Members enrolled in the BadgerCare Plus Basic Plan who are diagnosed with cancer, excluding non-melanoma skin cancers, may bypass the waitlist and apply for the BadgerCare Plus Core Plan. The diagnosis of cancer may be a new diagnosis since the member was enrolled in the Basic Plan or it may be a pre-existing condition.
To enroll a Basic Plan member diagnosed with cancer in the Core Plan, a physician or osteopath who has diagnosed the member with cancer is required to complete the Core Plan Waitlist — Medical Bypass Determination form. The provider is required to indicate a description of the type of cancer on the form.
Note: Basic Plan members with a diagnosis of one of the non-melanoma skin cancers are not eligible to apply for the Core Plan through the Core Plan waitlist bypass process.
The form must be submitted to the ESC by fax at (888) 415-2115 or by mail to the following address:
Enrollment Services Center
PO Box 7190
Madison WI 53707-7190
Providers are encouraged to submit completed forms by fax to ForwardHealth to avoid delays in mailing of forms.
A copy of the completed Core Plan Waitlist — Medical Bypass Determination should be kept in the member's medical record.
After the completed Core Plan Waitlist — Medical Bypass Determination form is received by ForwardHealth, the ESC will verify the information on the form and contact the member to complete the application process via telephone. If the member cannot be reached via telephone, a letter will be mailed to encourage him or her to complete the application process. If the member is eligible for the Core Plan, enrollment will begin on the next first or fifteenth day of the month after the application is approved. The enrollment process is designed to ensure there is no gap in coverage during a member's transition from the Basic Plan to the Core Plan.
If the member does not meet eligibility criteria for the Core Plan, a notice of denial will be mailed to the member and enrollment in the Basic Plan will be terminated since the eligibility criteria for the Core Plan and the Basic Plan are the same.
The usual application processing fee for the Core Plan does not apply to members who have been diagnosed with cancer who will transition from the Basic Plan to the Core Plan. The member's most recent premium paid for the Basic Plan is applied as the enrollment fee for the Core Plan.
Women may be enrolled in the WWWP and the Basic Plan at the same time. Women who are diagnosed with breast cancer or cervical cancer while enrolled in WWWP are eligible to be enrolled in WWWMA through the WWWP. WWWMA covers the same services as Wisconsin Medicaid; therefore, enrollment in WWWMA enables members to receive comprehensive treatment, including services not related to their diagnosis.
Once a woman is enrolled in WWWMA, she is no longer eligible for the Basic Plan. If the woman becomes ineligible for WWWMA in the future, she may be eligible to receive benefits from the Basic Plan.