-409-1979

Balance of State:

CDPU

PO Box 5234

Janesville, WI 53547-5234

Fax: 1-855-293-1822

If a fee is returned for any reason (NSF, unsigned, foreign currency) prior to the time the application or renewal has been processed, the application or renewal will not be processed until the full fee is paid.

If a fee is returned for any reason after enrollment, the member will be contacted and given another chance to pay the fee. If the fee is still not paid, the enrollment will be terminated with timely notice and any benefits received during the enrollment period are considered a recoverable overpayment.

43.4.2.3 Medicaid Certified Provider Processing Fee Policy

Medicaid certified providers cannot pay enrollment fees on behalf of individual BadgerCare Plus Core Plan members. An offer by a Medicaid certified provider to pay a fee on behalf of a prospective Medicaid member may violate federal laws against kickbacks. These laws are federal criminal statutes that are interpreted and enforced by federal agencies such as the United States Department of Justice and the Department of Health and Human Services; Office of Inspector General. Organizations that are not Medicaid-certified providers may pay an enrollment fee on behalf of prospective Medicaid members according to the following procedures.

43.4.2.4 Community Based Organization Payment Options for the Processing Fee

Community based organizations may pay the annual, non-refundable $60 processing fee for the BC+ Plus Core Plan on behalf of one or more applicants. Medicaid certified providers cannot pay the processing fee on behalf of specific members. The following payment options are available:

Pay online using credit/debit card or electronic check using ACCESS and the ePayment system

- If a community based organization is assisting the individual complete their ACCESS application for BC+ Core Plan and wished to pay the processing fee immediately following the electronic signature and completion of the HNA, the organization could use their credit card, debit card or electronic check using the ePayment system.
- If they wish to pay using a credit/debit card or electronic check and the applicant is no longer at the organization, they would use Option 2 below.

Pay by phone using credit/debit card or electronic check

- If a community based organization would like to pay the processing fee for one or more BC+ Core Plan applicants using a credit/debit card or electronic check and are paying at a different time than the ACCESS application was submitted, they will need to call Member Services to make the payment(s).
- The community based organization will need to provide the following information:
- First and Last Name of each Applicant/Member
- ACCESS Tracking Number for each applicant or the CARES Case Number for each member
- Credit/Debit Card or Electronic Check Information
- Member Services will need to process each transaction separately. The ePayment System will currently not allow an amount greater than $60.00.
Note: The payment cannot be processed unless the applicant has electronically signed and submitted their ACCESS BC+ Core Plan application.

Pay by mail via check or money order
- If the community based organization wishes to pay the processing fee for one or more BC+ Core Plan applicants via the mail, they will complete these steps:

Retrieve and complete the Payment Form which is available on the web at: http://www.dhs.wisconsin.gov/forms/F0/F00623.pdf
The form will require the organization to type in the first and last name and the CARES Case Number for each applicant.
If they cannot print the form, they can also call the local agency and request a form to be mailed to them.

Note: Handwritten forms are not searchable in the US Bank tracking system.

- Send one check or money order for the entire amount along with the completed form to the lock box for entry.
- - The form will have instructions for making out the check or money order and the address of the lock box.
  - The lock box has instructions to deposit the check or money order and split the payment evenly to each applicant. If the amount is not enough, each applicant will be short and a partial fee letter will be mailed to each applicant.

43.4.2.5 Screening

All applicants will receive a pre-screening to determine potential eligibility for the Core Plan before the processing fee is collected. If an applicant does not appear to meet all eligibility requirements, s/he will be notified of that fact and discouraged from paying the processing fee. Written documentation of the reason why s/he does not qualify based on information provided will be made available if requested to access charitable care and community programs.

43.4.2.6 Processing Fee as a Medical Expense

The processing fee is considered a medical expense for FoodShare and can also be used toward meeting a Medicaid deductible .

This page last updated in Release Number: 12-02

Release Date: 10/05/12

Effective Date: 07/01/12