How To Apply For Medicaid In Wisconsin


What You Need For Your Appointment

Wisconsin submits request to drug test Medicaid applicants
  • Income for everyone in the household

  • Your most recent tax return

  • Social security numbers for everyone you want covered on the plan, if they have one

  • Date of birth for everyone you want covered

  • A list of prescriptions and how much you take

  • The names of your doctors and clinics

  • Your log-in information, if you already have an account

  • If you are losing your current health insurance, bring a letter that shows the date your coverage is ending.

  • How Do I Enroll In Medicaid In Wisconsin

    What Are The Income Requirements For Medicaid In Wisconsin

    Financial Medicaid eligibility requirements in Wisconsin help the state determine which low-income households qualify for health care coverage assistance. An applicant who is eligible for Medicaid based on personal factors may not qualify for benefits due to earning limits. Knowing what the requirements are for Medicaid include determining the petitioners household income.

    While not all Medicaid programs have income requirements, the financially based health care coverage options are available for low-income applicants that do not fulfill the personal requirements such as age or disability. WI Medicaid benefits eligibility calculates the earning of the applicants household, not just their personal income. These calculations reflect the federal poverty level guidelines in relation to the family size.

    For example, the annual household income for a family of four to be at the federal poverty level is $24,300, while a family of two reaches the threshold with $16,020. Many Medicaid programs require that a family income must be a percentage of the federal poverty level to meet the Medicaid eligibility requirements in Wisconsin. If a Medicaid program requires an applicants household to make less than 250 percent of federal poverty level, the income for a family of four must be less than $60,750 annually.

    You can to learn more about Medicaid requirements.

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    How To Apply For Medicaid In Wisconsin By Mail

    You can also apply for Wisconsin Medicaid through traditional mail. By learning where to apply for Medicaid using the postal system, there will be no need to visit an actual Medicaid office. Print the application form from the Internet and fill it out with accurate details and documents, before mailing it to your local Medicaid office. The office that accepts Medicaid applications in the state of Wisconsin is known as the Income Maintenance Agency.

    Tuberculosis Only Related Services Program

    What You Should Know About Wisconsin Medicaid and BadgerCare Plus

    If you have Tuberculosis and dont qualify for other Medicaid programs in Wisconsin, you might still qualify for the Tuberculosis Only Related Services Program. This program covers some of the costs associated with the care of Tuberculosis, including:

    • Physician services
    • Services designed to encourage completion of the treatment program
    • Services needed due to the side effects of the treatment

    To qualify, you must have a monthly gross income less than $1501 and assets valued at less than $2000 for a one-person household.

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    How Does Medicaid Provide Financial Help To Medicare Beneficiaries In Wisconsin

    Many Medicare beneficiaries receive assistance from Medicaid with Medicare premiums, prescription drug costs, and expenses not covered by Medicare including long-term care.

    Our guide to financial assistance for Medicare enrollees in Wisconsin includes overviews of these benefits, including Medicare Savings Programs, Medicaid nursing home coverage, and eligibility guidelines for assistance.

    How To Apply For Medicaid Long

    Long-term care is for persons who are no longer able to complete day-to-day activities such as bathing, dressing, meal prep, etc. without assistance.

    ADRC Information & Assistance start here

    ADRC is the place to start to learn about and apply for the Medicaid long-term care program. The application process is very extensive, we are here to guide you through it.

    There are two Medicaid long-term care programs in Wisconsin: Family Care and IRIS.

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    Elderly Blind Or Disabled Fiscal Group

    An EBD fiscal group includes the individual who is nonfinancially eligible for Medicaid and anyone who lives with him or her, who is legally responsible for him or her. EBD FTGfiscal test groups will always be a group of one or two. Spouses who live together are in each others fiscal group. This means that the income and assets of both spouses are counted when determining Medicaid eligibility for either or both spouses. The fiscal group size for this situation/living arrangement is two.

