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Starting in January 2018, in order to provide high quality care for adult Wisconsin Medicaid members, certain Supplemental Security Income (SSI) members must enroll in an HMO of the member’s choice. Members who do not choose an HMO will have one chosen for them. HMO enrollment will be done by region with the last region enrolling by June 2018.
Members affected by this change will get a letter in the mail. See an example of the letter for Region 1. If you have questions about this process, call the HMO enrollment specialist at 1-800-291-2002. Members currently enrolled in an SSI HMO, children under age 18 with Medicaid SSI, tribal members, and members dually enrolled in Medicare are not affected.
When is the change happening?
If this change applies to you, you will get a letter with details sometime between December 2017 and May 2018 based on the region you live in. After your letter, you will also get an enrollment packet that includes an HMO program guide and HMO choice booklet (pictured below).
The change will begin based on the list below for the region you live in. A map below shows which region your county is in.
- February 2018: Region 1 (North)
- March 2018: Region 3 (West Central)
- April 2018: Region 5 (Southeast)
- May 2018: Region 6 (Milwaukee)
- June 2018:
- Region 2 (Northeast)
- Region 4 (South Central)
If you don't know the name of your county, you can find it by looking for your home town on the list of Wisconsin municipalities (PDF). You can click on the image below to make it larger.
What do I need to do?
When you get your letter and enrollment packet, review your HMO choices and select an HMO. Once you select your HMO, either call the HMO enrollment specialist to enroll in that HMO or mail the enrollment choice form found in your enrollment packet.
If you need help picking an HMO, you can call the HMO enrollment specialist to share what providers you currently see, and the enrollment specialist will let you know which HMOs have those providers in their network.
Who is and is not affected?
Who must enroll in an SSI HMO?
Medicaid SSI members must enroll in an SSI HMO if all of the following apply:
- You live in one of the SSI HMO service areas (refer to your enrollment packet).
- You are 19 years of age or older.
- You receive Medicaid SSI or SSI-related Medicaid because of a disability determined by the Disability Determination Bureau.
Who may enroll in an SSI HMO?
Medicaid SSI members may choose to enroll in an SSI HMO if any of the following apply:
- You get both Medicaid and Medicare.
- You are in the Medicaid Purchase Plan (MAPP).
- You only have one SSI HMO available in the area where you live.
- You are Native American and a member of a federally recognized tribe.
If any of these apply and you do not want to enroll in an SSI HMO, you do not need to take any action.
Who cannot enroll in an SSI HMO?
You cannot enroll in an SSI HMO if any of the following apply:
- You are 18 years of age or younger.
- You live in a medical facility or nursing home.
- You take part in a Home and Community-Based Waivers program, for example, Family Care, Family Care Partnership, IRIS (Include, Respect, I Self-Direct), or Program of All-Inclusive Care for the Elderly (PACE).
Where can I get more information?
Resources available to help you learn more about this change are available through the following:
- Medicaid SSI HMO Enrollment Changes Fact Sheet (P-02032)
- Medicaid SSI HMO Expansion Frequently Asked Questions (P-02045) (PDF)
- Attend a meeting in your region. Information for meetings for each region will be added when details become available. You can also view materials and videos for past meetings.
- Learn more about the HMOs in your area by going to the Medicaid member information page and click on "Picking an HMO." Here you will find each HMO's webpage, member handbook, and list of providers.
- Call the HMO enrollment specialist at 1-800-291-2002.
Benefits of Enrolling in an HMO:
Your HMO’s job is to provide you with the care you need when you need it. Your HMO has a variety of doctors, specialists, clinics, and hospitals for you to choose from. Your HMO will support you and help you get appointments with doctors or specialists that could be hard for non-HMO members to get. HMOs make sure that you are able to see a primary care doctor within 30 days of when you call and a behavioral health provider within 30 days after an inpatient mental health stay.
If you have a doctor or a provider that is not part of an HMO, your HMO will let you see that provider for 90 days to continue your care. If you have approval for a certain service under fee-for-service Medicaid, your HMO will let you continue to get that service from the same provider for 90 days.
Your HMO has a care manager who will:
- Support you.
- Work with you to develop a care plan to make sure you receive the care you need.
- Help you schedule appointments with providers.
- Review doctor instructions with you.
- Help you with your medications.
- Follow up with you after a hospitalization or an emergency room visit.
Your care manager will also help you with other issues that impact your well-being, like housing, employment, legal help, food security, transportation, and child care. Fee-for-service members do not have a care manager to help them.
Your HMO is required to provide you with all of the care you need while also meeting high standards of care. As part of the high-quality care HMOs provide, they will reach out to assess your health care needs so they can connect you to services, and they may provide reminders for important services you need.
If you have problems getting health care services, there are resources to help you. Resources include advocates, an ombudsman, and an enrollment specialist.