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determining if their current health care provider is participating in an HMO. Recipients may enroll by phone or by mailing in the HMO enrollment choice form. Recipients may make a choice at any time within the process by sending in the enrollment form or contacting the enrollment contractor and enrolling over the telephone.

If a recipient has not chosen an HMO within two weeks of receiving an enrollment packet, a reminder card is sent encouraging them to send in their HMO choice form or contact the enrollment contractor for assistance. At the same time, the enrollment contractor is supplied the list of recipients who were sent reminder cards for the purpose of telephone and mail outreach.

If a recipient has not chosen an HMO after four weeks, the recipient is assigned to an HMO certified to provide services in the zip code the recipient resides. An enrollment form is sent with the notice of auto-assignment, giving the recipient a final opportunity to change HMOs if they are not satisfied with their assigned HMO. Recipients also receive a notice confirming enrollment in their assigned HMO for the following month, then later receive a BadgerCare Plus HMO identification card. Recipients are covered under fee-for-service until they are enrolled into an HMO.

Recipients are auto-assigned to HMOs on a random and equal basis up to each HMO’s enrollment limit. For example, if there are three available HMOs in a zip code, each will receive one-third of auto-assigned cases.

In addition, once recipients are in their first month of enrollment in an HMO, whether they have chosen or have been assigned, they still have the opportunity to change to a different HMO during that month.

Enrollment Contractor. Wisconsin contracts with a statewide enrollment contractor to provide assistance, education and outreach to BadgerCare Plus and Medicaid recipients regarding the managed care program. The enrollment contractor’s role is to perform enrollment, education, outreach and advocacy for Medicaid managed care enrollees. The enrollment contractor is a knowledgeable single point of contact for enrollees, solely dedicated to managed care issues. It is a resource where enrollees can receive help in making the appropriate choices and resolving problems. Recipients may call a toll free phone number to obtain assistance in selecting an appropriate HMO or may have a face- to-face meeting at numerous sites across the State.

The State intends to expand the services of the enrollment contractor and incorporate additional outreach and education functions to support enrollment for BadgerCare Plus. These additional functions will include after-hours availability. Currently the enrollment contractor is available by phone from 8:00 a.m. to 6:00 p.m. and in person at six regional sites from 8:00 a.m. to 4:30 p.m.

WISCONSIN

Effective Date:

Approval Date: 11