BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012
SECTION 5– ENROLLMENT & ELIGIBILITY INFORMATION
ELIGIBILITY
Group Health covers the following groups of Medicaid HMO Members and their corresponding group numbers:
Group Health BadgerCare Plus Standard Plan (7100-7299)
Group Health BadgerCare Plus Benchmark Plan (7300-7499)
Group Health BadgerCare Plus Core Plan (7000-7001)
Group Health Medicaid SSI (6000-6299 & 6500-6799)
Compcare BadgerCare Plus Standard Plan (7600-7799)
Compcare BadgerCare Plus Benchmark Plan (7800-7999)
Compcare BadgerCare Plus Core Plan (7500-7501)
Compcare Medicaid SSI (6300-6302)
BadgerCare Plus Standard Plan covers families with income at or below 200% of the Federal Poverty Level (FPL).
BadgerCare Plus Benchmark Plan covers families, self-employed parents, and Caretakers with income above
200% of the FPL. The Benchmark plan provides more limited services than the Standard Plan.
BadgerCare Plus Core Plan provides childless adults with access to basic health services including primary and
preventive care.
Medicaid SSI Plan recipients receive benefits and coverage comparable to the BadgerCare Plus Standard Plan
and are eligible for Medicaid due to their eligibility for SSI (Supplemental Security Income) for limited income and
resources.
Members may choose their own HMO or work with the HMO Enrollment Specialist to choose the best one for
their needs. They may choose an HMO at any time during the enrollment process. All eligible members of the
member’s family must choose the same HMO. However, individuals within a family may be eligible for an
exemption from enrollment.
Following is the enrollment process:
1. Members residing in an HMO service area receive an HMO enrollment packet. The packet has an
enrollment form, a list of available HMOs, and instructions on how to choose an HMO and how to find out
if a provider is affiliated with an HMO.
2. If the member does not choose an HMO within two weeks of receiving the enrollment packet, s/he
receives a reminder card. Members in areas with only one available HMO do not have to enroll in an
HMO, unless the zip code has been designated rural mandatory by DHS.
3. If the member has not chosen an HMO after four weeks, and resides in a mandatory enrollment zip code
area, s/he will be assigned an HMO. A letter explaining the assignment will be sent to him/her. S/he will
receive another enrollment form and have an opportunity to change the assigned HMO.
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