Medicaid SSI Recipients Required to Enroll in HMOs in 2018

January 05, 2018

Under a change being implemented by the Department of Health Services (DHS), starting in January, Medicaid recipients age 19 and older who receive Medicaid because of a disability will be required to enroll in an HMO in order to receive health care services. This category of Medicaid is typically referred to as Medicaid-SSI to indicate these individuals are receiving supplemental security income because of a disability. 

In the past, Medicaid-SSI recipients could choose not to enroll in an HMO, with services paid for on a fee-for-service basis. Starting in January, these recipients will need to choose an HMO or will have an HMO chosen for them. The change will be effective at different times in 2018 for different regions of the state, and recipients will have to choose an HMO prior to the effective dates. The effective dates are:  

  • February 2018: Region 1 (North)
  • March 2018: Region 3 (West Central)
  • April 2018: Region 5 (Southeast)
  • May 2018: Region 6 (Milwaukee)
  • June 2018: Region 2 (Northeast)
  • June 2018: Region 4 (South Central)

According to DHS, there are eight HMOs that will participate in the program for Medicaid-SSI. Participation may vary by region, but include: Anthem Blue Cross Blue Shield; Care Wisconsin Health Plan; Group Health Cooperative of Eau Claire; Independent Care (ICare); Managed Health Services; Molina Healthcare; Network Health Plan; and United Healthcare Community Plan.

For providers, the change is important as Medicaid-SSI recipients previously were likely enrolled in Medicaid fee-for-service and would have been able to choose their provider. Under an HMO, the recipient will have access only to the providers enrolled with the Medicaid HMO that is participating in SSI. Providers would need to have contracts in place with the Medicaid SSI HMOs to continue serving these patients. 

More information about these changes can be found on the DHS website at: www.dhs.wisconsin.gov/medicaid/hmo-2018chng.htm. In addition, DHS is planning several public hearings. Starting in January, these hearings will be held in areas in the Northern Region of the state. Current planned hearings are: 

  • Wednesday, January 10, 2018: Region 1 (North), Marathon County
    1:30 - 3:30 p.m. or 5 - 7 p.m.
    Northcentral Technical College, 1000 W. Campus Dr., Wausau, WI 54401
  • Wednesday, January 10, 2018: Region 1 (North), Iron County
    1:30 - 3:30 p.m. or 5 - 7 p.m.
    Iron County Human Services, 300 Taconite St., Suite 201, Hurley, WI 54534
  • Wednesday, January 10, 2018: Region 1 (North), Douglas County
    1:30 - 3:30 p.m. or 5 - 7 p.m.
    Government Center, 1316 N. 14th St., Suite 400, Superior, WI 54880
  • Wednesday, January 10, 2018: Region 1 (North), Shawano County
    1:30 - 3:30 p.m.
    Shawano County Department of Human Services 
    607 E. Elizabeth St., Lundmark Room, Shawano, WI 54166
  • Wednesday, January 10, 2018: Region 1 (North), Dunn County
    1:30 - 3:30 p.m. or 5 - 7 p.m.
    Dunn County Community Services Building
    3001 US Highway 12 East, Room 54 (Basement), Menomonie, WI 54751
  • Wednesday, January 10, 2018: Region 1 (North), Oneida County
    1:30 - 3:30 p.m. or 5 - 7 p.m.
    The Human Service Center, 705 E. Timber Dr., 132 Rhinelander Room, Rhinelander, WI 54501
  • Tuesday, February 6, 2018: Region 3 (West Central), La Crosse County
    1:30 - 3:30 p.m. or 5 - 7 p.m.
    Onalaska Omni Center, 255 Riders Club Rd., Onalaska, WI 54650

 

This story originally appeared in the January 05, 2018 edition of WHA Newsletter