    There are some exceptions to this concept. A blind or disabled minorA minor is a person less than age 18. living with his or her parents would be a one-person fiscal group. Special instructions for deeming parental income and assets to the disabled minor are described in Section 24.1 SSI Related Medicaid Introduction.

    Another exception to the fiscal group policy involves SSI recipients. If one spouseA spouse is that person recognized by Wisconsin law as another person’s legal husband or wife. Wisconsin does not recognize common law marriage. is applying for EBD Medicaid and the other spouse is an SSI recipient, the spouse who is an SSI recipient is not included in the other spouses fiscal group. For this situation you would again have a one-person fiscal group when determining the Medicaid eligibility of the non-SSI spouse.

    What Is A Navigator

    Medicaid Minute: Wisconsin’s Medicaid Rules Regarding Vehicles

    A navigator is a certified health insurance expert that works year-round to help you find, sign up, and use health insurance for free. They help you:

    • Look at different insurance plans and find the best deals for the Marketplace, also called Obamacare or

    • Sign up for BadgerCare Plus/Medicaid

    • Find info for financial help

    • Understand insurance and assist with complex cases, billing questions, and appeals

    Madison Office: 261-1455 Milwaukee Office: 400-9489 Administration Office: 262-2618

    Our privacy notices are available in both English and Spanish by clicking the buttons below:

    Covering Wisconsin is a federally certified and state licensed navigator entity. We do not discriminate on the basis of age, race/ethnicity, religion, physical appearance, gender, disability, marital status, sexual orientation, national origin, cultural differences, arrest or conviction record, military participation, or political beliefs.

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    Cost Of Medicaid In Wisconsin

    For people who are enrolled in Wisconsin Medicaid and BadgerCare, there are no premium costs as long as enrollees meet income guidelines for various medical services. When some services are actually accessed, copays may apply.

    However, only the deductibles and a portion of the coinsurance are paid when services are covered by Medicare.

    Under the Medicaid Purchase Plan , people who are working or who are interested in working can buy healthcare insurance through Wisconsin Medicaid. Depending on the persons income, there may be a premium associated with this coverage. Family coverage is not available through MAPP.

    Apply For Medicaid In Wisconsin

    Online at or or by phone, in person or with a paper application at local Income Maintenance Agencies.

    Eligibility: The aged, blind, and disabled. Also, children and pregnant women with incomes up to 300% of poverty other adults with incomes up to 100% of poverty.

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    What Are Qmb Slmb And Slmb+medicare Savings Programs

    The Medicare Savings Programs are partial benefit Medicaid programs for Medicare beneficiaries, run by the State of Wisconsin. These programs exist in most states, and the State’s Department of Health Services determines eligibility. In Wisconsin, apply through your local Medicaid agency or on Qualified Medicare Beneficiary

    • Pays Medicare Part B premium
    • Includes Low-Income Subsidy for prescription drug coverage
    • Covers Medicare A and B deductibles and coinsurance
    • Has small copays
    • QMB begins the month after application and cannot be backdated


    • Pays Medicare Part B premium
    • Includes Low-Income Subsidy for prescription drug coverage
    • Can be backdated up to 3 months


    • Pays Medicare Part B premium
    • Includes Low-Income Subsidy for prescription drug coverage
    • Can be backdated up to 3 months
    • Cannot be combined with any other Medicaid program

    No Aca Medicaid Expansion But No Coverage Gap Either

    Free Wisconsin Medicaid Prior (Rx) Authorization Form

    Although Wisconsin has not expanded Medicaid under the guidelines laid out in the Affordable Care Act , the states Medicaid program does cover all legally present residents with incomes under the poverty level. Wisconsin is the only non-Medicaid-expansion state that does not have a coverage gap all low-income residents either have access to Medicaid or subsidies to help them purchase private coverage in the exchange.

