MedicaidAdministrativeMedium impact
Review of recipients eligible to be enrolled in a Wisconsin Medicaid and BadgerCare HMO
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Feb 1, 2003
We identified it
Jun 20, 2026
Summary
This policy clarifies Wisconsin Medicaid and BadgerCare HMO enrollment eligibility, specifying which recipients are eligible (AFDC/AFDC-Related, BadgerCare, Healthy Start) versus excluded (Family Planning Waiver, SeniorCare, Wisconsin Well Woman). It outlines mandatory vs. voluntary enrollment based on ZIP codes, open enrollment periods, and provides contact information for HMO programs.
Action Required
Billing team should verify patient HMO enrollment status for Wisconsin Medicaid and BadgerCare recipients before submitting claims. Use the Service Area Grid on the Wisconsin Medicaid website to confirm enrollment requirements by ZIP code. Contact the Enrollment Specialist at (800) 291-2002 for questions about patient enrollment eligibility or exemptions.