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Medicaid SSI & BadgerCare Plus Appeals

 

If you are asking to appeal a decision for your Medicaid SSI or BadgerCare Plus benefits, a written request must be postmarked within 45 calendar days from the date of the denial letter.

You have three options for an appeal. You may choose Local Appeal, DHS Review, and/or Fair Hearing.  You may begin with any of these three options. But you cannot request a local appeal after completing a DHS Review or Fair Hearing.

Medicaid Appeals

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Option 1 - Local Appeal

There are two types of Local Appeals:

1.  Standard:  Standard appeal decisions are made no later than 30 calendar days from receiving the request for an appeal. iCare may extend the timeframe up to 14 days if you request more time or if iCare is thinks more time is in your best interest.

2.  Expedited (fast) Appeal:  You can ask for a fast appeal if you feel your health could be at risk by waiting. Fast appeals can be transferred to the standard timeframe if your life is not at large risk.  iCare will decide whether the appeal qualifies as fast within 2 business days. If the request for a fast appeal is denied, you will be notified in writing of your right to file a fast grievance.

If iCare agrees that your appeal should be fast, it will follow the same steps as a standard appeal. The appeal process will be completed within 72 hours from receiving the appeal request.

Standard appeals must be submitted within 45 calendar days from the date on the denial notice by writing to:

Quality Improvement Department

Attention: Member Appeals

iCare

1555 N. RiverCenter Dr. Ste. 206

Milwaukee, WI 53212-3958

Fax: 414-918-7592

 

If you need help writing your appeal request, please contact the Member Advocate at: 414-231-1076.

Or

You can call Disability Rights Wisconsin at: 414-773-4646 or 1-800-708-3034.

Or

You can call the Wisconsin Medicaid Managed Care Ombudsman at 1-800-760-0001.

 

What Happens Next?

Step 1: Within 5 calendar days you will receive a letter saying your appeal has been received.

Step 2: Within 30 calendar days of receiving your appeal iCare will make all reasonable efforts to gather more info about to your appeal.

Step 3: An Appeal Committee meeting is scheduled. Members are asked to attend the appeal meeting and speak with the Committee.

Step 4: The Committee reviews all of the info.  They ask the member if they want to participate. Then the benefit is either approved or denied. 

Step 5: If the Committee approves the service, iCare will okay the service in dispute.

Step 6: If the Committee denies the benefit, you can ask the state to review the denial or request a Fair Hearing.

You will receive the final decision in writing.

Option 2 - DHS Review

To ask the State to review our decision you can call 1-800-760-0001 or write to:

Wisconsin Medicaid

Managed Care Ombudsman

P.O. Box 6470

Madison, WI 53716-0470

Option 3 - Fair Hearing

You can ask for a fair hearing by sending a written request to:

Department of Administration

Division of Hearings and Appeals

P.O. Box 7875

Madison, WI 53707

IC200 DHS Approved 08/13/19
Last Updated 08/13/19

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