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• The member is residing in a service area where there is only one HMO available. • The member reports they are a Native American, American Indian, an Alaskan Native, or a member of a federally recognized tribe or has verified their tribal member status for eligibility purposes. • The member is eligible for both Medicaid and Medicare, often referred to as a dual eligible. • The member is eligible for benefits under MAPP. MAPP is a voluntary enrollment program. 21.6.2 HMO Selection and Assignment Members can choose an HMO after they are found eligible for SSI Medicaid, SSI-Related Medicaid, or MAPP. Individuals who are applying for benefits online through ACCESS can indicate an HMO preference when they submit their application. Indicating a preference does not guarantee the individual will be enrolled in the HMO they selected when they submitted the application, but the preference will be taken into account when assigning the member to an HMO after they become eligible for benefits. If the member did not indicate a preference when they submitted their application, an HMO will be assigned for the individual based on any previous enrollment in an SSI HMO or based on a round-robin HMO assignment. Enrollment in an SSI HMO is on an individual basis, meaning household members could be in different HMOs from other members of the household or their spouse. If the member was previously enrolled in an SSI HMO in the last 12 months, the member will be assigned to their previous HMO. For members who are required to enroll in an HMO, if the member never indicated a preference to begin with, they will be assigned to an HMO and will receive an HMO enrollment packet in the mail. The enrollment packet includes a cover letter with information on their assigned HMO and start date, an SSI HMO Program Guide (P-12770) with a list of available HMOs and their service areas, an enrollment form, and instructions on how to choose or change an HMO. Voluntary members will also receive an HMO enrollment packet but will not be assigned to an HMO. They will receive a cover letter explaining they are not required to enroll in an HMO but can choose one if they want to. To select an HMO, check their current enrollment status, or make a change to their current enrollment, members can:

Log in to their ACCESS account and navigate to the “Manage My HMO” tab.

Complete and return the HMO Enrollment Choice form by mail.

Call the HMO Enrollment Specialist by phone at 1-800-291-2002. Members with questions about their rights as HMO members or concerns about the care they receive from the HMO may contact the HMO Ombuds. The HMO Ombuds can assist members in researching and resolving grievances or conflicts about their care. HMO Ombuds P.O. Box 6470 Madison, WI 53791-9823 Phone: 1-800-760-0001 (Monday through Friday from 8 a.m. to 4:30 p.m.) The SSI Managed Care External Consumer Advocate also provides advocacy services for SSI Medicaid HMO members with a disability. Members can contact the SSI Managed Care External Consumer Advocate at 800-928-8778 from 8:30 a.m. to 5 p.m., Monday through Friday.