COVID-19 Update: Presumptive eligibility for BadgerCare Plus Express Enrollment through the online Express Enrollment application in ACCESS for Partners and Providers has been expanded.
The table below lists the populations that are included in expanded presumptive eligibility, the populations that are currently included in presumptive eligibility, and the qualified entities that may complete Express Enrollment for those populations.
|Qualified Hospitals||Qualified Providers||Qualified Partners|
|Presumptive eligibility is expanded to include:|
|Adults age 65 and older with an income of up to 100% of the federal poverty level (FPL)||X|
|Adults who are blind or disabled and who are enrolled in Medicare with an income of up to 100% of the FPL||X|
|Presumptive eligibility continues to include:|
|Non-blind, non-disabled adults with an income of up to 100% of the FPL||X|
|Pregnant women with an income of up to 306% of the FPL||X||X|
|Individuals with an income of up to 306% of the FPL who want Family Planning Only Services||X||X|
|Children younger than age 1 in households with an income of up to 306% of the FPL||X||X||X|
|Children ages 1–5 in households with an income of up to 191% of the FPL||X||X||X|
|Children ages 6–18 in households with an income of up to 156% of the FPL||X||X||X|
Note: The online Express Enrollment application in ACCESS for Partners and Providers and the process for submitting an application have not changed.
The Express Enrollment page of the ForwardHealth Portal contains information about becoming a qualified hospital, provider, or partner for making presumptive eligibility determinations.
More information is available in Alert 014, titled “ForwardHealth Will Expand Presumptive Eligibility for Express Enrollment (Hospitals),” which is available on the COVID-19: ForwardHealth Provider News and Resources Portal page.
This page is intended for partners to serve as a central resource for Express Enrollment.
What Is Express Enrollment?
Express Enrollment is the online application used in ACCESS to make presumptive eligibility determinations to temporarily enroll individuals in BadgerCare Plus or Family Planning Only Services until a full application is completed and processed. Presumptive eligibility determinations are based on preliminary household and financial information provided by the applicant. This process allows the applicant to receive immediate health care coverage, for a short period of time, while his or her full application for ongoing BadgerCare Plus or Family Planning Only Services is completed and processed.
- Express Enrollment: The process of making a presumptive eligibility determination to temporarily enroll an individual in BadgerCare Plus or Family Planning Only Services.
- Presumptive eligibility: The determination of whether or not an applicant is eligible to temporarily enroll in BadgerCare Plus or Family Planning Only Services.
- Temporary enrollment: Short-term eligibility for BadgerCare Plus or Family Planning Only Services.
Who Can Make Presumptive Eligibility Determinations?
|Presumptive Eligibility Determinations for|
|Children||Pregnant Women||Family Planning
|Adults Younger than Age 65,
Parents, and Caretakers
Qualified Hospitals and Providers
Hospitals that are Medicaid-enrolled and certified through ForwardHealth for Express Enrollment will be considered a qualified hospital. Providers that are Medicaid-enrolled and certified through ForwardHealth as an Express Enrollment provider will be able to make presumptive eligibility determinations for children, pregnant women, and Family Planning Only Services.
Qualified hospitals and providers interested in making presumptive eligibility determinations may access the online provider enrollment application via their secure ForwardHealth Portal account.
Partners who meet the Express Enrollment criteria and are certified through ForwardHealth as an Express Enrollment partner will be able to make presumptive eligibility determinations for children.
- Enrollment Criteria for Partners and Providers to Provide Express Enrollment of Children in BadgerCare Plus, F-11318 (PDF)
- ForwardHealth Portal Express Enrollment Partner Application
Note: This application is only for partners and will only allow the partner to make presumptive eligibility determinations for children. Hospitals and providers should access the online provider enrollment application via their secure ForwardHealth Portal account.
Express Enrollment Training
The presentation meets the Express Enrollment training requirement for partners, providers, and qualified hospitals that are approved by ForwardHealth to complete Express Enrollment applications.
Information about Express Enrollment
- Chapter 12 of the ACCESS Handbook
- Family Planning Only Services—Temporary Enrollment
- BadgerCare Plus Temporary Health Insurance for Children Fact Sheet, P-10168
- BadgerCare Plus Temporary Health Insurance for Pregnant Women Fact Sheet, P-10169
- Example of the letter to members about temporary enrollment has ended
- Example of the letter to members about temporary enrollment has been extended
For questions about Express Enrollment, please email us.