Elderly, Blind, or Disabled Medicaid and SSI Medicaid Member Information
You’ll receive Elderly, Blind, or Disabled Medicaid or Supplemental Security Income (SSI)-Related Medicaid for 12 months once you enroll. That’s unless a change affects your eligibility.
You can find information below about:
- How to use your ForwardHealth card.
- How to pick an HMO (health maintenance organization).
- What services are covered.
- Who has to pay a copay.
- How to report changes.
- How to renew your coverage.
Using your ForwardHealth card
After you get Medicaid, we’ll send you a ForwardHealth card in the mail. If you had Medicaid, BadgerCare Plus, or Family Planning Only Services in the past, you won’t get a new card. You can use the same card you used before.
Your ForwardHealth card includes your name. It also has a 10-digit number and magnetic stripe. There is a place for you to sign your name as soon as you get it. If you need help, the Member Services phone number is on the card. They’re available from 8 a.m.–6 p.m., Monday through Friday.
You must show your card when you go to the doctor. You also need it when you pick up medicine at the pharmacy. Need to get a new card? If your card is lost or was stolen, go to your ACCESS account or call ForwardHealth Member Services at 800-362-3002.
Manage your benefits with ACCESS
Picking an HMO
Some people in Medicaid for the Elderly, Blind, or Disabled or SSI Medicaid get their health care through HMOs. These are insurance companies that offer services from select providers. If you need to pick an HMO, you’ll get a letter and enrollment book with a list. If you don’t choose an HMO by the deadline included in the letter, one will be picked for you.
To enroll in an HMO or if you have questions about HMOs, call an HMO enrollment specialist at 800-291-2002.
If you have a provider you’d like to use, make sure they’re in the HMO network you choose. If they aren’t, you may have to change providers.
View our full list of HMOs below. You can use the links to learn more about each HMO and see which counties it covers.
- Anthem Blue Cross and Blue Shield plan site
- Anthem Blue Cross and Blue Shield member handbook
- Anthem Blue Cross and Blue Shield provider directory
- 855-690-7800 or 711 (TTY)
- Counties covered: all
- Group Health Cooperative of Eau Claire plan site
- Group Health Cooperative of Eau Claire member handbook
- Group Health Cooperative of Eau Claire provider directory
- 888-203-7770 or 800-947-3529 (TTY)
- Counties covered: Adams, Ashland, Barron, Bayfield, Brown, Buffalo, Burnett, Chippewa, Clark, Columbia, Crawford, Dodge, Door, Douglas, Dunn, Eau Claire, Florence, Forest, Grant, Green, Green Lake, Iowa, Iron, Jackson, Juneau, Kewaunee, La Crosse, Lafayette, Langlade, Lincoln, Marathon, Marinette, Marquette, Menominee, Monroe, Oconto, Oneida, Outagamie, Pepin, Pierce, Polk, Portage, Price, Richland, Rock, Rusk, Saint Croix, Sauk, Sawyer, Shawano, Taylor, Trempealeau, Vernon, Vilas, Washburn, Waupaca, Waushara, Winnebago, Wood
- iCare plan site
- iCare member handbook
- iCare provider directory
- 800-777-4376 or 800-947-3529 (TTY)
- Counties covered: Adams, Ashland, Barron, Bayfield, Brown, Buffalo, Calumet, Chippewa, Columbia, Crawford, Dane, Dodge, Door, Douglas, Florence, Fond du Lac, Grant, Green, Green Lake, Iowa, Iron, Jackson, Jefferson, Juneau, Kenosha, Kewaunee, La Crosse, Lafayette, Manitowoc, Marinette, Marquette, Menominee, Milwaukee, Monroe, Oconto, Outagamie, Ozaukee, Pepin, Pierce, Racine, Richland, Rock, Sauk, Sawyer, Shawano, Sheboygan, Trempealeau, Vernon, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago
- MHS Health Wisconsin plan site
- MHS Health Wisconsin member handbook
- MHS Health Wisconsin provider directory
- 888-713-6180 or 800-947-3529 (TTY)
- Counties covered: all
- Molina Health Care plan site
- Molina Health Care member handbook
- Molina Health Care provider directory
- 888-999-2404 or 711 (TTY)
- Counties covered: Adams, Brown, Calumet, Chippewa, Clark, Columbia, Crawford, Dane, Dodge, Door, Eau Claire, Florence, Fond du Lac, Forest, Grant, Green, Green Lake, Iowa, Jackson, Jefferson, Juneau, Kenosha, Kewaunee, La Crosse, Lafayette, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Milwaukee, Monroe, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Richland, Rock, Sauk, Shawano, Sheboygan, Trempealeau, Vernon, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago
Molina Health Care, Inc. acquired My Choice Wisconsin on September 1, 2023. Beginning July 1, 2024, members of the My Choice Wisconsin HMO will be identified as Molina members. Learn more about the purchase and how it affects members of My Choice Wisconsin.
