Benefits Overview
MHS Health Wisconsin offers health insurance plans with comprehensive healthcare services that suit the needs of families and individuals throughout Wisconsin.
View some of MHS Health Wisconsin's benefits below. You can also view more information in our Member Handbook.
As a Wisconsin health plan option, MHS Health Wisconsin can help you find a provider, find local resources, plan an appointment and find transportation. Call Member Services at 1-888-713-6180 (TDD/TTY: 1-800-947-3529).
Children and adults who go to their follow-up appointment after a psychicatric hospitalization qualify for a $25 member reward.
Care coordination and disease coaching are part of your health benefits and are provided to you at no cost. MHS Health Wisconsin pays for these services. We provide services for many conditions, such as asthma, diabetes, COPD, high-risk pregnancy and many more. Call Member Services at 1-888-713-6180 (TDD/TTY: 1-800-947-3529).
MHS Health provides free pre-programmed cell phones for members who meet specific eligibility requirements.
As a MHS Health Wisconsin Member, you can choose who you see for your healthcare needs from our network of Providers. We have many for you to choose from. If you need help choosing a doctor, call Member Services at 1-888-713-6180 (TDD/TTY: 1-800-947-3529).
If you do not live in Milwaukee, Waukesha, Racine, Kenosha, Washington or Ozaukee County, your dental benefit is covered by the State, not MHS Health. You may get dental services from any dentist who will accept your ForwardHealth card.
All BadgerCare Plus & SSI members are entitled to:
- An exam and cleaning once a year
- Simple extractions and oral surgery if medically needed
- X-rays
- Fillings
If you DO live in Milwaukee, Waukesha, Racine, Kenosha, Washington or Ozaukee counties, please choose an MHS Health dentist.
Preventative care visits are covered by MHS Health Wisconsin. This means visiting the doctor for a regular check-up, rather than waiting until you are sick.
MHS Health Wisconsin covers an annual physical for adults.
Regular child check-ups are also covered for those under the age of 21. These doctor visits should occur at the below ages. Children also need a blood lead test at 12 and 24 months of age.
Child Wellness Guidelines
| Age | Service Needed |
|---|---|
Birth or neonatal | Exam – and vaccine for Hepatitis B |
2 to 4 days old | Exam |
By 1 month | Exam |
2 months | Exam and vaccines for Hepatitis B + DTAP + PCV + HiB + IPV + RV |
4 months | Exam and vaccine DTAP + PCV + HiB + IPV + RV |
6 months | Exam and vaccines for Hepatitis B + DTAP + PCV + HiB + IPV + RV |
9 Months | Exam |
12 months | Exam and vaccines for MMR + PCV + HiB + VZV + Hepatitis A (also lead test) |
15 months | Exam and vaccine for DTAP |
18 months | Exam |
24 months | Exam and vaccine for Hepatitis A (also lead test) |
Every year thereafter | Once per year exam from 2 years old through 20 years old |
- Varicella (VZV) vaccine - protects against the Chickenpox
- DTAP vaccine – protects against diseases that affect your breathing and your brain
- Hepatitis A vaccine – protects against liver damage
- Hepatitis B vaccine – protects against liver damage
- Influenza (Flu) - Remember to get your child their flu shot every year before winter time!
- Pneumococcal (PCV) vaccine - protects against many types of germs
- Polio (IPV) vaccine – protects against a virus that may attack the nervous system
- Rotavirus (RV) vaccine - protects against a virus that causes vomiting and diarrhea
- HIB vaccine - protects against brain and lung infections
- Measles, Mumps, Rubella (MMR) vaccine – protects against 3 serious viral infections
Adult Wellness Guidelines
Frequency | Service needed |
|---|---|
Once a year | Physical/wellness exam |
Every 1-3 years | Weight, Body Mass Index (BMI) |
Every 2 years | Blood pressure |
As needed, at discretion of your PCP | Hearing and vision assessment |
Frequency depends on method | Colorectal cancer screening (ages 50-74) |
Monthly self-exam, mammogram annually | Breast cancer screening (ages 50-74) |
Pap test every 3 years /with HPV screen every 5 | Cervical cancer screening (ages 21-64) |
Once a year | Chlamydia screening (ages 16-26) |
Exam once a year | Prostate cancer screening (age 50+) |
Monthly self-exam, exam once a year | Testicular cancer screening (age 18+) |
Total skin exams at discretion of your PCP | Skin cancer screening |
Bone mass density ordered at discretion of PCP | Osteoporosis screening (age 65+) |
As needed | Depression screening |
Once a year | Dental exam |
The State of Wisconsin covers most prescriptions for Medicaid members under Medicaid fee-for-service. The Preferred Drug List (PDL) is located on the ForwardHealth website. It is updated regularly and lists medications that are covered by the State. Some medications may need approval before they are covered.
