Enrollment and Benefits Handbook

1 Information About Your Enrollment and BenefitsImportant Note About COVID-19 During the COVID-19 public health emergency, some of the program rules in this Handbook have been changed to protect the health and well-being of our members. For example: Most people who enroll in Medicaid or BadgerCare Plus will keep their coverage through the end of the federal public health emergency. Premiums for Medicaid and BadgerCare Plus have been suspended during the federal public health emergency. FoodShare benefit amounts have increased on a temporary basis. For more information about these and other temporary policies in effect during COVID-19 for health care and food programs, please see Reporting Fraud Report public assistance fraud by calling 877-865-3432 (toll free) or visiting You may remain anonymous. Getting This Document Translated or in Another Format If you have a disability and need this information in a different format, need it translated to another language, or have any questions about your rights and responsibilities, contact your agency or call Member Services at 800-362-3002.

2 All language services are free of charge. Getting Information About the Agency Who Can Help You To get the address or phone number of your agency, go to or call 800-362-3002. The information concerning the health care programs provided in this Handbook is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code. The information concerning the FoodShare program provided in this Handbook is pursuant to chapter 15 of title 44, United States Code, Federal Register Title 7 Subtitle B Chapter II Subchapter C. The information concerning the FoodShare Employment and Training program provided in this Handbook is pursuant to chapter 15 of title 44, United States Code, Federal Register Title 7 Subtitle B Chapter II Subchapter C; and Chapter 49 of the Wisconsin Statutes.

3 The information concerning the Caretaker Supplement program provided in this Handbook is published in accordance with Section of the Wisconsin Statutes and Chapter HA 3 of the Wisconsin Administrative Code. Your Connection to Health Care coverage and Nutrition Benefits Enrollment and Benefits November 2021 Table of Contents RESOURCES AND CONTACT INFORMATION .. 1 OVERPAYMENTS, FRAUD, AND INTENTIONAL PROGRAM VIOLATIONS .. 3 FoodShare Overpayments .. 3 FoodShare Fraud .. 3 FoodShare Intentional Program Violation .. 3 Health Care Overpayments .. 4 Health Care Fraud .. 4 GENERAL PROGRAM INFORMATION .. 5 Do You Have Questions? .. 5 Program Income and Asset Limits .. 5 ForwardHealth .. 5 Nutrition 5 FoodShare Wisconsin .. 5 Health Care .. 5 BadgerCare Plus .. 5 BadgerCare Plus Prenatal Plan .. 5 Plans for People Who Are Elderly, Blind, or Disabled.

4 5 Limited coverage Plans .. 5 Who Can Enroll? .. 5 FoodShare Wisconsin .. 5 BadgerCare Plus .. 6 BadgerCare Plus Prenatal Plan .. 6 Wisconsin Medicaid for the Elderly, Blind, or Disabled .. 6 Wisconsin Well Woman Medicaid .. 6 Help From Others .. 6 Legal Guardian, Power of Attorney, and Conservator .. 7 Authorized Representative .. 7 NUTRITION ASSISTANCE .. 8 FoodShare Wisconsin .. 8 How to Apply .. 8 Priority FoodShare Services .. 8 Work Requirement for Able-Bodied Adults Ages 18 Through 49 .. 8 Work Registration Requirement for Applicants and Members Ages 16 Through 59 .. 9 Work Registration Requirement Sanction .. 9 FoodShare Employment and Training (FSET) Program .. 10 How Your FoodShare Benefits Are Calculated .. 10 Household Income .. 10 Income Credits .. 10 Other Credits .. 10 Examples of How Income and Credits Are Calculated.

5 11 Wisconsin QUEST Card .. 12 When You Get Your Benefits .. 13 Spending Your Benefits .. 13 Authorized Buyers .. 14 Account Balance .. 14 Selecting a Personal Identification Number (PIN) .. 15 Keep Your PIN Safe .. 15 If You Forget Your PIN .. 15 Problems With Your QUEST Card .. 16 Error Messages .. 16 Taking Care of Your QUEST Card .. 16 If Your Card Is Lost or Stolen .. 16 If Your Card Is Damaged .. 16 Monitoring of Excessive Replacement QUEST Cards .. 16 Using Your Card .. 16 Store Adjustments .. 17 Returning a Purchase .. 17 If You Move .. 17 Keep Your QUEST Card .. 17 FoodShare Rules and Responsibilities .. 18 Overpayments .. 18 Quality Control Review .. 18 Reporting Changes .. 18 FoodShare Six-Month Reporting .. 19 Renewals .. 19 FULL coverage HEALTH CARE PLANS .. 20 BadgerCare Plus .. 20 Table of Contents How to Apply.

