Medicaid Coverage Information Foster Care Medicaid (including coverage under Adoption Assistance and Subsidized Guardianship) All children placed in out-of-home care through a court order or voluntary placement agreement are eligible to receive Foster Care Medicaid. Children who have an Adoption Assistance or Subsidized Guardianship Agreement are eligible for Medicaid during the term of their agreement (another form of Foster Care Medicaid). Foster Care Medicaid is often referred to as Title XIX (19) Medicaid or Medical Assistance (MA). Foster Care Medicaid is a full benefit, fee-for-service plan. This means there are no co-pays, premiums, or deductibles. The same coverage is provided as the BadgerCare Plus Standard Plan. Certification is not based on household income. A list of services covered by Wisconsin Medical Assistance (MA) can be found on the Department of Health Services website. Children who are covered by Foster Care Medicaid should receive a ForwardHealth MA Card. A replacement card can be requested through the child welfare worker or the family can call ForwardHealth Member Services at 1-800-362-3002. The following table provides more information about the types of Foster Care Medicaid. It includes information about reporting a move to another state. Learn more about the Interstate Compact on Adoption and Medical Assistance (ICAMA) referral process: Medicaid Coverage for Children in Out-of-Home Care Children in out-of-home care, including court-ordered kinship care, are eligible for Foster Care Medicaid. This includes children who are both IV-E (4-E) and non IV-E (4-E) eligible. This coverage is not based on income or resources. Coverage is automatically certified through the electronic Wisconsin Statewide Automated Child Welfare Information System (eWiSACWIS). For more information about how this coverage is certified and maintained, see The Certification of Foster Care Medicaid 2015-21i of the DSP Informational Memo Series. While in out-of-home care, children should receive medical care based on the HealthCheck schedule. For more information, see the HealthCheck brochure. Some children may be eligible for additional health care benefits through the Care4Kids pilot program. Medicaid Support Information may help if you have questions about Medicaid. Medicaid Coverage for Children with an Active Adoption Assistance Agreement Children with an active Adoption Assistance (AA) Agreement are eligible for Foster Care Medicaid. This coverage is not based on income or resources, and is automatically certified through eWiSACWIS. This coverage is effective on the same date as the AA Agreement. It will continue as long as the AA Agreement is in effect. If the child is covered by the parent/guardian’s private health insurance, the private insurance is the primary insurance. This insurance is billed first for medical services. MA is considered secondary insurance. It is billed for services that are not covered by the family’s private health insurance. Families are responsible for notifying the Department of Children and Families (DCF) by calling 1-866-666-5532 when there is a change of address. Interstate Compact on Adoption and Medical Assistance (ICAMA) Referral Process Children cannot be certified for MA in more than one state. If a family is moving to a new state, they must notify DCF as soon as possible to ensure continual MA coverage. The following process allows families to ensure continued coverage: The family must notify the Wisconsin MA contact at 1-866-666-5532 as soon as possible with their new address. DCF makes an Interstate Compact on Adoption and Medical Assistance (ICAMA) request for the new state to certify the child for MA. Wisconsin cancels the MA effective the last day of the month that the family is in Wisconsin. Families must notify DCF each time the family moves. Families should note that it can take up to 45 days to obtain a Medicaid card in the new state. Families should fill any prescriptions before moving out of state. Medicaid Support Information may help if you have questions about Medicaid. Medicaid Coverage for Children with an Active Subsidized Guardianship Agreement Children with an active Subsidized Guardianship (SG) Agreement are eligible for Foster Care Medicaid. This coverage is not based on income or resources, and is automatically certified through eWiSACWIS. This coverage is effective on the same date as the SG Agreement. It will continue as long as the SG Agreement is in effect. If the child is covered by the parent/guardian’s private health insurance, the private insurance is the primary insurance. This insurance is billed first for medical services. MA is considered secondary insurance. It is billed for services that are not covered by the family’s private health insurance. Families are responsible for notifying