- Network Health Plan plan site
- Network Health Plan member handbook
- Network Health Plan provider directory
- 888-713-6180 or 800-947-3529 (TTY)
- Counties covered: all
- Quartz plan site
- Quartz member handbook
- Quartz provider directory
- 800-362-3310
- Counties covered: Dane, La Crosse, Milwaukee
- Security Health Plan plan site
- Security Health Plan member handbook (PDF)
- Security Health Plan provider directory
- 800-791-3044 or 800-472-2363
- Counties covered: Barron, Chippewa, Clark, Dunn, Eau Claire, Lincoln, Marathon, Oneida, Portage, Price, Rusk, Sawyer, Taylor, Vilas, Washburn, Wood
- UnitedHealthcare of Wisconsin plan site
- UnitedHealthcare of Wisconsin member handbook
- UnitedHealthcare of Wisconsin provider directory
- 800-504-9660 or 711 (TTY)
- Counties covered: all
- Learn more about HMO ownership, controlling interest, and accreditation.
- View the Managed Care Program Annual Reports (MCPARs). Under CMS regulation 42 CFR § 438.66(e), states must complete one MCPAR for each managed care program in the state. These reports are for the Medicaid SSI HMO program:
Covered services
Medicaid for the Elderly, Blind, or Disabled and SSI Medicaid cover the services listed below. They could change, so check with your provider or call Member Services at 800-362-3002 for the most up-to-date information. They can tell you whether a service you need is covered and if there are limits on the services you need.
- Case management services
- Chiropractic services
- Dental services
- HealthCheck, a Medicaid health care benefit for young people
- Some home and community-based services
- Home health services or nursing services if a home health agency is unavailable
- Hospice care
- Inpatient hospital services, other than those performed in a mental health facility
- Inpatient hospital, skilled nursing facility, and intermediate care facility services for patients who are 65 and older and in a mental health facility
- Intermediate care facility services, other than those performed in a mental health facility
- Lab and X-ray services
- Medical supplies and equipment
- Mental health and medical outpatient treatment
- Mental health and psychosocial rehabilitative services, including case management services, provided by staff of a certified community support program
- Nursing services, including those performed by a nurse practitioner
- Optometric/optical services, including eyeglasses
- Outpatient hospital services
- Personal care services
- Physical and occupational therapy
- Physician services
- Podiatry services
- Prescription drugs and over-the-counter drugs
- Respiratory care services for those who need a ventilator
- Rural health clinic services
- Skilled nursing home services, other than those performed in a mental health facility
- Speech, hearing, and language disorder services
- Substance abuse services
- Transportation to get medical care
- Treatment to stop smoking
- Treatment for tuberculosis
Copays
A copay is what you pay for a medical service. You pay it each time you receive the service.
Copays typically depend on monthly income. If your monthly income is more than the below, you may have to pay a copay.
- One-person family: Monthly income of $531.67
- Two-person family: Monthly income of $718.34
Who does not have to pay copays?
Providers aren’t allowed to collect copays from these members:
- Children under age 19, no matter their income or benefit program
- Children in foster care or the adoption system, no matter their age
- American Indians or Alaskan Native Tribal members, children or grandchildren of a tribal member, or anyone who can get Indian Health Services. Age and income do not matter. This applies when getting items and services from an Indian Health Services provider or from the Purchase and Referred Care program.
- Anyone receiving services through Express Enrollment
- Pregnant people
Members of these programs don’t have to pay copays:
- Family Planning Only Services
- Katie Beckett Medicaid
- Institutional Medicaid (not including adults without children who are enrolled in BadgerCare Plus and live in a medical facility)
- Wisconsin Well Woman Medicaid
These services don’t require a copay:
- Case management
- Crisis intervention
- Community support
- Emergency
- Family planning, including sterilizations
- HealthCheck
- HealthCheck “Other Services”
- Home care
- Hospice care
- Immunizations
- Independent lab
- Injections
- Private Duty Nursing (PDN) and PDN services for members on a ventilator
- Pregnancy-related
- Preventive services with an A or B rating from the U.S. Preventive Services Task Force
- Residential substance use disorder treatment
- School-based
- Substance abuse day treatment
- Surgical help
How much are copays?
Most copays are between 50 cents and $3, depending on the service. If you get more than one service, you may have to pay more than one copay.
| Service Cost | Copay |
|---|---|
| Up to $10 | 50 cents |
| $10.01-$25 | $1 |
| $25.01-$50 | $2 |
| Over $50 | $3 |
Is there a limit to the amount I pay each month?
Yes. Your copay will never be more than 5% of your total income before taxes or other deductions. Your monthly copay limit is based on certain things, including:
- Your family size.
- Your income.
- Who in your household has copays.
If you owe copays, you’ll get an “About Your Benefits” letter (PDF) letting you know how much your monthly limit is.
If your copays reach your limit before the end of the month, you’ll get a “You Have Met Your Copay Limit” letter (PDF) letting you know. In this case, you won’t have to pay copays for the rest of the month.
Reporting changes
You must report any of the following changes within 10 days:
- Someone moves in or out of your home.
- Someone becomes pregnant or gives birth.
- Your living arrangement changes. (For example, you’re incarcerated, or you move into a nursing home.)
- Someone in your house has a change in health insurance.
- You get married or divorced.
- You move to a new address.
Also, if you have a change in your income or assets, you must report it by the 10th day of the next month. You can report changes:
- By phone or in person to your local county or tribal agency.
- Online through ACCESS.
- By using the Medicaid Change Report, F-10137.
Renewing your benefits
Every year, you must renew your benefits. A month before your benefits end you will get a letter. The letter will tell you how to renew them.
Learn more about renewals.