If you are eligible for Wisconsin Medicaid for the Elderly, Blind, or Disabled or SSI Medicaid, you will be enrolled for 12 months unless there are changes that impact your eligibility. While enrolled, you may need to know about the following:
Using Your ForwardHealth Card
Shortly after you become enrolled in a Medicaid plan, you will get a plastic ForwardHealth card in the mail, unless you used to be enrolled in Medicaid, BadgerCare Plus, or the Family Planning Only Services Program.
If you used to be enrolled in Medicaid, BadgerCare Plus, or the Family Planning Only Services Program, you will not automatically get a new ForwardHealth card. You can use the same card you used before if you still have it. If you did not keep your ForwardHealth card, you can ask for a new card through your ACCESS account or by calling Member Services at 800-362-3002.
Your ForwardHealth card will include your name, a 10-digit identification number, a magnetic stripe, a place for your signature, and the Member Services telephone number. Once you get your ForwardHealth card, you should sign it in the space provided.
You will need to show your ForwardHealth card when you have an appointment or pick up a prescription at a pharmacy.
Picking an HMO
Certain people enrolled in Medicaid for the Elderly, Blind, or Disabled or SSI Medicaid get their health care through HMOs (health maintenance organizations). If you need to pick an HMO, you will be sent an HMO choice enrollment booklet and a letter telling you which HMOs you can choose from. If you do not choose an HMO by the deadline in the letter, one will be picked for you. To enroll in an HMO or have your HMO questions answered, call an HMO enrollment specialist at 800-291-2002.
Keep in mind, if you have a particular provider you want to see, you should check to make sure the provider is in the HMO network you select, or you may have to change providers.
Here is information to help you pick your HMO:
|HMO||Counties Covered by HMO|
|Adams, Brown, Calumet, Clark, Columbia, Crawford, Dane, Dodge, Door, Fond du Lac, Grant, Green, Green Lake, Iowa, Jackson, Jefferson, Juneau, Kewaunee, La Crosse, Lafayette, Manitowoc, Marquette, Monroe, Oconto, Outagamie, Ozaukee, Richland, Rock, Sauk, Shawno, Sheboygan, Trempealeau, Vernon, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago|
|Adams, Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Clark, Columbia, Crawford, Douglas, Dunn, Eau Claire, Forest, Grant, Green, Iowa, Iron, Jackson, Juneau, La Crosse, Lafayette, Langlade, Lincoln, Marathon, Monroe, Oneida, Pepin, Pierce, Polk, Portage, Price, Richland, Rusk, St. Croix, Sauk, Sawyer, Shawano, Taylor, Trempealeau, Vernon, Vilas, Washburn, Wood|
|Adams, Brown, Calumet, Columbia, Crawford, Dane, Dodge, Door, Fond du Lac, Grant, Green, Green Lake, Iowa, Jackson, Jefferson, Juneau, Kenosha, Kewaunee, La Crosse, Manitowoc, Marinette, Milwaukee, Monroe, Oconto, Outagamie, Ozaukee, Racine, Richland, Rock, Sauk, Shawano, Sheboygan, Trempealeau, Vernon, Walworth, Washington, Waukesha, Waupaca, Winnebago|
|Brown, Calumet, Dodge, Door, Florence, Fond du Lac, Forest, Green Lake, Jefferson, Kenosha, Kewaunee, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago|
You must report any of the following changes within 10 days of the change:
- You move to a new address.
- Someone moves in or out of your home.
- Someone becomes pregnant or gives birth.
- Your living arrangement changes (for example you are incarcerated or you go into a nursing home).
- You get married or divorced.
- Someone in your home has a change in health insurance.
- Someone has a change in expected tax filing status.
If you have a change in income that makes your gross monthly income go over the Medicaid limit, you must report the change by the 10th day of the next month. You can report changes to your local income maintenance agency or tribe, online through ACCESS, or by using the Medicaid Change Report, F-10137.
Medicaid for the Elderly, Blind, or Disabled and SSI Medicaid covers the services listed below. These services could change, so you should always check with your provider or call Member Services at 800-362-3002 for the most up-to-date information about whether a service you need is covered and if there are any limits on the services you need.
- Case management services
- Chiropractic services
- Dental services
- HealthCheck: Preventive health care for children and young adults through age 20 (Early and Periodic Screening, Diagnosis and Treatment benefit)
- Some home and community-based services
- Home health services or nursing services if a home health agency is unavailable
- Hospice care
- Inpatient hospital services other than services in an institution for mental disease
- Inpatient hospital, skilled nursing facility, and intermediate care facility services for patients in institutions for mental disease who are 65 years of age or older
- Intermediate care facility services, other than services at an institution for mental disease
- Laboratory and X-ray services
- Medical supplies and equipment
- Mental health and medical day treatment
- Mental health and psychosocial rehabilitative services, including case management services, provided by staff of a certified community support program
- Nursing services, including services performed by a nurse practitioner
- Optometric/optical services, including eye glasses
- Outpatient hospital services
- Personal care services
- Physical and occupational therapy
- Physician services
- Podiatry services
- Prescription drugs and over-the-counter drugs
- Respiratory care services for ventilator-dependent individuals
- Rural health clinic services
- Skilled nursing home services other than in an institution for mental disease
- Smoking cessation treatment
- Speech, hearing, and language disorder services
- Substance abuse (alcohol and other drug abuse) services
- Transportation to obtain medical care
- Tuberculosis (TB) services
A copay is a set amount of money you pay for a medical service. You pay this amount each time you get a service.
Who has to pay copays?
You may have to pay copays if your monthly income is more than the amount listed in the table below for your family size.
|Family Size||Monthly Income|
Who does not have to pay copays?
The following members do not have to pay copays:
- American Indians or Alaska Natives of any age or income level who get or have gotten health items or services from an Indian health care provider or by referral under contract health services
- People getting hospice care
- Nursing home residents
How much are copays?
Most copays are between $0.50 and $3.00, depending on the service. If you get more than one service, you may have more than one copay.
|Cost of Services||Copay|
|Up to $10.00||$0.50|
|From $10.01 to $25.00||$1.00|
|From $25.01 to $50.00||$2.00|
Is there a limit to the amount I pay each month?
Yes. Your copay amount will never be more than 5% of your total income before taxes or other deductions. Your monthly copay limit is based on your income, your family size, and who in your household has copays.
If you owe copays, you will get a letter titled "About Your Benefits," letting you know how much your monthly copay limit is.
If your copays reach your limit before the end of a month, you will get another letter letting you know. You will not have to pay copays for the rest of the month.
Renewing Your Coverage
Your coverage must be renewed yearly. About one month before your coverage ends, you will get a letter with information about how to renew your coverage.