their County worker when there is a change in address. If a family is moving to a new state, please contact DCF (Department of Children and Families) at 1-866-666-5532 as soon as possible to verify if the new state provides Medicaid coverage for children with an active SG (Subsidized Guardianship) Agreement Interstate Compact on Adoption and Medical Assistance (ICAMA) Referral Process Children cannot be certified for MA in more than one state. If a family is moving to a new state, they must notify DCF as soon as possible to ensure continual MA coverage. The following process allows families to ensure continued coverage: The family must notify the Wisconsin MA contact at 1-866-666-5532 as soon as possible with their new address. DCF makes an Interstate Compact on Adoption and Medical Assistance (ICAMA) request for the new state to certify the child for MA. Wisconsin cancels the MA effective the last day of the month that the family is in Wisconsin. Families must notify DCF each time the family moves. Families should note that it can take up to 45 days to obtain a Medicaid card in the new state. Families should fill any prescriptions before moving out of state. Medicaid Support Information may help if you have questions about Medicaid. BadgerCare Plus for Former Foster Care Youth Some youth may be eligible for MA coverage until their 26th birthday. These youth include youth who were: Placed in foster care (including court-ordered kinship care) on their 18th birthday Under a Subsidized Guardianship Agreement on their 18th birthday These youth must meet some eligibility requirements, but no income test is required. There are no premiums required, but may be a small co-pay for some services. For more information about eligibility requirements and the enrollment process, see The Affordable Care Act (ACA) Provision for Former Foster Care Youth Enrolled in BadgerCare Plus Clarification 2014-18i of the DSP Informational Memo Series . BadgerCare Plus for Parents and Caregivers When Children are Temporarily Removed from Home Some parents and relative caregivers may qualify for BadgerCare Plus coverage. Eligibility determinations for this coverage are done through local Income Maintenance (IM) agencies. Caregivers should work with their child welfare agency to coordinate coverage. BadgerCare Plus for Children Voluntarily Placed with a Kinship Care Provider Children voluntarily placed with a kinship care provider may be eligible for BadgerCare Plus coverage. This coverage is certified by local Income Maintenance (IM) agencies. Kinship care providers should work with their child welfare agency to coordinate coverage. For more information about BadgerCare Plus Coverage, including Foster Care Medicaid, you can review the BadgerCare Plus Eligibility Handbook. Medicaid Support Information The table has contact information for your questions and issues using Medicaid coverage. Find out more about Medicaid Coverage For information on what services are covered by Medicaid call Member Services: 1-800-362-3002 For information on when does Medicaid end and if it can be extended call 1-866-666-5532, Press 3 for Medicaid For information about eligibility for services NOT covered by Medicaid call the WI HealthCheck: 1-800-722-2295 Visit Forward Health Find a Medicaid Provider Find a Medicaid provider in your area call Member Services: 1-800-362-3002 Find a Dental provider that accepts Medicaid in your area call the Dental Ombudsman: 608-221-4746 Changes to Medicaid Record in Forward Health Add a parent’s name to a child’s Forward Health Record call 1-866-666-5532, Press 3 for Medicaid Change or correct a name, date-of-birth (DOB), or social security number (SSN) call 1-866-666-5532, Press 3 for Medicaid Report an address change call 1-866-666-5532, Press 3 for Medicaid Medicaid Help The child’s Foster Care Medicaid is not active contact the county child welfare case manager The child’s Adoptive or Guardianship Medicaid is not active call 1-866-666-5532, Press 3 for Medicaid There is a Medicaid billing issue call Member Services: 1-800-362-3002 I need a replacement ForwardHealth card call Member services 1-800-362-3002 OR call 1-866-666-5532, Press 3 for Medicaid My child needs Medicaid coverage while out of state temporarily (vacation) call Member services 1-800-362-3002 OR call 1-866-666-5532, Press 3 for Medicaid The pharmacy or clinic needs enrollment verification call Provider Services: 1-800-947-9627 To Request an Authorization OR to Follow-up on a Prior Authorization call Ombudsman: 608-421-6007 Request a Claims History Report call Ombudsman: 608-421-6007 Additional Contacts To report fraud call Member Services: 1-800-362-3002 File a complaint against a provider call Member Services: 1-800-362-3002 Request Transportation Services/Mileage Reimbursement call MTM: 1-866-907-1493
