BadgerCare Plus and Medicaid SSI HMO Contract

2024–2025

• 2025 HMO Contract, effective Jan. 1, 2025
• 2024 HMO Contract (includes November amendment), effective Jan. 1, 2024
• 2024 November Amendment
• 2024 HMO Contract, effective Jan. 1, 2024
• Substantive changes from prior contract

Materials Cited in the BadgerCare Plus and Medicaid SSI HMO Contract

• HMO Provider Network Adequacy Standards
• Member Grievance and Appeals Letter Templates/Mandatory Language:

  The HMO must submit all notice language for approval prior to its use. Template letters with mandatory language have been provided below. Specific instructions are provided in brackets; mail merge fields are included between </>.

  When noted in the instructions, the HMOs should also include a copy of the Fair Hearing Request Form (PDF) from the doa.wi.gov/RequestAHearing webpages.

  • Letter templates that need to include the Fair Hearing Request Form:
    • Appeal Acknowledgement
    • Notice of Extension of Time to Decide
    • Appeal Resolution—Adverse Benefit Determination Upheld
  • Letter templates that do not need the Fair Hearing Request Form:
    • Notice of Denial, Change, or Delay in Services
    • Denial of Request for Expedited Appeal
    • Acknowledgement of Grievance
    • Appeal Resolution—Adverse Benefit Determination Reversed

Dual Eligible Special Needs (D-SNP) Contract

• 2025 D-SNP Contract
• 2024 D-SNP Contract

Wisconsin Medicaid HMO Initial Readiness Assessment

All HMOs interested in participating in the WI Medicaid SSI and/or BadgerCare Plus program must complete a readiness assessment prior to signing an initial contract. Please contact DHSHMOContract@wisconsin.gov to request a meeting to discuss the readiness assessment process.

The readiness assessment for new HMOs includes completing the document below:

• HMO Initial Readiness Assessment

Standard Member Handbook Language for BadgerCare Plus and Medicaid SSI

• English
• Arabic
• Burmese
• Chinese
• Hmong
• Laotian
• Russian
• Somali
• Spanish
• Vietnamese