6 20 Enrollment 20 Income Rules and Limits .. 20 How Income Is Counted .. 20 Who Is Included in Your Group .. 20 Exceptions: Income .. 22 Types of Income That Are Counted .. 22 Income Deductions and Disregards .. 23 Income Disregards .. 25 Medicaid for the Elderly, Blind, or Disabled .. 26 How to Apply .. 26 Enrollment 26 Income Credits .. 26 Program Income and Asset Limits .. 28 Assets .. 29 SSI-Related Medicaid .. 29 Asset Limit .. 29 Income Test .. 29 Medicaid Purchase Plan .. 30 Asset Limit .. 30 Income Limit .. 30 Medicaid Purchase Plan Premiums and Copays .. 30 Long-Term Care Services .. 31 Asset Limit .. 32 Income Test .. 32 Institutional Medicaid .. 32 Home and Community-Based Waivers for Adults .. 33 Long-term Care Support Services for 33 Family Care .. 34 Family Care Partnership .. 34 Spousal Impoverishment Protections.

7 34 Divestment .. 36 Estate Recovery Program .. 36 ForwardHealth Card .. 37 LIMITED coverage HEALTH CARE PLANS .. 38 Family Planning Only Services .. 38 Medicare Savings Program .. 39 Qualified Medicare Beneficiary (QMB) .. 39 Specified Low-Income Medicare 39 Specified Low-Income Medicare Beneficiary Plus .. 39 Qualified Disabled and Working Individual .. 39 When Your Payments Will Begin .. 39 Medicare Savings Program Calculations .. 39 SeniorCare Prescription Drug Assistance Program .. 40 coverage Levels .. 40 SeniorCare Card .. 40 Tuberculosis-Related Medicaid .. 40 Emergency Services Plan .. 41 IMPORTANT INFORMATION FOR ALL HEALTH CARE PLANS .. 42 Deductible Plans .. 42 Limits for Emergency Services .. 42 Prior Authorization for Services .. 43 If You Get a Bill .. 43 Enrollment in a BadgerCare Plus or Medicaid Health Maintenance Organization (HMO).

8 43 Enrolling in an HMO .. 43 Benefits of an HMO .. 43 Better Access to Care .. 43 Personalized and Coordinated Care .. 44 Increased Quality .. 44 Member Safeguards .. 44 Other Providers .. 44 Report Your Changes .. 44 BadgerCare Plus and Medicaid .. 44 Family Planning Only Services .. 45 Well Woman Medicaid .. 45 How to Report Changes .. 45 Renew Your Benefits .. 45 Monthly Premiums .. 45 People Who Do Not Pay Premiums for BadgerCare Plus .. 45 BadgerCare Plus Premiums for Children .. 46 Paying BadgerCare Plus Premiums for Children .. 46 Table of Contents BadgerCare Plus Premiums for Adults .. 46 Paying BadgerCare Plus Premiums for Adults .. 46 47 Other Health Insurance .. 47 Access to Affordable Employer-Sponsored Health Insurance .. 47 Applying for BadgerCare Plus for Pregnant Women .. 48 BadgerCare Plus Prenatal Services.

9 48 Accident and Injury Claims .. 48 Required Proof/Verification for FoodShare and Health Care .. 49 Health Care for People Who Are Incarcerated .. 49 NON-EMERGENCY MEDICAL TRANSPORTATION .. 50 Mileage Reimbursement (Gas Payment) .. 50 Meals and Lodging .. 50 Schedule a Ride .. 50 OTHER PROGRAMS .. 52 Caretaker Supplement .. 52 WIC (Women, Infants, and Children Program) .. 52 Job Center of Wisconsin .. 52 COLLECTION AND USE OF INFORMATION .. 53 YOUR RIGHTS .. 54 Fair Hearings .. 54 Prehearing Conference .. 54 Fair Hearing .. 54 When to Use the Fair Hearing Process .. 54 How to Ask for a Fair Hearing .. 55 Preparing for a Fair 55 Continuation of Benefits .. 55 Effects of the Fair Hearing .. 55 Rehearing .. 56 Appealing a Hearing or Rehearing Decision .. 56 Legal Help .. 56 Letters About Your Benefits .. 56 NONDISCRIMINATION.

10 57 Nondiscrimination Notice .. 57 USDA Nondiscrimination Statement .. 59 APPENDIX A: PROGRAM INCOME LIMITS .. 60 APPENDIX B: COVERED SERVICES AND COPAYS FOR BADGERCARE PLUS AND MEDICAID PROGRAMS .. 61 Covered Services and Copays .. 61 Copay 61 Monthly Copays Based on Income .. 62 Medicare Savings 62 Home and Community Based Waivers Group B and B Plus .. 62 Meeting Your Monthly Copay Limit .. 63 Out-of-State Claims .. 63 Emergencies .. 63 Non-Emergencies .. 63 Services Not Covered Under Any Plan .. 63 HealthCheck .. 63 Table of Covered Services and Copays .. 64 Table of Copay Limits for BadgerCare Plus and Medicaid Programs .. 66 APPENDIX C: BADGERCARE PLUS PREMIUMS FOR CHILDREN .. 67 APPENDIX D: EXAMPLES OF PROOF .. 68 Page | 1 Resources and Contact Information All Applicants and Members Use the ACCESS Website ( ) to: See what health, nutrition, and other support programs you may be able to get.