Wis. ForwardHealth Online Handbook, Hospice, Topic #229

Certain members may be enrolled in a limited benefit category. These limited benefit categories include the following:

• BadgerCare Plus Prenatal Program

• EE (Express Enrollment) for Children

• EE for Pregnant Women

• Family Planning Only Services, including EE for individuals applying for Family Planning Only Services

• QDWI (Qualified Disabled Working Individuals)

• QI-1 (Qualifying Individuals 1)

• QMB Only (Qualified Medicare Beneficiary Only)

• SLMB (Specified Low-Income Medicare Beneficiary)

• Tuberculosis-Related Medicaid

Members may be enrolled in full-benefit Medicaid or BadgerCare Plus and also be enrolled in certain limited benefit programs,

including QDWI, QI-1, QMB Only, and SLMB. In those cases, a member has full Medicaid or BadgerCare Plus coverage in

addition to limited coverage for Medicare expenses.

Members enrolled in the BadgerCare Plus Prenatal Program, Family Planning Only Services, EE for Children, EE for Pregnant

Women, or Tuberculosis-Related Medicaid cannot be enrolled in full-benefit Medicaid or BadgerCare Plus. These members

receive benefits through the limited benefit category.

Providers should note that a member may be enrolled in more than one limited benefit category. For example, a member may be

enrolled in Family Planning Only Services and Tuberculosis-Related Medicaid.

Providers are strongly encouraged to verify dates of enrollment and other coverage information using Wisconsin's EVS

(Enrollment Verification System) to determine whether a member is in a limited benefit category, receives full-benefit Medicaid or

BadgerCare Plus, or both.

Providers are responsible for knowing which services are covered under a limited benefit category. If a member of a limited

benefit category requests a service that is not covered under the limited benefit category, the provider may collect payment from

the member if certain conditions are met.