BadgerCare Plus Members

BadgerCare Plus is a state and federal program that provides health care coverage for Wisconsin individuals and families. Currently, the following Wisconsin residents qualify for BadgerCare Plus:

• Parents or caretakers of dependent children under 19 years of age with household income at or below 1​00% of the Federal Poverty Level (FPL).
• Pregnant people with household income at or below 300% of the FPL.
• Children under 19 years of age, regardless of household income.

Click Here to See What Programs You May be Eligible For
Apply Online Here!

Help is available for you:

If you need help applying or finding other health insurance, visit WisCovered.com or call 211 or (877) 947-2211 to reach a local navigator.

The easiest way to renew is through your ACCESS account at access.wi.gov. If you don’t have an ACCESS account, click the link below to easily register for one!

Click Here to Login to Your ACCESS Account

You can also, renew by mail, over the phone, or in person.

Click Here to Learn More About the Process

Help is available to for you to complete a renewal.

If you need help completing your renewal or finding other health insurance, visit WisCovered.com or call 211 or (877) 947-2211 to reach a local navigator.

If you have enrollment questions, call a ForwardHealth Enrollment Specialist at (800) 291-2002.

If you have a smartphone, the MyAccess app makes navigating BadgerCare and Medicaid simple.
The MyACCESS mobile app makes it easy to access and manage your benefits!

Get the app in three easy steps:

1. Go to your Apple App Store or Google Play Store
2. Search for “myACCESS Wisconsin”
3. Download the app on to your device at no cost!

Once downloaded, use the app to:

• Check your benefits and programs
• Receive reminders and notifications
• Submit and track documents

Click Here for Mobile App Support

• Ask if you have health insurance at your job
  • Apply within 60 days of losing BadgerCare or Medicaid

• Apply on HealthCare.gov (Federal Health Insurance Marketplace)
  • Apply online within 60 days through healthcare.gov
  • *Financial help is available through healthcare.gov
  • Click here for more information or call (800) 318-2596

• Apply for Medicare if you are 65 or older
  • Apply within 6 months for Medicare Part A and Part B
  • Apply within 3 months for Medicare Advantage Plan and Medicare Part D (prescription drug coverage)
  • Call the Medigap Helpline at (800) 242-1060

Contact your County Consortium. Click here to learn more.

If you have questions on your ForwardHealth ID card or need a new ID card, call ForwardHealth Member Services at (800) 362-3002.

The State of Wisconsin assists with these services. Please call the Department of Health at (800) 362-3002 for information about your prescription drug benefits.

You can get these services. You must find a doctor or clinic that accepts your ForwardHealth ID card. To find a doctor or clinic, call ForwardHealth Member Services at (800) 362-3002.

You can also call the GHC-SCW BadgerCare Plus Coordinator at (608) 662-4991.

Men

• Condoms
• Sexual health check-up
• Tests and treatment for STDS or sexually transmitted infections
• Procedure to prevent future pregnancy: Vasectomy

Women

• Birth control services and supplies
• Sexual health check-up including PAP tests
• Tests and treatments for STDs or sexually transmitted infections
• Surgery to tie tubes (tubal ligation)

Pregnancy

BadgerCare Plus pays for the baby’s delivery and your health care while you’re pregnant. For the mom, this health insurance lasts 60 days after the baby is born.

You may qualify for BadgerCare Plus if:

• You are pregnant
• Your household’s monthly income is equal to or lower than 300% of the Federal Poverty Level.

Click here to apply!

After the birth:

1. Call ForwardHealth Member Services at (800) 362-3002
2. Tell the county agency that the baby was born and needs BadgerCare
3. Ask if any adults or other children in the household qualify

