Sponsored by Survival Coalition and Family Voices of Wisconsin

Survival Coalition and Family Voices of Wisconsin are interested in your family's experiences with Medicaid prior authorization as well as your use and understanding of a Wisconsin Medicaid benefit for children called HealthCheck Other Services.To learn more about insurance prior authorizations and HealthCheck Other Services see the Family Voices fact sheets at Insurance Prior Authorizations and HealthCheck Other Services. 

* 1. Who are you?

* 2. Age of Person Receiving Medicaid:

* 4. Which Medicaid programs do you/your child use to access needed services? Check all that apply.

* 5. During the past 12 months, have you or a provider requested services that required prior authorization through Medicaid? (If "No" go to Question 12)

* 6. How satisfied were you with the prior authorization process?

* 7. How long did it take to receive a response to the request?

* 8. What was the result of the prior authorization request? Check all that apply.

* 9. If a service was denied, do you know why?

* 10. If yes, briefly explain the reason given for the denial.

* 11. What service was denied? Check all that apply.

* 12. Some services for children ages 0-21 can be covered through a Medicaid benefit called HealthCheck Other Services also known as EPSDT. How knowledgeable are you about this program?

* 13. Have you used HealthCheck Other Services to pay for a Medicaid service?

* 14. What could Medicaid do to make HealthCheck Other Services easier to use and better understood?