MedicaidAdministrativeHigh impact
Updated SSI HMO Enrollment Policy
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Feb 1, 2018
We identified it
Jun 20, 2026
Summary
Wisconsin is implementing mandatory SSI HMO enrollment for eligible SSI and SSI-related Medicaid members starting February 1, 2018, rolling out by region through June 2018. Most services must be billed to the SSI HMO, but certain carve-out services like behavioral health, pharmacy, and school-based services must continue to be billed to ForwardHealth on a fee-for-service basis.
Action Required
By February 1, 2018 (Region 1): Billing team must identify SSI and SSI-related Medicaid members and verify their HMO enrollment status before rendering services. Update billing workflows to submit claims to the member's SSI HMO for most services, but continue billing ForwardHealth directly for carve-out services including behavioral health, pharmacy, school-based services, and chiropractic care. Contact the member's SSI HMO before providing services to verify provider network requirements and claims submission processes.