• You have the right to have an interpreter with you during any BadgerCare Plus covered service.
• Your right to get the BadgerCare member handbook in another language or format.
• Your right to be free from discrimination. GHC-SCW must obey laws that protect you from discrimination and unfair treatment. GHC-SCW provides covered services to all eligible members regardless of the following:
  • Age, Color, Disability, National origin, Race, Sex, Religion, Sexual orientation, Gender identity
  • All medically necessary, covered services are available and will be provided in the same manner to all members. All persons or organizations connected with GHC-SCW that refer or recommend members for services shall do so in the same manner for all members
• Your right to be free from any form of restraint or seclusion used to coerce, discipline, be convenient or retaliate. This means you have the right to be free from being restrained or forced to be alone to make you behave in a certain way, to punish you or because someone finds it useful.
• Your right to privacy. GHC-SCW must follow laws protecting the privacy of your personal and health information. See GHC-SCW’s Notice of Privacy Practices for more information.
• Your right to have covered services be available and accessible to you when you need them. When medically appropriate, services must be available 24 hours a day, seven days a week.
• Your right to have covered services be available and accessible to you when you need them. When medically appropriate, services must be available 24 hours a day, seven days a week.
• Your right to get information about treatment options, regardless of cost or benefit coverage.
• Your right to accept or refuse medical or surgical treatment and participate in making decisions about your care.
• Your right to plan and direct the types of health care you may get in the future if you become unable to express your wishes. You can make these decisions by completing an advance directive, living will, or power of attorney for health care.
• Your right to a second opinion if you disagree with your provider’s treatment recommendation. Call Customer Service for more information about how to get a second opinion.
• Your right to ask if GHC-SCW has special financial arrangements (physician incentive plans) with our physicians that can affect the use of referrals and other services you might need. To get this information, call our Customer Service Department at (800) 608-4327 and request information about our physician payment arrangements.
• Your right to request information about GHC-SCW providers, including the provider’s education, board certification, and recertification. To get this information, call our Customer Service Department at (800) 608-4327.
• You may correct inaccurate information in your medical records if your doctor agrees to the correction.
• Call (800) 608-4327 for assistance with requesting a copy or change to your medical records. Please note that you may have to pay to copy your medical records.
• Your right to be informed of how to access these services through FowardHealth using your ForwardHealth card.
• Your right to disenroll from GHC-SCW if GHC-SCW does not cover a service you want because of moral or religious objections.
• Your right to request a fair hearing if you are dissatisfied with GHC-SCW’s decision about your appeal or if GHC-SCW does not respond to your appeal in a timely manner.
• Your right to request a Department of Health Services grievance review if you are unhappy with GHC-SCW’s decision about your grievance or if GHC-SCW does not respond to your grievance in a timely manner.
• Your right to know about any big changes with GHC-SCW at least 30 days before the effective date of the change.
• Your right to make recommendations about GHC-SCW’s Member Rights and Responsibilities Policy.

You have a responsibility to:

1. You have a responsibility to provide the information that GHC-SCW and its providers need to provide care.
2. You have a responsibility to let GHC-SCW know how best to contact and communicate with you. You have a responsibility to respond to communications from GHC-SCW.
3. You have a responsibility to follow plans and instructions for care that you have agreed to with your providers.
4. You have a responsibility to understand your health problems and participate in creating treatment goals with your providers.

You have a right to:

1. Receive information about GHC-SCW, its services and its providers, including the right to receive a copy of the GHC-SCW Patient Rights and Responsibilities.
2. Be treated with dignity and respect in a confidential manner.
3. Participate with your providers in making decisions about your health care.
4. Participate in a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
5. Voice complaints about the service and care you receive without penalty or disenrollment.
6. Receive notification and a rationale when case management services are changed or no longer needed.
7. Receive a certificate outlining the coverage to which you and/or your family members are entitled, and to whom the benefits are paid.
8. Ask questions regarding your medical plan coverage, the preauthorization process or claims payment.
9. Submit complaints about appeals about GHC-SCW or the care we provide.
10. Select a primary care provider and to request a new provider without indicating a reason.
11. Receive a full explanation of any charges billed to you as a result of care.
12. Participate in the governance of GHC-SCW. Each member must be at least 18 years of age to be a voting member of the Cooperative and is encouraged to actively participate in its operation.
13. Make recommendations regarding the organization’s member rights and responsibilities.
14. Receive informed consent, as required by law, prior to procedures or treatments. To the extent permitted by law, it is your right to refuse the recommended treatment and be informed of the consequences of this decision.
15. Receive confidential treatment of all communications and records concerning your care, except as otherwise provided by law.
16. View and receive a copy of your health records and x-rays upon receipt of written authorization.
17. Receive a copy of the GHC-SCW Notice of Privacy Practices.

You have a responsibility to:

1. Be considerate of others.
2. Observe safety and smoking regulations in all GHC-SCW facilities.
3. Treat GHC-SCW employees with consideration and respect.
4. Provide information that the organization and its practitioners and providers need in order to provide care.
5. Use facilities and equipment properly.
6. Read and understand your coverage.
7. Be on time for appointments and inform the clinic in advance when appointments cannot be kept.
8. Follow plans and instructions for care as agreed to with your provider.
9. Work with your provider to clearly understand your health problems and participate in creating mutually agreed upon treatment goals.
10. Pay your financial obligations under the benefit plan.
11. Know and confirm your benefits before receiving treatment.
12. Obtain preauthorization for services indicated in your certificate.
13. Notify GHC-SCW of changes in your address, phone number or family status.