BadgerCare Plus Home Page>>Common Questions

HMO CHANGES FOR SOUTHEAST WISCONSIN FAMILIES ENROLLED IN 

Common Questions

Printable Version (PDF 84KB)

I live in Southeastern Wisconsin and I heard that my HMO will be changing.  Do I have to do anything today?

Nothing will change for you today and you can still use your current health care providers.  In July, August, and September you will need to choose an HMO. It is likely that most providers will be part of one of the HMOs. 

Who does this change affect?

Most children and families enrolled in BadgerCare Plus Standard or Benchmark plans in Milwaukee, Racine, Kenosha, Waukesha, Ozaukee and Washington counties will need to choose a new HMO.

Note: This does not affect members who are enrolled in SSI Medicaid, Medicaid for the Elderly Blind or Disabled (EBD) or BadgerCare Plus Core Plan.  HMOs in Milwaukee, Racine, Kenosha, Ozaukee, Washington and Waukesha counties that serve SSI Medicaid members and HMOs in Milwaukee that serve the Core Plan will stay the same. 

What is an HMO?

A Health Maintenance Organization (HMO) is an organization that works with doctors, clinics and hospitals to help you manage your health care.  Most BadgerCare Plus members are enrolled in an HMO. 

Which HMOs will be available?

The Department of Health Services is contracting with four HMOs:

• Abri Health Plan,

• Children’s Community Health Plan,

• Community Connect, and

• UnitedHealthcare

Why are the BadgerCare Plus HMOs changing in Southeastern Wisconsin?

This change is being made in an effort to improve the quality of health care you get.  These HMOs must meet certain contract rules to provide you with services such as:

• Testing for diabetes, 
• Testing children for lead poisoning, 
• Offering and providing childhood vaccinations (shots),
• Asthma management, 
• Making sure you are able to see a doctor so you do not have to got to the emergency room for services that are not an emergency, and
• And coordinating care for high-risk pregnant women.

Will I get a letter or notice telling me I need to choose an HMO?

You will be sent an enrollment packet in the mail when it is time for you to choose an HMO.  The packet will include information about each HMO and how to enroll.

When will I get my enrollment packet?

In mid-July, mid-August and mid-September 2010 packets will be sent based on where you live. Please keep in mind, you should not try to choose an HMO until you get your enrollment packet.

Am I enrolled in an HMO/How to I find out who my HMO is?

Most BadgerCare Plus Standard and Benchmark plan members are enrolled in an HMO.  To find out which HMO you are enrolled in, you can call Member Services at 1-800-362-3002. 

I am not in an HMO; will I have to choose one?

Usually, if you and your children are members of the BadgerCare Plus Standard or Benchmark plans, you will need to choose an HMO.  There are some cases when you may be able to get an exemption and not need to enroll in an HMO.

What is an HMO exemption?

An HMO exemption means you do not have to join an HMO to get your health care benefits.  Most exemptions are only a short period of time so you can finish a course of treatment before you are enrolled in an HMO.  

You may be able to get an exemption if you are in the last three months of pregnancy, have a high-risk pregnancy or you have a severe illness or chronic condition that you are being treated for and your provider is not in any of the HMOs taking part in BadgerCare Plus Standard and Benchmark Plans.  More information about exemptions and how to ask for one will be in your enrollment packet.

I have an HMO exemption; will I need to choose an HMO?

If you have an HMO exemption now, your exemption will stay in effect and you will not need to choose an HMO.

If I am already in an HMO that is on the list do I need to do anything?

If you want to stay enrolled in that HMO, you will need to choose it when you get your enrollment packet.

I like my health care providers; will I be able to keep seeing them?

Most providers take part in at least one of the BadgerCare Plus HMOs.

How do I choose an HMO?

There are several ways to choose an HMO.  Your enrollment packet will explain them to you.

What happens if I don’t choose an HMO?

If you do not choose an HMO, you will be assigned to one of the BadgerCare Plus HMOs. We ask all members to choose an HMO that will work best for them.

How long will I be in this HMO?

You will belong to the HMO you choose or are assigned to for a 12 month period, as long as you are a BadgerCare Plus member. If, for some reason, you do not want to stay in that HMO, you will have 90 days from the date you were enrolled HMO to choose a new HMO.

Will I still get the same benefits?

You will get the same BadgerCare Plus Standard or Benchmark plan covered services, but will get them from providers who take part in the HMO.

I am in the process of applying for BadgerCare Plus.  How will this affect me?

P-00163 (07/10)