State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

24-01 Version of 36.2 WWWMA Enrollment

36.2.1 Administration of Wisconsin Well Woman Medicaid

WWWMA is administered by the DHS DMS Enrollment Management Central Application Processing Operation (EM CAPO). EM CAPO handles all enrollments and renewals.
Temporary Enrollment/Presumptive Eligibility enrollment is processed by the fiscal agent.

Any applications received in local IMincome maintenance or tribal agencies should be faxed to the EM CAPO at 608-267-3381 immediately upon receipt to prevent any delay in eligibility determination or treatment for the applicant.

CONTACTS:

EM CAPO: DHSEMCAPO@dhs.wisconsin.gov

Fax: 608-267-3381

Phone: 1-877-246-2276

Customer line: 608-266-1720

36.2.2 Enrollment through the Wisconsin Well Woman Program

The WWWPThe Wisconsin Well Woman Program is administered by the DHSDepartment of Health Services Division of Public Health (DPH). WWWP provides eligible persons with various health screenings (including breast and cervical cancer screening), referrals, education, and outreach.

The WWWP performs the financial and initial non-financial screening for WWWMA for WWWP enrollees. A WWWP enrollee must have a health screening through WWWP, be diagnosed, and need treatment for breast or cervical cancer to be considered for WWWMA.

WWWP Local Coordinating Agencies (LCA)Local Coordinating Agencies for the Wisconsin Well Woman Medicaid Program. enroll persons in WWWP and perform some of the basic non-financial and all financial data gathering, and verification for WWWMA. They also coordinate the WWWP member’s referral to a health care provider for breast and cervical cancer screening.

1. The WWWP LCA will complete the F-44818 (formerly DPH-4818) with the assistance of the applicant prior to the applicant’s health care screening. The F-44818 enrolls the person in WWWP. Their WWWP eligibility will be in interChange under medical status code "CS."
2. The WWWP member will receive a breast and cervical cancer screening from a WWWP provider. If the WWWP member is diagnosed with breast or cervical cancer, their provider will complete the F-10075 recording the diagnosis and indicating that treatment is required. The provider will sign and date the F-10075. The WWWP member will also sign and date the F-10075. The signature dates do not have to be the same date.
3. The provider will fill in the beginning and end dates of the temporary enrollment/presumptive eligibility for WWWMA on the F-10075.
4. The provider will forward a copy of the F-10075 to the WWWP LCA.
5. The WWWP LCA will provide the member with a copy of the signed F-10075 and F-44818 forms.
6. The WWWP LCA will check to be sure correct temporary eligibility dates (if appropriate) are entered on the F-10075 and explain that the member’s temporary enrollment for WWWMA will end on the last day of the following calendar month.

36.2.2.1 Temporary Enrollment (TE) / Presumptive Eligibility (PE) Available Only to Persons Enrolling through WWWP

Temporary Enrollment (TE), also known as Presumptive Eligibility (PE), is a streamlined eligibility determination for temporary enrollment in Wisconsin Well Woman Medicaid (WWWMA). It allows eligible applicants immediate access to cancer treatment for a short period until an application for ongoing coverage is completed and processed. TE is only available to persons who are enrolling through the Wisconsin Well Woman Program (WWWP). An applicant may only be temporarily enrolled once in a rolling 12-month period.

The provider doing the medical screening enters the TE dates in the section "Temporary Eligibility Begin Date" and "Temporary Eligibility End Date" on the F-10075. The dates should cover the time period beginning on the date of diagnosis through the last day of the following calendar month.

The WWWP Local Coordinating Agency (LCA) should then fax a copy of the completed F-10075 to the fiscal agent at 608-221-8815 within five days of the diagnosis date. The fiscal agent will enter the temporary enrollment data in ForwardHealth interChange (with a medical status code of "CB") and send the member a ForwardHealth card with the temporary enrollment dates activated on the card. If the member had a previous ForwardHealth card, it will be reactivated.

Until the ForwardHealth card arrives or is reactivated, the new WWWMA memberA recipient of Medicaid; formerly referred to as a "client." may receive services by presenting both of the following completed forms to any Medicaid provider:

1. WWWP Enrollment Form (F-44818)
2. WWWMA Determination Form (F-10075)

To continue receiving WWWMA, the member or the WWWP LCA must submit an F-10075 to the EM CAPO. If the member does not apply, their WWWMA benefits will end at the end of the month following the month of diagnosis.  

The TE period extends from the date of diagnosis on the F-10075 through the following month. A new TE period would only occur if a new cancer diagnosis was established for the same member and only if it has been at least 12 months since the first day of their last TE period.

Note

If the member applies during their TE certification period and the EM CAPO is not able to process their application within the 30-day processing time frame, the EM CAPO will extend the members' eligibility for an additional 30 days from the last day of their Wisconsin Well Woman Medicaid TE with a medical status of "CB.” Submit an F-10110 (formerly DES 3070) to extend the Well Woman Medicaid TE for an additional calendar month.

36.2.3 WWWP Members Enrolling in WWWMA

36.2.3.1 Applications for Wisconsin Well Woman Medicaid through the Wisconsin Well Woman Program

The standard Medicaid application form is not used to enroll in WWWMA. To apply for WWWMA through the WWWP, the applicant or the WWWP LCA must send or fax the completed F-44818 and F-10075 forms to the EM CAPO. The applicant may apply for WWWMA at any time after the WWWP screening and diagnosis. Eligibility may only be backdated to the first of the month up to three months prior to the application date or from the date of diagnosis, whichever is most recent. 