    Premium subsidies in the marketplace are only available if a persons income is at least the poverty level. In most states, subsidy eligibility actually starts above 138% of the poverty level, as Medicaid expansion covers adults with income up to that level. But there are 12 states that have not expanded Medicaid under the ACA. Wisconsin is one of them, but Wisconsin does make Medicaid available to adults with income up to the poverty level. So theres a seamless transition from Medicaid eligibility to premium subsidy eligibility in Wisconsin.

    Thats not the case in the other 11 states that have not expanded Medicaid. Instead, Medicaid for adults under 65 is not available at all in those states unless a person is disabled, pregnant, or caring for a minor child. And the income limits for parents tend to be quite low well below the poverty level.


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    What Are The Medicaid Applications Guidelines For Wisconsin Programs

    To find out what are the requirements for Medicaid in WI, interested applicants can review the program highlights below. Details include who is eligible for Medicaid and plan coverage. Medicaid benefits eligibility is subject to change with adjustments to the law and program.

    • Family Care and Partnership Program is available for the elderly and adult residents with physical and mental disabilities. Both programs provide eligible applicants with long-term care for health conditions expected to last longer than 90 days.
    • ForwardHealth is a possible option for the elderly and low-income families at or below the monthly program limit. ForwardHealth is a culmination of many health care, nutrition and other subsidy programs.
    • IRIS is a Medicaid option for adult Wisconsin residents with long-term health care needs. Disabled and elderly applicants determined financially eligible and require nursing home level of care who also lives in a county where IRIS is available may apply.
    • Wisconsin Medicaid Purchase Program offers working adult residents with disabilities free to low cost health care coverage. Applicants of this Medicaid program must have an adjusted family income less than 250 percent of the federal poverty level.
    • Wisconsin Medicaid BadgerCare Plus Deductible Plans are available for applicants who do not meet the income limit but have a high medical bill. Eligible applicants include pregnant women, minor children, elderly and disabled residents.

    Katie Beckett Medicaid: How To Apply

    To apply, families can call 888-786-3246. They will be connected with an eligibility specialist who will explain the Medicaid benefit and help the family decide whether they want to pursue enrollment in Katie Beckett.

    If a parent decides to apply, they will receive an application packet. The eligibility specialist will set up a meeting with the parents to review the application materials, verify certain documentation, answer questions, and complete the functional screen. The screen gives the eligibility specialist a picture of a day in the childs life and determines if a child is functionally and financially eligible for Katie Beckett Medicaid. This is the first part of the two-part eligibility process.

    The application is sent to the Disability Determination Bureau for the second part of the eligibility determination. DDB does their own investigation into a childs needs to determine if they are disabled by Social Security Act standards.

    A recertification of eligibility is required every year after the initial approval or whenever significant changes in the childs condition occur.

    Members should notify the program of address or insurance changes, changes that may affect eligibility, or any problems in getting the Medicaid card by calling toll-free at 888-786-3246,

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    What Are The Financial Requirements For Medicaid In Wisconsin

    A Wisconsin Medicaid application will not be successful if the applicants income is too high. Ones yearly cumulative household income before taxes must be below a certain threshold in order to sign up for Medicaid in WI. Federal Poverty Level guidelines can change annually, but you must know for WI Medicaid application forms to be accepted, income for childless adults must not exceed 138 percent of the FPL. Annual income limits are dependent on group size and if you continue to wonder how to apply for WI Medicaid, refer to our state qualifications page.

    What Are The Different Medicaid Programs Available In Wisconsin

    COVID-19: Medicaid Waiver Approved in Wisconsin

    The two main types of Medicaid available in Wisconsin are SSI-Related Medicaid and BadgerCare Plus. SSI-Related Medicaid is available for the elderly, blind or disabled and is generally just referred to as Medicaid in the state.

    BadgerCare Plus, normally just called BadgerCare, offers health insurance for a wider range of low-income people and also encompasses the states CHIP program. It is largely funded by Medicaid, but it should be noted that some people may be eligible for both BadgerCare and SSI-Related Medicaid.

