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Welcome  » April 13, 2024 8:11 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Hospital, Outpatient

Member Information : Special Enrollment Circumstances

Topic #279

Members Traveling Out of State

When a member travels out of state but is within the United States (including its territories), Canada, or Mexico, BadgerCare Plus and Wisconsin Medicaid cover medical services in any of the following circumstances:

  • An emergency illness or accident
  • When the member's health would be endangered if treatment were postponed
  • When the member's health would be endangered if travel to Wisconsin were undertaken
  • When PA has been granted to the out-of-state provider for provision of a nonemergency service
  • When there are coinsurance, copayment, or deductible amounts remaining after Medicare payment or approval for dual eligibles

Note: Some providers located in a state that borders Wisconsin may be Wisconsin Medicaid enrolled as a border-status provider if the provider notifies ForwardHealth in writing that it is common practice for members in a particular area of Wisconsin to seek their medical services. Border-status providers follow the same policies as Wisconsin providers.

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