Wisconsin Department of Children and Families

Protecting Children, Strengthening Families, Building Communities

 

 

Medicaid Coverage

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:

  1. The family must notify the Wisconsin MA contact at 1-866-666-5532 as soon as possible with their new address.
  2. DCF makes an Interstate Compact on Adoption and Medical Assistance (ICAMA) request for the new state to certify the child for MA.
  3. 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 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:

  1. The family must notify the Wisconsin MA contact at 1-866-666-5532 as soon as possible with their new address.
  2. DCF makes an Interstate Compact on Adoption and Medical Assistance (ICAMA) request for the new state to certify the child for MA.
  3. 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