    The states waivers and smaller programs are designed to help specific sections of the community. One example is the Family Care program that helps older adults access long-term care services.

    Wisconsin residents may also hear the term ForwardHealth used. ForwardHealth is an overarching program that brings together the administration of a number of Social Security programs, including BadgerCare, Medicaid and nutritional assistance programs. Its aim is to help people identify and access the programs they need from one place. Medicaid beneficiaries do use the system, but ForwardHealth isn’t a separate Medicaid program.

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    Your Assets And Medicaid

    Assets are part of the eligibility review in applying for Medicaid. The topics below talk about some options available to preserve assets as well as information about how divestment and estate recovery work.

    WISPACT Trusts

    A type of trust created to help preserve the assets of people with disabilities. WISPACT trust assets are not counted when applying for Medicaid.

    Estate Recovery

    Estate recovery is a program where the state of Wisconsin can recoup some of the money that was spent on long-term care Medicaid programs such as Family Care, IRIS, or Institutional Medicaid.

    Spousal Impoverishment Protection

    Provides protection for spouses of persons who qualify for long-term care coverage. The rules are designed to protect the income and asset of the spouse who is not applying for long-term care Medicaid.


    When applying for Medicaid for long-term care, the eligibility office looks back in time to determine if the applicant transferred any income, assets, or property for less than fair market value , for the purpose of becoming eligible for a long-term care Medicaid program. If divestment is determined, there may be a penalty assessed before the person will be found eligible for Medicaid.

    Learn About Requirements For Medicaid In Wisconsin

    The process of learning how to qualify for Medicaid is essential for Wisconsin residents who need assistance with health care coverage. Wisconsin Medicaid eligibility requirements help officials determine which low-income applicants can receive coverage through the program. The program helps recipients pay for certain health care services and resources such as doctor visits and prescription drugs. Both the federal and state government determine who is eligible for Medicaid in Wisconsin by establishing eligibility guidelines the reference categories like age, health and income. Since the program is jointly funded, Wisconsin can surpass the minimum federal requirements and broaden qualifications to incorporate more residents into the program. The Wisconsin Department of Health Services determines who meets the WI Medicaid benefits eligibility requirements by reviewing the necessary information on the Medicaid application. Find out what are the requirements for Medicaid in Wisconsin by reading through the information provided on this page.

    Who qualifies for Medicaid in Wisconsin?

    Medicaid also provides coverage for children, families with children and residents with physical or developmental disabilities. Wisconsin children in homes not eligible for Medicaid coverage may still be able to sign up for medical assistance through the states Childrens Health Insurance Program.

    How do I qualify for Medicaid in Wisconsin?
    What are the Medicaid application guidelines in Wisconsin?

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    How To Apply For Medicaid And Badgercare Plus In Wisconsin

    Before you start the application process, you should have the following information available:

    • You and your spouses taxable income.
    • Social Security numbers and birthdates of people in your home.
    • Current or recent health insurance information.
    • Identity and citizenship information, or alien registration information.
    • Income information including employer name, address and phone number, of all household members who are employed.
    • Amount of money received from other types of income.
    • Expected date of delivery and number of babies of any pregnant household member.
    • Current health insurance information for all household members with health insurance including company name, policy or group number, type of coverage, effective date, policy holders name, and ID.

    Applicants can apply online, by phone, by mail or in person at their local Wisconsin Department of Health Services agency.

    Prescription Drugs With Medicaid In Wisconsin

    Wisconsin Medicaid Preferred Drug List Jan 2019 â

    Wisconsins Medicaid programs do cover prescription drugs. However, the type of prescription drugs and the amount covered can vary depending on your plan. For example, if you only qualify for the Tuberculosis Related Services plan, only the prescription medications needed for your Tuberculosis treatment would be covered.

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