Express Enrollment

COVID-19 Update: Presumptive eligibility for BadgerCare Plus Express Enrollment through the online Express Enrollment application in ACCESS for Partners and Providers has been expanded. Expand the table below to see who may be eligible for presumptive eligibility and expanded presumptive eligibility, as well as the qualified entities that may complete Express Enrollment.

	Qualified hospitals	Qualified providers	Qualified partners
Presumptive eligibility is expanded to include:
Adults age 65 and older with an income of up to 100% of the federal poverty level (FPL)	X
Adults who are blind or have a disability and who are enrolled in Medicare with an income of up to 100% of the FPL	X
Presumptive eligibility continues to include:
Adults who are not blind and do not have a disability with an income of up to 100% of the FPL	X
Pregnant people with an income of up to 306% of the FPL	X	X
Individuals with an income of up to 306% of the FPL who want Family Planning Only Services	X	X
Children younger than age 1 in households with an income of up to 306% of the FPL	X	X	X
Children ages 1–5 in households with an income of up to 191% of the FPL	X	X	X
Children ages 6–18 in households with an income of up to 156% of the FPL	X	X	X

Note: The online Express Enrollment application in ACCESS for Partners and Providers and the submission process have not changed.

The Express Enrollment page of the ForwardHealth Portal contains information about becoming a qualified hospital, provider, or partner for making presumptive eligibility determinations.

More information is available in Alert 014, titled “ForwardHealth Will Expand Presumptive Eligibility for Express Enrollment (Hospitals),” which is available on the COVID-19: ForwardHealth Provider News and Resources Portal page.

Member notice

You may be able to temporarily enroll in BadgerCare Plus or Family Planning Only Services if you need service right away and meet the eligibility criteria. This process is called Express Enrollment. It allows you to get the benefits you need while your program application is being completed and processed. Your health care provider or hospital would start your Express Enrollment. Some community partners may be able to start Express Enrollment for children. You cannot apply for temporary benefits on your own. If your provider cannot help you, call Member Services at 800-362-3002. They can tell you the qualified hospitals, providers, or partners near you.

Resources for hospitals, providers, and partners

Express Enrollment is the online application used in ACCESS to make presumptive eligibility determinations to temporarily enroll individuals in BadgerCare Plus or Family Planning Only Services until a full application is completed and processed. Presumptive eligibility determinations are based on preliminary household and financial information provided by the applicant. This process allows the applicant to receive immediate health care coverage, for a short period of time, while their full application for ongoing BadgerCare Plus or Family Planning Only Services is completed and processed.

Definitions

Express Enrollment: The process of making a presumptive eligibility determination to temporarily enroll an individual in BadgerCare Plus or Family Planning Only Services.
Presumptive eligibility: The determination of whether or not an applicant is eligible to enroll in BadgerCare Plus or Family Planning Only Services temporarily.
Temporary enrollment: Short-term eligibility for BadgerCare Plus or Family Planning Only Services.

Who can make presumptive eligibility determinations?

	Population
	Children	Pregnant people	Family Planning Only Services	Adults younger than 65, parents, and caretakers
Qualified hospitals	X	X	X	X
Providers	X	X	X
Partners	X

Qualified hospitals and providers

Hospitals that are Medicaid-enrolled and certified through ForwardHealth for Express Enrollment are considered qualified. Qualified hospitals will be able to make presumptive eligibility determinations for children, pregnant people, adults, and Family Planning Only Services. Providers that are Medicaid-enrolled and certified through ForwardHealth as an Express Enrollment provider can make presumptive eligibility determinations for children, pregnant people, and Family Planning Only Services.

ForwardHealth Portal Provider Enrollment Information

Qualified hospitals and providers interested in making presumptive eligibility determinations may access the online provider enrollment application via their secure ForwardHealth account.

Partners

Partners who meet the Express Enrollment criteria and are certified through ForwardHealth as an Express Enrollment partner will be able to make presumptive eligibility determinations for children.

Note: This application is only for partners and will only allow the partner to make presumptive eligibility determinations for children. Hospitals and providers should access the online provider enrollment application via their secure ForwardHealth Portal account.