Free Certification Criteria for Partners and Providers to Provide Express Enrollment of Children in BadgerCare Plus, F11318 - Wisconsin

FORWARDHEALTH PROVIDER SERVICES 6406 BRIDGE ROAD MADISON WI 53784

Jim Doyle Governor Karen E. Timberlake Secretary

State of Wisconsin Department of Health Services

Telephone: 800-947-9627 TTY: 608-221-4746

www.forwardhealth.wi.gov www.forwardhealth.wi.gov/members

CERTIFICATION CRITERIA For Partners and Providers to Provide Express Enrollment of Children in BadgerCare Plus State and federal laws allow for the temporary enrollment of children under age 19 into BadgerCare Plus. Under these laws, certain "qualified entities" are allowed to temporarily enroll children based on preliminary information about family income. A qualified entity is any individual, agency, or organization the state designates as qualified to make these determinations. Qualified Partners and Providers In the state of Wisconsin, qualified partners and providers include the following: 1. 2. 3. 4. Wisconsin Medicaid Providers certified under ch. HFS. 105, Wis. Admin. Code: Agencies that determine eligibility for Head Start under the federal Head Start Act; Agencies that determine eligibility for child care under the Child Care and Development Block Grant Act of 1990; Agencies that determine eligibility for the Special Nutrition Program for Women, Infants, and Children (WIC) under s. 17 of the Child Nutrition Act of 1966; Elementary or secondary schools, as defined in s. 14101 of the Elementary and Secondary Education Act of 1965; Elementary or secondary schools operated or supported by the Bureau of Indian Affairs: Government entities: State, Tribal, or local governments; Organizations providing emergency food and shelter under a grant from the Stewart B. McKinney Homeless Assistance Act; Faith-based organizations providing services to low-income children and families; and

5. 6. 7. 8. 9.

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10. Community-based organizations providing health or social services to low-income children and families. Other Entities Entities not defined above may also apply for certification to temporarily enroll children in BadgerCare Plus. The Department will review these applications on a case-by-case basis. The Department will make a decision based on several factors, including: geographic location, population typically served by the agency, and the agency's ability to meet the Department's requirements for making timely determinations. Application To be qualified to use the Express Enrollment Web-based tool to temporarily enroll children in BadgerCare Plus, interested agencies must complete the Application to Become a Certified Partner/Provider for BadgerCare Plus Express Enrollment for Children form, F-10148. The Security Administrator is any individual the partner or provider designates as the authorized representative to establish online access for the agency or clinic. Applicants must complete all fields, except as follows: · The name of the individual completing the form is not required if it is the same as the Security Administrator. · The additional site information is not required if the primary site is the only location. Note: Separate applications or certification is not required for satellite locations or for individuals working within an agency, clinic, or health care facility. Notification The Department will notify applicants of approvals or denials in writing. Once your application is approved, you will receive two letters: · The first will be your approval letter, which will provide you with a partner/provider number that identifies you as qualified to use Express Enrollment to temporarily enroll children in BadgerCare Plus. · Your Security Officer will receive an e-mail that will include a one-time use PIN. Once your Security Officer receives the PIN, he or she will be able to log in and set up administrative rights for individuals in your agency to begin using the BadgerCare Plus Express Enrollment application on the ACCESS for Partners and Providers Web site. You will also receive information about where to find instructional materials and information you will need to begin using BadgerCare Plus Express Enrollment.

Page 3 of 3 Please call Provider Services at (800) 947-9627 if: · You have questions about the enclosed materials or · Your application is approved, but you do not receive your PIN within 14 days following the receipt of your first letter containing your partner/provider number. Partners and providers may not temporarily enroll children in BadgerCare Plus without written approval from the Department. F-11318 (10/08)