Download Wisconsin

1) State: Wisconsin
2) Own or Federal Exchange? Federal
Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/wisconsin.html
3) Medicaid Expansion? No
Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/wisconsin.html
4) What kind of coverage is available for mental health/substance abuse treatment through
Medicaid?
Wisconsin Medicaid (Badger Plus) covers the follow services related to mental health/substance abuse:
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Inpatient hospital services other than services in an institution for mental disease
Inpatient hospital, skilled nursing facility, and intermediate care facility services for patients in
institutions for mental disease who are:
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o
o
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Under 21 years of age
Under 22 years of age and was getting services when you turned 21 years of age
65 years of age or older
Intermediate care facility services, other than services at an institution for mental disease
Mental health and medical day treatment
Mental health and psychosocial rehabilitative services, including case management services,
provided by staff of a certified community support program
Skilled nursing home services other than in an institution for mental disease
Substance abuse (alcohol and other drug abuse) services
Source: http://www.dhs.wisconsin.gov/badgercareplus/standard.htm
5) Does the state allow the court to order treatment and still have it paid by Medicaid?
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The court can order treatment and have it paid by Medicaid if the services are covered by
Medicaid (shown in the question above).
6) Are there restrictions related to treatment providers for probationers, substance abuse, or mental
health treatment? Will only certain providers be covered?
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The Division of Mental Health and Substance Abuse Services (DMHSAS) manages programs that
provide community mental health and substance abuse services. It also administers the State’s
institutional programs for persons whose mental needs or developmental disabilities cannot be
met in a community setting. The Division, under the Department of Health Services, also
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operates two psychiatric hospitals and three Secure Treatment Facilities that provide care and
treatment for persons with mental illness.
Treatment providers must be contracted with Wisconsin DMHSAS and must have the
appropriate license and certification to treat patients in Wisconsin.
Source: http://www.dhs.wisconsin.gov/aboutDHS/DMHSAS/index.htm
7) Is there coverage for residential substance abuse treatment? What are the parameters?
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Wisconsin has limited services available for Medicaid adult beneficiaries. All psychiatric hospital
admissions are not covered for beneficiaries between the ages of 22 and 65
Source: http://www.dhs.wisconsin.gov/badgercareplus/standard.htm
http://store.samhsa.gov/shin/content/NMH05-0202/NMH05-0202-WI.pdf
8) What is the process and what are the regulations for treatment providers to be able to participate?
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Providers must be licensed or certified to practice in the state of Wisconsin. They also must be
Wisconsin Medicaid Certified to receive reimbursements.
Medicaid reimbursement is available for mental and behavioral health services covered under
various service categories: physician services, inpatient and outpatient hospital services,
licensed practitioner’s services, clinics, and rehabilitative services.
Source: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/MentalHealth-Services-.html
9) Is dental care covered?
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Dental care is an option in the Marketplace, but is not included in the basic plan (except for
children).
Wisconsin Medicaid adult dental care coverage is limited to an exam and cleaning one time per
year, and the frequency of x-rays are limited by type.
Source: http://kff.org/medicaid/state-indicator/dental-services/#