MedicaidCoverageHigh impact
Changes to BadgerCare Plus Basic Plan Copayments and Service Limitations
Wisconsin Medicaid (ForwardHealth)·WI · Emergency Medicine, Radiology, Pain Management +4 more·Medical Policy
Effective date
Jan 1, 2011
We identified it
Jun 20, 2026
Summary
BadgerCare Plus Basic Plan members will face new copayments and service limits starting January 1, 2011, including $10 copayments for brand name drugs and vaccines, $5-20 copayments for radiology services, reduced emergency room visits from 5 to 2 per year, and a 5-prescription monthly limit on opioids. Members with certain serious conditions can bypass waitlists to enroll in the Core Plan.
Action Required
By January 1, 2011: Billing team must update system to collect new copayments - $10 for brand name drugs (Humalog, Lantus, Tamiflu, Relenza) and vaccines, $5 for X-rays/ultrasounds/mammograms, $20 for CT/MRI/MRA/PET scans. Update encounter forms to track opioid prescriptions (max 5 fills per month) and emergency room visits (max 2 per enrollment year). Train front desk staff to inform eligible patients about Core Plan bypass process for cancer, heart conditions, or combined hypertension/high cholesterol.