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Express Enrollment

Q: What is the procedure for extending Temporary Eligibility period for people whose full applications remain unprocessed at the end of the second month?
A: Express Enrollment (EE or temporary enrollment) is available only to children and pregnant women. EE can be extended for an additional calendar month if the member submits a full benefits BadgerCare Plus application on or before the last day of their temporary enrollment period, and the full benefits application is not processed by the end of the temporary enrollment period. The income maintenance worker should complete a form which will extend the coverage period by one month.

Q: Are there any co-pays for someone covered under the temporary express enrollment?
A: There are nominal co-pays for children covered by Express Enrollment for some services.
BC+ Express Enrollment (EE) for pregnant women provides pregnancy related out patient care, including pharmacy services, to pregnant women who meet the following financial and non-financial criteria:

• Pregnant
• US Citizen
• Family income at or below 300% of FPL
• If her income is at or below 200%, she will be eligible for prenatal services under the Standard plan, if it is between 201% and 300%, she will be eligible for prenatal services under the Benchmark Plan.  

For details on co-pays and covered services.

Q: Are there any premiums for someone covered under the temporary express enrollment?
A: No.

Q: How can I become certified to conduct express enrollment?
A: Express Enrollment for Children: Qualified entities (such as Medicaid providers, schools, and community-based or faith-based organizations) need to fill out an application and receive identification and PIN numbers.

Express Enrollment for Pregnant Women: Qualified providers (certified Medicaid providers) need to fill out an application and receive identification and PIN numbers.

Both applications are available at: http://www.badgercareplus.org/partner.htm

Q: If a pregnant woman is enrolled through Express Enrollment at the time of delivery, will the cost of delivery be covered by BadgerCare Plus?
A: Express Enrollment services are limited to out-patient pregnancy-related services. The pregnant woman should apply for full-benefit BadgerCare Plus, and can backdate for coverage for her delivery.

Q: Can express enrollment for pregnant women be completed more than once, if the woman has not yet applied for BadgerCare Plus?
A: Participants are strongly encouraged to complete the full application for BadgerCare Plus as soon as possible after using Express Enrollment. The time period for Express Enrollment can be extended if the full application was completed at some point during the Express Enrollment time period, but it has not been processed.

Participants are not encouraged to apply for Express Enrollment more than once.

Q: Will there still be paper application cards given for PE for pregnant women and FPW applicants?
A: Under BadgerCare Plus, Presumptive Eligibility is called Express Enrollment. When a pregnant woman applies under Express Enrollment, she will be given a paper card at the time she applies. A plastic Forward Health card will be mailed in 3-5 business days. Express Enrollment is temporary (only up to two months), and participants are encouraged to complete the full BadgerCare Plus applications.

A temporary ID card will also be issued to Family Planning Services applicants (formerly the FPW or Family Planning Waiver), followed by a plastic card.

Q: According to the BC+ Handbook, if a patient who gained Temporary Eligibility (TE) through Express Enrollment (EE) reaches the end of their second month of eligibility and their full BC+ application has been submitted but has not yet been processed, that patient should be granted an extension of TE until the application is processed. What is the actual procedure for extending TE if the application isn’t processed by the end of the enrollment period? Who is responsible for taking action on this matter?
A: If the application was submitted but not processed by the end of the temporary enrollment period, the IM worker will extend the enrollment period for an additional calendar month by submitting a form to the BC+ fiscal agent.

Q: Can children who are in the hospital be granted temporary MA status under the temporary MA card?
A: Yes, children may be temporarily enrolled in BadgerCare Plus through Express
Enrollment if their family income is below 150% of FPL.

Q: Why is the FPL limit 150% for children who need temporary MA, when it is 300% for pregnant women?
A: Express Enrollment is limited to these income ranges to maximize the capture of federal funding under the Medicaid program.

Q: We have inmates from Taycheedah Correctional Institute who deliver their babies here and they have MA but the babies do not. TCI does not assist us with MA for the baby. The mom goes back to prison usually the same day as the birth and the baby stays here until the baby is discharged, some to foster care, some to family, etc. But we have no MA. With Badgercare Plus, will we be able to do the temporary application for these babies?
A: Yes, these children may be signed up through Express Enrollment.

Q: How was presumptive eligibility (PE) for pregnant women handled in the past?
A: PE applications have been processed by medical providers. Now, health care providers will be able to conduct express enrollment online for pregnant women and for children.

Q: Can express enrollment be granted for out patient prenatal services?
A: Yes. That is what PE has always been for. We’re just calling it by a new name.

Q: Is it true that the State will follow up with people that have received express enrollment and outline what they need to do next to apply for benefits and what forms of verification are needed?
A: The Express Enrollment process includes receiving an immediate notice which includes information about how to apply and what will be needed to determine eligibility when an application is filed with the County. As long as the provider/partner who is determining the temporary eligibility provides the printed documents to the customer, they will have the information.

Q: What are the differences in the processes of granting express enrollment for children compared to pregnant women?
A: The process is essentially the same. The eligibility requirements differ so the questions that are asked when using the Express Enrollment tool are not the same. Only certified healthcare providers may conduct Express Enrollment for pregnant women. Express Enrollment for children may be conducted by community-based organizations who have been certified.

Q: Will there be any interface between express enrollment and the full application, or will the same information need to be entered twice?
A: For now, the information will need to be entered twice. However, plans for the future include a link between the two and a quick start number that will be provided in the express enrollment process that can be used to begin the full online application process so the information can be brought over automatically.

Q: If the person is granted express enrollment based on the information they provide is that a guarantee of payment to the provider? If the person is later found to not be eligible will there be any recap of payments for services?
A: As long as member eligibility is on file for the date(s) a service is provided to someone who is temporarily enrolled, services covered by BadgerCare + will be reimbursed. Eligibility can be verified through Provider Services. If the services are provided within the first 24 hours of the express enrollment, eligibility may not actually be on file yet, however, as long as the member presents a Temporary BC+ card, services will be covered.

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Last Revised: October 24, 2008