HMO Enrollment Changes for Medicaid Supplemental Security Income Members

Starting in January 2018, certain Supplemental Security Income (SSI) members must enroll in a health maintenance organization (HMO) of the member’s choice to continue getting health care through the SSI Medicaid program. 

In the past, people on SSI Medicaid or SSI-related Medicaid had the option to opt out of managed care, but that option is no longer available. As a result, from December 2017 to June 1, 2018, the state will require 28,000 individuals currently on fee-for-service (straight Title 19) SSI Medicaid or SSI-related Medicaid to enroll into managed care HMOs. If an individual does not choose an HMO, one will be chosen for them.

This roll out will occur by region of the state, with South Central Wisconsin as the last region, in June 2018. If this change affects you, you will get a letter about the change and an enrollment packet between December 2017 and January 2018. More details on this change can be found on the New DHS Website – SSI Medicaid Managed Care Expansion. Also, see the ForwardHealth Fact Sheet.

NOTE: This change does NOT affect people enrolled in Home and Community-Based Medicaid Waivers or Long-Term Care Medicaid, such as Family Care, IRIS, Pace, Partnership and legacy waivers. It also does not affect those who receive both Medicare and Medicaid.

The SSI-Managed Care External Advocacy Project at DRW is available to help answer your questions about this expanded enrollment, and direct you to the proper resources for choosing an HMO. Our advocates can be reached at 800-708-3034 or 414-773-4646.