MedicaidAdministrativeMedium impact
Clarification of Copayment Exemptions for BadgerCare Plus and Medicaid Members
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Apr 1, 2015
We identified it
Jun 20, 2026
Summary
BadgerCare Plus and Wisconsin Medicaid clarified copayment exemptions, adding that children under 18 who are blind or disabled and receive SSI or SSI-related Medicaid are exempt from all copayments. The policy also provides a comprehensive list of member categories and services that are exempt from copayment collection.
Action Required
Immediately: Billing team must update patient eligibility verification process to identify BadgerCare Plus and Wisconsin Medicaid members who are exempt from copayments, including children under 18 receiving SSI or SSI-related Medicaid. Update front desk procedures to check Wisconsin's Enrollment Verification System (EVS) for exemption status before collecting copayments. Train staff on the expanded list of exempt member categories to avoid improper copayment collection.