State of Wisconsin Department of Health Services

Release 24-03 December 18, 2024

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36.2 WWWMA Enrollment

 WWWMA is administered by DHS DMS Enrollment Management Central Application Processing Operation (EM CAPO). EM CAPO handles all WWWMA applications and renewals. Any applications received in local IM 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.

The standard Medicaid application form is not used to enroll in WWWMA. To apply for WWWMA, the applicant must complete the Wisconsin Well Woman Medicaid Application and Renewal form (F-10075) and submit it following the instructions on the form. The applicant may apply for WWWMA at any time after the screening and diagnosis of breast or cervical cancer or certain precancerous condition of the breast or cervix.

The filing date of a WWWMA application is the day a signed, valid application is received by EM CAPO. See Section 2.4 Valid Application.

WWWMA eligibility begins the first day of the month in which the valid application is submitted and all eligibility requirements are met.

Example 1

Maria is diagnosed with cervical cancer on December 16. She applies for WWWMA on December 17. She does not request backdated coverage. Maria is determined eligible for WWWMA. Her WWWMA enrollment starts on December 1.

36.2.1 WWWMA Backdated Eligibility

All applicants may have their WWWMA eligibility backdated to the first of the month, up to three months prior to the month of application. Eligibility may not be backdated earlier than the first of the month of the date of diagnosis.

The applicant may be certified for any backdate month in which they would have been eligible had they applied in that month.

Example 2

Yura is diagnosed with a precancerous condition of the breast on October 25. She applies for WWWMA on December 5. She requests three months of backdated coverage (September, October, November). Yura is determined eligible for WWWMA. Her WWWMA enrollment starts on October 1 since that is the first of the month of her diagnosis date. She is not eligible for WWWMA in September since that month was before her diagnosis.

36.2.2 WWWMA Enrollment through the Wisconsin Well Woman Program

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

In addition to the requirements in Section 36.3 WWWMA Nonfinancial Requirements and Section 36.4 WWWMA Financial Requirements, a WWWP client must have a health screening through WWWP, be diagnosed, and need treatment for breast or cervical cancer or a precancerous condition of the breast or cervix to be eligible for WWWMA.

WWWP coordinating agencies enroll persons in WWWP and may assist them with completing the WWWMA application. They also coordinate the WWWP, client's referral to a health care provider for breast and cervical cancer screening.

36.2.2.1 WWWP Process for Assisting with WWWMA Application

1. The WWWP coordinating agency will complete the F-44818 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 client will receive a breast and cervical cancer screening from a WWWP provider.
3. If the WWWP client is diagnosed with breast or cervical cancer or a precancerous condition of the breast or cervix and wants to apply for WWWMA, they will complete Part A - Applicant/Member Information in the Wisconsin Well Woman Medicaid Application and Renewal form (F-10075).They will sign and date the application,
4. The WWWP provider will complete Part-B Diagnosing or Recertifying Provider in the F-10075 recording the diagnosis and indicating that treatment is required. The provider will sign and date the F-10075. The applicant and provider signature dates do not have to be the same date.
5. If doing a temporary enrollment determination: The provider will fill in the begin and end dates of the temporary enrollment for WWWMA in Part C – Temporary Enrollment / Presumptive Eligibility on the F-10075. The begin date is the date of diagnosis. The end date is the last day of the month following the month of diagnosis. See Section 36.2.2.2 Temporary Enrollment (TE) Available Only to Persons Enrolling Through WWWP.
6. The provider will forward a copy of the F-10075 to the WWWP coordinating agency.
7. The WWWP coordinating agency will provide the member with a copy of the signed F-10075 and F-44818 forms.
8. If doing a temporary enrollment determination: The WWWP coordinating agency will check to be sure correct temporary eligibility dates are entered on the F-10075 and explain that the client’s temporary enrollment for WWWMA will end on the last day of the following calendar month. The WWWP coordinating agency will 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 in ForwardHealth.
9. The WWWP coordinating agency or the member will fax, mail, or scan and email the F-44818 and the F-10075 to EM CAPO. EM CAPO will process the application and determine eligibility for a 12-month certification period for WWWMA.

36.2.2.2 Temporary Enrollment (TE)  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).

WWWP coordinating agencies perform the eligibility determination for TE in WWWMA by completing the Wisconsin Well Woman Medicaid Application and Renewal form (F-10075), including the TE/PE section. See Section 36.2.2.1 WWWP Process for Assisting with WWWMA Application.

TE enrollment in WWWMA is processed by the fiscal agent. When the fiscal agent receives the F-10075 from the WWWP coordinating agency, they 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 member may receive services by presenting both of the following completed forms to any Medicaid provider:

1. WWWP Enrollment Form (F-44818)
2. WWWMA Application and Renewal Form (F-10075)

An applicant may only be temporarily enrolled once in a rolling 12-month period.TE in WWWMA begins on the date the person is found temporarily eligible. TE does not go back to the first of the month. TE in WWWMA ends the last day of the following calendar month.A person can only be eligible for a new TE period if a new cancer diagnosis was established 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 to extend the Well Woman Medicaid TE for an additional calendar month.

 

Example 3

Jamie is diagnosed with breast cancer on February 18. On that same day, her provider completes the Wisconsin Well Woman Medicaid Application and Renewal form (F-10075), including the TE/PE section, and finds her eligible for TE for WWWMA. Jamie is eligible for TE for WWWMA from February 18 through March 31.

To continue receiving WWWMA, the member or the WWWP coordinating agency must submit an F-10075 to the EM CAPO. See Section 36.2.2.1 WWWP Process for Assisting with WWWMA Application. If the member does not apply, their WWWMA benefits will end at the end of the month following the month of diagnosis.

36.2.3 WWWMA Enrollment for Family Planning Only Services Members

In addition to the requirements in Section 36.3 WWWMA Nonfinancial Requirements and Section 36.4 WWWMA Financial Requirements, a person enrolled in FPOSFamily Planning Only Services who meets one of the following criteria, may 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 major medical insurance or other insurance that would cover their cancer treatment.

A Wisconsin Well Woman Medicaid Application and Renewal form (F-10075) submitted by a Family 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 and meet the criteria  in Section 36.2.4 Enrollment for Family Planning Only Services Members may be eligible for WWWMA. See Process Help 9.1.2 WWWMA Application for information on processing WWWMA applications.

36.2.4 WWWMA Enrollment for BadgerCare Plus Members

In addition to the requirements in Section 36.3 WWWMA Nonfinancial Requirements and Section 36.4 WWWMA Financial Requirements, a person enrolled in BadgerCare Plus who meets one of the following criteria, may 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 BadgerCare Plus 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 major medical insurance or other insurance that would cover their cancer treatment.

The person’s enrollment in BadgerCare Plus must end prior to their enrollment in WWWMA. The person must contact their income maintenance agency to disenroll from BadgerCare Plus. EM CAPO does not manage BadgerCare Plus enrollment. See Process Help 9.1.2 WWWMA Application for information on processing WWWMA applications.

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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