Wis. ForwardHealth Online Handbook, Hospice, Topic #398

HMOs

BadgerCare Plus HMO enrollment is either mandatory or voluntary based on ZIP code-defined enrollment areas as follows:

• Mandatory enrollment — Enrollment is mandatory for eligible members who reside in ZIP code areas served by two or

more BadgerCare Plus HMOs. Some members may meet criteria for exemption from BadgerCare Plus HMO enrollment.

• Voluntary enrollment — Enrollment is voluntary for members who reside in ZIP code areas served by only one

BadgerCare Plus HMO.

Members living in areas where enrollment is mandatory are encouraged to choose their BadgerCare Plus HMO. Automatic

assignment to a BadgerCare Plus HMO occurs if the member does not choose a BadgerCare Plus HMO. In general, all members

of a member's immediate family eligible for enrollment must choose the same HMO.

Members in voluntary enrollment areas can choose whether or not to enroll in a BadgerCare Plus HMO. There is no automatic

assignment for members who live within ZIP codes where enrollment is voluntary.

SSI HMOs

Medicaid SSI HMO enrollment is either mandatory or voluntary as follows:

• Mandatory enrollment — Most SSI and SSI-related members are required to enroll in an SSI HMO. A member may

choose the SSI HMO in which he or she wishes to enroll.

• Voluntary enrollment — Some SSI and SSI-related members may choose to enroll in an SSI HMO on a voluntary basis.