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Updates for local agencies, community-based organizations, and providers who provide assistance to members of Wisconsin's health and nutrition public assistance programs.
Residential Substance Use Disorder Treatment Coverage for BadgerCare Plus and Medicaid Members Starting February 1, 2021
Starting February 1, 2021, the Wisconsin Department of Health Services will include residential substance use disorder (SUD) treatment as a covered service for most BadgerCare Plus and Medicaid members.
This service is covered when it is provided at facilities that are Medicaid-certified as residential SUD treatment providers. The benefit will only cover the cost of treatment for residential substance use disorder for these members. BadgerCare Plus and Medicaid are not able to cover the cost of room and board while a member gets treatment.
As a result of adding residential SUD treatment as a covered service, there will be some eligibility rule changes that will affect these members. These changes include:
- Members getting residential SUD treatment will be considered temporarily absent from their home as long as they will return home after treatment.
- Members who reside in an institution for mental disease while getting residential SUD treatment will remain enrolled in their Medicaid program with full benefits as long as they meet the program’s rules.
- Members who are living in a medical institution for the purpose of getting residential SUD treatment will not be considered to be living in an institution. Therefore, they will not be subject to the patient liability, divestment, and spousal impoverishment rules normally applied to institutionalized members.
A new provider form, Residential Substance Use Disorder Treatment for BadgerCare Plus and Medicaid Members, F-02766, was created, so that SUD facilities can inform income maintenance and tribal agencies that a member is getting residential SUD treatment.
Please inform members and providers of this new coverage as applicable.
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