MedicaidAdministrativeMedium impact
Cost Sharing Clarification for Medicaid, BadgerCare Plus Standard Plan, and BadgerCare Plus Benchmark Plan
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Nov 1, 2011
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid, BadgerCare Plus Standard, and BadgerCare Plus Benchmark plans have clarified cost sharing requirements and copayment exemptions. Providers must verify member exemption status through Wisconsin's Enrollment Verification System before collecting copayments, with specific exemptions for children in mandatory coverage categories, American Indians/Alaska Natives, and certain services like pregnancy-related care.
Action Required
Immediately: Billing team must verify all Wisconsin Medicaid and BadgerCare Plus member exemption status using Wisconsin's Enrollment Verification System (EVS) before collecting copayments. Update front desk procedures to check for 'no copay' designation in EVS. Train staff on exempt populations (children in foster care, American Indians/Alaska Natives, nursing home residents, etc.) and exempt services (pregnancy-related, family planning, immunizations, hospice). Do not deny services to Medicaid/Standard Plan members unable to pay copayments, but may deny services to Benchmark Plan members who fail to pay required cost share.