Medicaid Changes Could Leave Disabled Without Needed Coverage

MILWAUKEE COUNTY, WI — Milwaukee-area residents on Medicaid who receive Supplemental Security Income will soon be required to sign up for an HMO — however some health experts are saying that the rollout is happening too fast and could lead to negative consequences for people with disabilities.

The changes have the potential to impact 12,000 Milwaukee-area residents who are on receive SSI and also have a disability, according to state data.

Disability Rights Wisconsin, a leading patient advocacy group, says there are two main issues with the rollout that has officials concerned: 1) If an SSI recipient does not enroll in the HMO of their choice in time, they will be automatically enrolled in an HMO that may not fit their unique health needs, and 2) If an SSI recipient has a representative payee, the change notice gets sent to them instead. The representative payee is supposed to help with financial matters and is not guaranteed to be a coverage advocate for the disabled, nor are they legally obligated to forward information to the people they serve.

"We have alerted the state on numerous occasions to our our concenrs, and we are very converned that individuals who are receiving notices and the ones who aren't are being auto-enrolled into an HMO not of their choice," Daniel Idzikowski, Executive Director of Disability Rights Wisconsin.

Idzikowski said of the recipients his organization has kept track of, about two-thirds of all SSI recipients were auto-enrolled, and only one-third of recipients actually chose their own plan.

"That's an unaccceptably low rate," Idzikowski said. "We would like the state to slow this process doen so it can ensure it has adequate outreach and opportunity for all enrollees to get the information they need to make an informed choice that reflects their own health care needs."

Among the pitfalls, Idzikowski said, most stem from the fact that people living with disabilities might have complex health care needs, and that some providers may not cover the specific care they need. In addition, he said recipients would have to go through a complicated process to get a coverage exception - with no guarantee that their needs would be met.

How to get additional information:

• Attend an Information Meeting in Milwaukee on April 11th or April 12th. SSI members, providers, case managers, advocates and others are encouraged to attend and learn about this major change.
• The Information Meetings will include speakers from the Department of Health Services; from the Enrollment Services Center; and from Disability Rights Wisconsin, the External Advocates for SSI Medicaid Managed Care. The SSI HMOs will have information tables and be available to answer questions.
• Check out the DHS website for more information: https://www.dhs.wisconsin.gov/medicaid/hmo-2018chng.htm. It includes specifics on who is and is not required to enroll in an HMO. For example, individuals enrolled in Family Care, Partnership or IRIS cannot enroll in an SSI HMO.
• To receive email updates about the expansion, go to the DHS web page for “HMO Enrollment Changes for Medicaid Supplemental Security Income Members” and join the email list: https://www.dhs.wisconsin.gov/medicaid/hmo-2018chng.htm

Advocacy Assistance

• Individuals who would like to receive advocacy assistance with SSI Medicaid Managed Care may contact Disability Rights Wisconsin at 800-708-3034 or 414-773-4646. This could include questions related to continuity of care, lack of notice, or other concerns.

Special Concerns:

• Individuals who have a Social Security representative payee may not receive the notice and enrollment packet, as these materials seem to be sent to the representative payee and not the beneficiary.
• Members have approximately six weeks to select an HMO. If they do not make a selection they will be assigned an HMO. They then will have 90 days to make a change and to request continuity of care if their providers are not in network.

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