Step-Therapy
In some cases, it is required you first try a certain medication to treat your medical condition before another medication is covered. For example, Medication A and Medication B both treat your medical condition. Medication B may not be covered unless you try Medication A first. If Medication A does not work for you, Medication B will be covered.
Our Nurse Advice Line is ready to answer your health questions 24 hours a day – every day of the year. It is staffed with Registered Nurses. These nurses have spent lots of time caring for people. Now they are ready and eager to help you. Call 1-888-713-6180 and say "Nurse."
Interpreter services are provided free of charge to you during any service or grievance process. This includes American Sign Language and real-time oral interpretation.
If you need something translated into a language other than English, please call MHS Health Wisconsin. We can also provide things in other formats such as Braille, CD or large print.
If you need an interpreter for your medical appointment, contact MHS Health Wisconsin 48 hours before your appointment. We will arrange for one to be at your appointment.
You may need help with activities of daily living but do not need a nurse. Personal Care services can help you stay independent. These services can be paid for by the Medicaid program. Medicare does not pay for Personal Care services.
Learn more about Personal Care Services (PDF).
Start Smart for Your Baby (Start Smart) is our special program for women who are pregnant and for those moms who just had a baby. We want to help you take care of yourself and your baby every step of the way. If you are pregnant, please let us know by completing a Notification of Pregnancy form. After completing this form you will be enrolled in Start Smart. You will receive information in mail and over the phone. You can also get information in the Health & Wellness section.
Tips for Pregnancy
If you are pregnant or want to become pregnant, keep these things in mind:
- Go before you show! Go to the doctor as soon as you think you are pregnant. It is important for you and your baby to see a doctor as early as possible. It will keep both of you healthy. It will also help your baby get off to a good start. It is even better to see a doctor before you are pregnant. This is so you can get your body ready for pregnancy.
- Maintain healthy lifestyle habits. This includes exercising, eating balanced and healthy meals, and resting for 8-10 hours every night.
- Do not use tobacco, alcohol or drugs now or while you’re pregnant.
Breastfeeding
Doctors and health organizations agree that breastfeeding is best. You may already know that breast milk is packed with the perfect mix of nutrients your baby needs. Did you know that it is also more than just food? Breast milk has special ingredients, like antibodies, that only you can provide. Breast pumps are helpful if you are breastfeeding and have to be away from your baby. Call us after you deliver to see if breast pumps are offered.
Are You Pregnant? Tell Us Right Away!
Call us. Or, you can login to your MHS Health Wisconsin account and fill out the Notification of Pregnancy form.
MTM is the non-emergency medical transportation manager for Wisconsin Department of Health Services. MTM can arrange transportation to covered appointments for Medicaid SSI and BadgerCare Plus members.
Contact MTM
- Call: 1-866-907-1493 (TTY: 711)
- Visit the MTM website for information and link to schedule appointments.
MHS Health Wisconsin covers ambulance transportation to the nearest hospital for emergency situations. You do not need to contact MHS Health, before using an ambulance for emergencies.
BadgerCare Plus and SSI members receive one eye exam and one pair of standard glasses a year. We also offer a $100 allowance for better eyeglass frames and an $80 opt-out allowance to use towards contact lenses.
You can earn rewards dollars from MHS Health Wisconsin when you complete healthy activities!
Learn more about our My Health Pays rewards program.