The date of receipt of the F-10075 is the filing date. See Chapter 20 for verification policies.

The following steps are completed to enroll the member in WWWMA:

1. Review the F-44818. There should be a "No" answer to the following questions.
   1. Does the applicant have any health insurance? (Item #32 on F-4818)
      If the applicant answers "Yes", determine if the insurance is one of those listed in Section 36.3.3 Non-Disqualifying Insurance Coverage Non-Disqualifying Insurance Coverage that covers treatment for breast or cervical cancer. If the applicant has coverage for the treatment, they are ineligible for WWWMA.   
   2. Does the applicant have Medicare Part B? (Item #33 on F-4818)
   3. Does the applicant have Medicare Part A.

   If the applicant answered "Yes" to any of these questions in a-c, the applicant is ineligible for WWWMA. The EM CAPO will refer the applicant back to the Well Woman Program and send a manual negative notice.

2. Review the F-44818 to ensure that the following fields have been completed: 1-5, 9-13, 16-25, and 27-45.
   If the form is incomplete, the EM CAPO will request that the applicant provide any missing information. If the applicant does not provide all necessary information, there may be a delay in enrollment.
3. Review F-10075 for an SSNSocial Security number. If the SSN is missing from the F-10075 and is not present on the F-44818 (# 6a); the EM CAPO will ask the applicant to provide their Social Security Number (SSN). Providing an SSN for the Well Woman Program is voluntary, but providing an SSN, or applying for one, is required for WWWMA.
   
   If the applicant fails to provide an SSN, or fails to apply for an SSN within the 30-day application processing time or within 10 days (whichever is later), the EM CAPO will send a manual negative notice to the applicant indicating that they are not eligible for WWWMA because they did not provide an SSN.
4. Ask the applicant if they are a U.S. citizen.
   If the applicant is not a U.S. citizen, ask them what their immigration status is and to provide their immigrant registration card. Verify that the applicant is in a qualified immigration status using the  Systematic Alien Verification for entitlement (SAVE) system.

   Note:

   Some applicants with breast and cervical cancer who do not meet the immigration-related eligibility criteria may be eligible to receive emergency services. If a non-qualifying immigrant has been screened by WWWP, determine their eligibility for emergency services using the criteria in 7.1 US Citizens and Nationals.

5. If there are any questionable items, contact the Wisconsin Well Woman Program Local Coordinating Agency (WWP LCA). 
6. EM CAPO will update interChange with the WWWMA eligibility information using a medical status code of "CB" to certify any member who has met the criteria listed above. Submit the completed Medicaid/BadgerCare Plus Eligibility Certification form (F-10110) to the fiscal agent by fax to 608-221-8815, through interChange, or by mail to:
   
   ForwardHealth
   Attn Eligibility Lead Worker WWWMA
   313 Blettner Blvd
   Madison WI
   53714-2405
7. Certify the member for 12 months from the filing date and backdate to whichever is more recent:
   1. Up to three months prior to the filing date
   2. To the date of the diagnosis (F-10075)

A person cannot be enrolled in WWWMA prior to their date of diagnosis.

Example 1:

Gina applies for Wisconsin Well Woman Medicaid (WWWMA) at the Local Coordinating Agency (LCA) on September 20. The LCA submits the F-44818 and F 10075 to EM CAPO. The F-10075 indicates that Gina is enrolled in Wisconsin Well Woman Program (WWWP). The F-44818 confirms Gina’s enrollment in the WWWP. Gina’s date of diagnosis on the F-10075 is August 6. Gina meets the following non-financial requirements: citizenship/ID documentation, provides a valid SSN and has no public or private insurance that will cover her cancer treatment and she is under 65 years of age. EM CAPO will certify Gina in interChange (iC) effective August 6 through July 31 with a CB medical status code. EM CAPO will send Gina a notice indicating her eligibility dates. About 45 days before the end of Gina’s eligibility period, EM CAPO will send Gina a renewal notice indicating she needs to renew her WWWMA.

For initial WWWMA certifications, if the applicant applies during their WWWMA TE certification period  and EM CAPO is not able to process their application within the 30-day processing time frame, EM CAPO will extend the applicant's eligibility for an additional 30 days from the last day of their WWWMA TE in iC with a medical status of "CB.” EM CAPO will note this extension in the CARES Comments section if appropriate.

To contact the WWWP LCA, refer to #27 of F-44818.

36.2.4 Enrollment for Family Planning Only Services Members

Persons enrolled in FPOSFamily Planning Only Services who meet one of the following criteria (regardless of age), will be eligible for WWWMA:

• Are screened for, and diagnosed with, breast or cervical cancer or a precancerous condition of the breast or cervix
• Receive a clinical exam through a FPOS provider and through follow up medical testing
  • Are found to be in need of treatment for breast or cervical cancer or precancerous condition  of the breast or cervix and
  • Do not have other insurance that would cover their cancer treatment.

36.2.4.1 Applications for Wisconsin Well Woman Medicaid Through Family Planning Only Services

A WWWMA Determination form (F-10075) submitted by a Famliy Planning Only Services (FPOS) member or their representative is a request to enroll in WWWMA and disenroll from FPOS. Individuals who are enrolled in FPOS in CARES and meet the criteria above (see Section 36.2.4 Enrollment for Family Planning Only Services Members) may be eligible for WWWMA.

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The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030