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Section 3. Methods of Delivery and Utilization Controls (Section 2102)(a)(4))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 4.

3.1 Describe the methods of delivery of the child health assistance using Title XXI funds to targeted low-income children. Include a description of the choice of financing and the methods for assuring delivery of the insurance products and delivery of health care services covered by such products to the enrollees, including any variations. (Section 2102)(a)(4) (42 CFR 457.490(a))

BadgerCare Plus Enrollment Process. Enrollment for BadgerCare Plus will use the same enrollment process that is currently used for Medicaid. We believe it is necessary to have coordinated eligibility determinations and subsequently enrollment into Medicaid managed care (or fee-for-service when required) for both Medicaid and BadgerCare Plus because we expect many families to have both Title 19 and Title 21 eligibles. Applications can be made using an Internet application, available at www.access.wisconsin.gov, that allows families to apply for Medicaid, SCHIP and Food Stamps on-line, in-person at county human services offices or through the mail.

Like Medicaid, for most recipients, health care benefits will be delivered through a managed care system. In areas of the State that do not have HMO services available, and in counties where there is only one HMO in operation (except in areas designated as rural exception counties), BadgerCare Plus is available on a fee-for-service basis.

Recipients determined eligible for BadgerCare Plus are provided a packet of informational materials regarding the plans available to them in their area and will be required to select an HMO. The enrollment date is the earliest possible month after a family has chosen an HMO. Recipients will be covered on a fee-for-service basis until HMO enrollment is effective.

As described in sections 2.3 and 5.1 of this document, has streamlined the process to the greatest extent possible to allow families to apply for BadgerCare Plus at locations convenient to them that fit their schedule, through an Internet website (https://access.wisconsin.gov/) and through telephone and mail-in application processes.

Current Medicaid Managed Care Process. All AFDC Medicaid, AFDC-related Medicaid and Healthy Start eligible recipients throughout the state are eligible to participate in the Wisconsin BadgerCare Plus HMO program.

Once eligibility is established, recipients receive an enrollment packet including a list of available HMOs, how to choose an HMO and who to contact for assistance in

WISCONSIN

Effective Date:

Approval Date: 10