BadgerCare Plus Members

BadgerCare Plus is a state and federal program that provides health care coverage for Wisconsin individuals and families. Currently, the following Wisconsin residents qualify for BadgerCare Plus:

• Parents or caretakers of dependent children under 19 years of age with household income at or below 1​00% of the Federal Poverty Level (FPL).
• Pregnant people with household income at or below 300% of the FPL.
• Children under 19 years of age, regardless of household income.

Help is available for you:

If you need help applying or finding other health insurance, visit WisCovered.com or call 211 or (877) 947-2211 to reach a local navigator.

The easiest way to renew is through your ACCESS account at access.wi.gov. If you don’t have an ACCESS account, click the link below to easily register for one!

You can also, renew by mail, over the phone, or in person.

Help is available to for you to complete a renewal.

If you need help completing your renewal or finding other health insurance, visit WisCovered.com or call 211 or (877) 947-2211 to reach a local navigator.

If you have enrollment questions, call a ForwardHealth Enrollment Specialist at (800) 291-2002.

If you have a smartphone, the MyAccess app makes navigating BadgerCare and Medicaid simple.
The MyACCESS mobile app makes it easy to access and manage your benefits!

Get the app in three easy steps:

1. Go to your Apple App Store or Google Play Store
2. Search for “myACCESS Wisconsin”
3. Download the app on to your device at no cost!

Once downloaded, use the app to:

• Check your benefits and programs
• Receive reminders and notifications
• Submit and track documents

• Ask if you have health insurance at your job
  • Apply within 60 days of losing BadgerCare or Medicaid
  • Apply on HealthCare.gov (Federal Health Insurance Marketplace)
    • Apply online within 60 days through healthcare.gov
    • *Financial help is available through healthcare.gov
    • Click here for more information or call (800) 318-2596
    • Apply for Medicare if you are 65 or older
      • Apply within 6 months for Medicare Part A and Part B
      • Apply within 3 months for Medicare Advantage Plan and Medicare Part D (prescription drug coverage)
      • Call the Medigap Helpline at (800) 242-1060
      Unsure Why You Lost BadgerCare?

      Contact your County Consortium. Click here to learn more.

      ForwardHealth ID Card

      If you have questions on your ForwardHealth ID card or need a new ID card, call ForwardHealth Member Services at (800) 362-3002.

      Pharmacy Questions

      The State of Wisconsin assists with these services. Please call the Department of Health at (800) 362-3002 for information about your prescription drug benefits.

      Dental, Chiropractic and Autism Services

      You can get these services. You must find a doctor or clinic that accepts your ForwardHealth ID card. To find a doctor or clinic, call ForwardHealth Member Services at (800) 362-3002.

      You can also call the GHC-SCW BadgerCare Plus Coordinator at (608) 662-4991.

      Non-Emergency Medical Transportation

      Information

      To Schedule Transportation, call Veyo at (866) 907-1493.

      • You must call at least two business days before your appointment
      • You will need the following information:
        • Your name, home address and phone number
        • Your ForwardHealth ID (10-digit number on your ForwardHealth ID Card)
        • The street address and the phone number for pick up
        • The name, phone number, address and zip code of the appointment location
        • The date and start time of your appointment
        • The end time of your appointment (if you know it)
        • Any special ride needs (if you need someone with you)
        • General reason for the appointment (check-up, eye appointment, labs, etc.)

        If you need further assistance, please call the GHC-SCW BadgerCare Plus Coordinator at (608) 662-4991.

        For more information on non-emergency medical transportation with BadgerCare or Medicaid, click here.

        Find a GHC-SCW Provider or Clinic

        

        GHC-SCW BadgerCare Plus Provider Directory

        

        GHC-SCW BadgerCare Plus Clinic Map

        Grievances (Complaints)/Appeals

        Grievances

        A grievance is a complaint about GHC-SCW or a health care provider that is not related to a benefit determination. We would like to know if you ever have a grievance about your care at GHC-SCW. To file a grievance you may:

        • Call GHC-SCW’s BadgerCare Member Advocate at (608) 662-4991
        • Write to GHC-SCW Member Services at the following address if you have a grievance:

        GHC-SCW Administration
        ATTN: Member Services Appeal Representative
        1265 John Q Hammons Dr. Madison, WI 53717

        • Call GHC-SCW Member Services at (608) 828-4853 or (800) 605-4327.

