Members

Medicaid BadgerCare Plus and SSI Member Handbook

Mother carrying smiling baby

Please read your Medicaid BadgerCare Plus and SSI Member Handbook. It tells you:

  • About your health plan.
  • About your benefits and what is covered.
  • How to get the services you need, including special health care needs.
  • How to contact Molina.
  • Your rights and responsibilities as a member.

 

Member Handbook (English)

 

Call Member Services.


Additional Resources

 

CMS-0057 Prior Authorization Annual Reporting

This report shows how prior authorization requests are handled, such as how many were approved or denied and how quickly decisions were made. To find out if a specific service needs prior authorization, members and providers should check the plan’s Prior Authorization Guide or use the Prior Authorization Lookup Tool.

  Prior Authorization Guide 2025
  Prior Authorization Lookup Tool

Medicaid SSI Prior Authorization Annual Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 93%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 7%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 57%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 100%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 92%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 78%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 92%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 8%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 6
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 4
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 29
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 23

 

Medicaid BadgerCare Plus Prior Authorization Annual Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 90%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 10%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 63%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 67%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 80%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 89%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 91%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 9%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 5
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 4
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 25
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 22