MedicaidReimbursementHigh impact
Fee-For-Service Hospital Access Payments Ended for State Fiscal Year 2025
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Sep 10, 2025
We identified it
Aug 26, 2026
Summary
ForwardHealth is ending fee-for-service hospital access payments for acute care, long-term acute care, critical access, and rehabilitation hospitals effective September 10, 2025. Claims with process dates after September 10, 2025 for dates of service between July 1, 2024 and June 30, 2025 will no longer receive access payments. This affects BadgerCare Plus and Medicaid fee-for-service claims only; managed care organizations (HMOs) are unaffected.
Action Required
By September 10, 2025: Billing team must implement claims processing changes to stop applying hospital access payment adjustments to all fee-for-service hospital claims (inpatient and outpatient) processed after this date. Update billing system logic to identify and flag claims that would have previously qualified for access payments but are now ineligible due to process date. Verify that managed care claims for BadgerCare Plus, Medicaid SSI, and other HMO programs continue to process normally with access payments intact. Communicate with hospital finance teams and claim review staff that denied access payment denials are expected and not errors. Monitor remittance advice reports for the transition period, as a single RA may contain both eligible claims (processed before Sept 10) and ineligible claims (processed after Sept 10). No claims submitted before September 10, 2025 will be affected.