        Interpreter services and deaf, hard of hearing, or speech impaired services assistance is available to help you file your grievance:

        • Interpreter Services: (608) 661-7215
        • En Español: (855) 243-8454
        • Deaf, hard of hearing or speech impaired:
          • 711
          • (608) 828-4815
          • (800) 947-3529 toll free

          An appeal is a request for a review of an adverse benefit determination.

          This could include any of the following:

          • GHC-SCW plans to stop, suspend, or reduce a service you are currently getting.
          • GHC-SCW decides to deny a service you asked for.
          • GHC-SCW decides not to pay for a service.
          • GHC-SCW asks you to pay an amount that you don’t believe you owe.
          • GHC-SCW decides to deny your request to get a service from a non-network provider when you live in a rural area that has only one health maintenance organization.
          • GHC-SCW fails to arrange or provide services in a timely manner.
          • GHC-SCW fails to meet the required timeframes to resolve your grievance or appeal.

          *Your authorized representative or your provider may request an appeal for you if you have given them consent to do so.*

          When requesting an appeal, you must appeal to your HMO program first.

          • The request for an appeal must be made no more than 60 days from the date on the written adverse benefit determination notice.
          • If you need help writing a request for an appeal, please call your GHC-SCW Advocate at (608) 662-4991.

          After the appeal process within the HMO, if you still disagree with the decision about your appeal, you may request a fair hearing with the State of Wisconsin Division of Hearing and Appeals within 90 days of your appeal denial from the HMO.

          If you want a fair hearing, send a written request to:

          Department of Administration Division of Hearings and Appeals
          P.O. Box 7875
          Madison, WI 53707-7875

          If you need help writing a request for a fair hearing, please call either the BadgerCare Plus Advocate at 608-662-4991 or the Medicaid SSI Ombuds at (800) 760-0001.

          Family Planning and Pregnancy

          What is Covered at a Family Planning Doctor Visit?

          Men

          • Condoms
          • Sexual health check-up
          • Tests and treatment for STDS or sexually transmitted infections
          • Procedure to prevent future pregnancy: Vasectomy

          Women

          • Birth control services and supplies
          • Sexual health check-up including PAP tests
          • Tests and treatments for STDs or sexually transmitted infections
          • Surgery to tie tubes (tubal ligation)

          Pregnancy

          BadgerCare Plus pays for the baby’s delivery and your health care while you’re pregnant. For the mom, this health insurance lasts 60 days after the baby is born.

          You may qualify for BadgerCare Plus if:

          • You are pregnant
          • Your household’s monthly income is equal to or lower than 300% of the Federal Poverty Level.

          Click here to apply!

          After the birth:

          1. Call ForwardHealth Member Services at (800) 362-3002
          2. Tell the county agency that the baby was born and needs BadgerCare
          3. Ask if any adults or other children in the household qualify

          Care Management

          Information

          If you need to see a specialist, it is best to contact our Care Management team. You can call them at (608) 257-5294 or call the GHC-SCW BadgerCare Advocate at (608) 662-4991.

          Specialist Services include, but not limited to:

          • Behavioral Health
          • Dermatology
          • Hospital Services
          • Genetic Counseling
          • Multi-Disciplinary Clinics
          • Ophthalmology
          • Optometry
          • Physical Therapy
          • Podiatry
          • Sports Medicine
          • Routine Lab/Radiology Services (excluding STAT labs or testing on a clinic collected specimen)

          Member Rights and Responsibilities:

          Your BadgerCare Rights
          • You have the right to have an interpreter with you during any BadgerCare Plus covered service.
          • You have the right to get the information provided in this member handbook in another language or format.
          • You have the right to get health care services as provided for in federal and state law. All covered services must be available and accessible to you. When medically appropriate, services must be available 24 hours a day, seven days a week.
          • You have the right to get information about treatment options including the right to request a second opinion.
          • You have the right to make decisions about your health care.
          • You have the right to be treated with dignity and respect.
          • You have the right to be free from any form of restraint or seclusion used as a means of force, control, ease, or reprisal.
          • You have the right to be free to exercise your rights without adverse treatment by the GHC-SCW and its network providers.
          • You may switch HMOs without cause during the first 90 days of GHC-SCW enrollment.
          • You have the right to switch HMOs, without cause, if the State imposes sanctions or temporary management on GHC-SCW.
          • You have the right to receive information from GHC-SCW regarding any significant changes with GHC-SCW at least 30 days before the effective date of the change.
          • You have the right to disenroll from the GHC-SCW if:
            • You move out of the GHC-SCW’s service area.
            • GHC-SCW does not, for moral or religious objections, cover a service you want.
            • You need a related service performed at the same time, not all related services are available within the provider network, and your PCP or another provider determines that receiving the services separately could put you at unnecessary risk.
            • Other reasons, including poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with your care needs.
            GHC-SCW Rights and Responsibilities:

            You have a right to:

            1. Receive information about GHC-SCW, its services and its providers, including the right to receive a copy of the GHC-SCW Patient Rights and Responsibilities.
            2. Be treated with dignity and respect in a confidential manner.
            3. Participate with your providers in making decisions about your health care.
            4. Participate in a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
            5. Voice complaints about the service and care you receive without penalty or disenrollment.
            6. Receive notification and a rationale when case management services are changed or no longer needed.
            7. Receive a certificate outlining the coverage to which you and/or your family members are entitled, and to whom the benefits are paid.
            8. Ask questions regarding your medical plan coverage, the preauthorization process or claims payment.
            9. Submit complaints about appeals about GHC-SCW or the care we provide.
            10. Select a primary care provider and to request a new provider without indicating a reason.
            11. Receive a full explanation of any charges billed to you as a result of care.
            12. Participate in the governance of GHC-SCW. Each member must be at least 18 years of age to be a voting member of the Cooperative and is encouraged to actively participate in its operation.
            13. Make recommendations regarding the organization’s member rights and responsibilities.
            14. Receive informed consent, as required by law, prior to procedures or treatments. To the extent permitted by law, it is your right to refuse the recommended treatment and be informed of the consequences of this decision.
            15. Receive confidential treatment of all communications and records concerning your care, except as otherwise provided by law.
            16. View and receive a copy of your health records and x-rays upon receipt of written authorization.
            17. Receive a copy of the GHC-SCW Notice of Privacy Practices.

            You have a responsibility to:

            1. Be considerate of others.
            2. Observe safety and smoking regulations in all GHC-SCW facilities.
            3. Treat GHC-SCW employees with consideration and respect.
            4. Provide accurate and complete health care information.
            5. Use facilities and equipment properly.
            6. Read and understand your coverage.
            7. Be on time for appointments and inform the clinic in advance when appointments cannot be kept.
            8. Follow plans and instructions for care as agreed to with your provider.
            9. Understand your health problems and participate in developing mutually-agreed-upon treatment goals.
            10. Pay your financial obligations under the benefit plan.
            11. Know and confirm your benefits before receiving treatment.
            12. Obtain preauthorization for services indicated in your certificate.
            13. Notify GHC-SCW of changes in your address, phone number or family status.

            Clinical Practice Guidelines

            These clinical practice guidelines have been adopted by GHC-SCW’s Clinical Content Committee and are meant to aid the health care decision making process. Please note, your ability to receive services depends on your coverage and these guidelines do not replace clinical judgement.

            Information

            Population Health Area Focus	Recognized Source Organization
            Heart Disease	American Heart Association
            Diabetes	American Diabetes Association
            Asthma	Global Initiative for Asthma (GINA)
            Preventative Care	US Preventative Services Task Force
            Behavioral Health	American Psychiatric Association
            Maternal Health	American College of Obstetricians and Gynecologists