Yes, medically supervised withdrawal management and inpatient detox are covered under the state Medicaid plan for BadgerCare Plus members, including those enrolled in an HMO. Residential withdrawal management is certified under DHS 75.57.

A standalone outpatient withdrawal management benefit had not been funded as of 2024, so inpatient or residential settings are the usual route.

Yes, a stand-alone intensive outpatient program benefit started March 1, 2025, covering 9 to 19 hours a week for adults and 6 to 19 hours for members under 18, for substance use, mental health or co-occurring needs. This applies to fee-for-service and HMO members alike.

Treatment itself needs prior authorization, though the initial assessment does not.

Yes. Preferred buprenorphine products, which include Suboxone, need no prior authorization under Wisconsin's 2018 policy, while non-preferred products still require it. This rule applies across BadgerCare Plus HMOs and fee-for-service members.

Prescribers bill through the member's ForwardHealth or HMO coverage depending on how the member is enrolled.

Yes, through certified opioid treatment programs, with no prior authorization required under Wisconsin's 2018 policy. Wisconsin had 28 opioid treatment programs in 2025 serving nearly 12,000 patients, with Medicaid the main payer at almost every site.

This methadone coverage applies statewide regardless of which BadgerCare Plus HMO a member has chosen.

Yes for residential treatment, which ForwardHealth authorizes directly using ASAM criteria rather than the HMO, with the first 10 days often approved automatically. Intensive outpatient treatment also needs authorization, though peer recovery support does not.

This applies the same way whether a member is enrolled in a BadgerCare Plus HMO or served fee-for-service.

No. BadgerCare Plus is Wisconsin's Medicaid program for residents under 65, run by the Department of Health Services, and most members get care through one of 13 contracted HMOs that deliver the state's Medicaid benefits.

A BadgerCare Plus HMO administers the same state-set substance use and mental health benefits rather than setting its own separate rules.

Thirteen HMOs deliver BadgerCare Plus benefits in Wisconsin: Anthem Blue Cross and Blue Shield, Chorus Community Health Plans, Dean Health Plan, Group Health Cooperative of Eau Claire, Group Health Cooperative of South Central Wisconsin, Independent Care Health Plan, MercyCare, MHS Health Wisconsin, Molina Healthcare, Network Health Plan, Quartz, Security Health Plan and UnitedHealthcare of Wisconsin.

Anthem, MHS Health Wisconsin and UnitedHealthcare serve all 72 counties; the rest cover set county lists.

Call the Wisconsin Addiction Recovery Helpline at 211 or 833-944-4673, free and available 24 hours a day, for a guided search to local treatment. ForwardHealth Member Services at 800-362-3002 can also help locate enrolled providers.

Since residential and withdrawal management benefits are paid fee-for-service, any DHS-certified program can serve a BadgerCare Plus HMO member regardless of HMO network.

Yes, the same substance use benefit covers alcohol and other drug treatment at identical levels of care, from outpatient counseling through residential and inpatient treatment. This applies to members on any BadgerCare Plus HMO as well as those served fee-for-service.

Members meeting ASAM criteria for a given level of care qualify the same way regardless of substance.

At least some BadgerCare Plus HMOs offer telehealth behavioral health visits; UnitedHealthcare of Wisconsin states telehealth appointments are available for behavioral health treatment, and MHS Health Wisconsin links members to Teladoc.

Availability varies by HMO, so a member should check directly with their own plan's member services line.