Wisewoman Eligibility Requirements

• Age 35-64 years
• Uninsured or underinsured
• Low income (at or below 250% of federal poverty level)
• Unable to pay the premium to enroll in Medicare Part B
  • Contact WISEWOMAN program staff in this scenario

Income Requirements

SMHW/WISEWOMAN participants must have an income at or below 250% of the federal poverty income guidelines. Adjusted gross income on tax return or net amount on pay stub determines income eligibility.

SMHW/WISEWOMAN FY22 Income Requirements

Insurance Requirements

SMHW/WISEWOMAN providers will use the SMHW/WISEWOMAN Participant Agreement Form (white) to document the insurance status of the participant.

Eligible Health Insurance Status

• No health insurance
• Health insurance does not cover services
• Participant states she is unable to pay deductible
• Have MO HealthNet with spend-down, but have not met spend-down
• Income eligible for Medicare Part B, but unable to pay premium
• Participants eligible to receive Medicare benefits, but not enrolled in Medicare should be encouraged to enroll
• ***Adult Expansion Group (AEG) with ME Code E2- Contact WISEWOMAN program staff to inquire about participant eligibility***

Ineligible Health Insurance Status

• Women with full MO HealthNet (ME Code 05), Adult Expansion Group (AEG) with ME Code E2, Medicare Part B, POS or HMO health coverage are not eligible for services

Participant Eligibility Guidance

Providers should develop plans to recruit SMHW participants into WISEWOMAN. Recruitment plans should reflect the following WISEWOMAN objectives:

• Serve as many eligible women as possible by using the most efficient means
• Reach populations that are at disproportionate risk for cardiovascular disease

WISEWOMAN Enrollment

Enrollment and participation in the WISEWOMAN Program is voluntary. WISEWOMAN participants must complete the SMHW/WISEWOMAN Participant Agreement Form (white), SMHW/WISEWOMAN Patient History Form (green) and must also be provided with the current DHSS Patient Privacy Rights Statement, in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations, prior to receiving services. The participant must also receive a HIPAA statement from the provider facility and retain proper documentation of this action. Current HIPAA regulations are located at the MDHSS website [NEEDS LINK]. After completing all required paperwork for enrollment, WISEWOMAN participants are eligible for an initial WISEWOMAN Screening Visit to complete Risk Reduction Counseling, followed by continued WISEWOMAN services.

WISEWOMAN PROVIDER MAP

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REGIONAL PROGRAM COORDINATORS

TRANSPORTATION SERVICES

Free transportation for all program services is available for SMHW/WISEWOMAN participants to help remove the barrier of access to care. Providers should contact WISEWOMAN Central Office Staff at 866-726-9926 or the RPC assigned to their area and request a travel voucher booklet. Transportation services are available Monday-Friday in most counties and the City of St. Louis, with charges based on urban or county trips and one-on-one or regular route travel. See page 18-19 for a complete list of transportation providers.

TRAVEL VOUCHER INSTRUCTIONS 

WHEN A PARTICIPANT CALLS TO MAKE AN APPOINTMENT FOR SMHW/WISEWOMAN SCREENING, DIAGNOSTIC OR EDUCATION SERVICES, PLEASE ASK HER THE FOLLOWING QUESTIONS/COMPLETE THESE STEPS BEFORE MAKING AN APPOINTMENT:

1. DOES THE CLIENT NEED TRANSPORTATION? 

• If yes, explain that free transportation is available for SMHW/WISEWOMAN participants 
• A transportation provider will pick her up at her home, take her to the clinic and return her to her home 
• Check with the transportation provider in your area for the transportation schedule 
• Ensure the clients appointment date and time coincides with the transportation provider’s schedule 

2. SECURE CLIENT ADDRESS AND TELEPHONE NUMBER 

• If the participant does not have a telephone, ask for a neighbor’s telephone number or for another number where she can be reached, as the transportation driver may not be familiar with the participant’s address and may need directions to the residence 

3. DOES CLIENT NEED ANY SPECIAL ASSISTANCE? 

• If the participant needs an assistant or helper, SMHW/WISEWOMAN will pay for transportation for one extra person 
• If a disabled participant needs more than one assistant, call SMHW/WISEWOMAN for approval 
• If the client has special medical equipment, such as a wheelchair or oxygen, please inform the transportation provider at the time of scheduling 

4. COMPLETE A TRAVEL VOUCHER 

• Complete the travel voucher and include the facility name and site code number 
• Provider can mail or fax the completed travel voucher to the transportation provider including the date and time of the appointment 
• A copy of the voucher may be given to the participant 
• Transportation provider will secure the participant’s signature on pickup 

5. CANCELLATION OF A VOUCHER 

• Notification of cancellation to the transportation provider is required to avoid a penalty charge to SMHW/WISEWOMAN for the cost of a one-way trip 
• Provide one business day notice to cancel a voucher

TRANSPORTATION PROVIDERS

Please check the Transportation Services Catalog for other transportation options that may help your clients receive appropriate services: Transportation Services Catalog Transportation Services Provided ( https://health.mo.gov/atoz/pdf/transportationservices.pdf )