MedicaidAdministrativeMedium impact
Copayment and Service Limitations Reset with HMO Enrollment for Members in BadgerCare Plus Core Plan for Adults with No Dependent Children
Wisconsin Medicaid (ForwardHealth)·WI · Physical Therapy, Occupational Therapy, Speech Therapy·Medical Policy
Effective date
Oct 1, 2009
We identified it
Jun 20, 2026
Summary
For BadgerCare Plus Core Plan members, copayment limits and service limitations reset when members transition between HMO enrollment and fee-for-service or switch between HMOs. This means previously used copayments and service limits (like the 20-visit therapy limit) start over with each enrollment change.
Action Required
Immediately: Billing team must verify BadgerCare Plus Core Plan member enrollment status before each service to determine current HMO vs fee-for-service status. Call Provider Services to check remaining service limitations for each member, as limits may have reset due to enrollment changes. Update workflows to track enrollment transitions that reset copayment and service limits.