Medicaid is a health insurance program for low-income individuals, families, and seniors that is federally and state-funded. It helps people who wouldn’t otherwise have insurance, as well as people with disabilities and seniors, obtain the insurance needed to get proper medical treatment. The Wisconsin Department of Health Services manages the state’s Medicaid program — which includes the ForwardHealth Medicaid plan, BadgerCare+, and Wisconsin Well Woman Medicaid.
Wisconsin’s Requirements for Medicaid Qualification
The type of Medicaid program you qualify for depends on your family’s income and assets, the type of care needed, and your household situation. The state offers several different plans, so before applying it’s important to understand which plan type is the correct option for you and your family.
ForwardHealth Medicaid Plan
The ForwardHealth Medicaid Plan covers people who are elderly, blind, or disabled. To qualify for this program you must:
- Be age 65 or older, blind, or disabled
- Have a family income that’s at or below the monthly program limit
- Be a US citizen or a legal immigrant
If you meet these requirements, you might also qualify for the Community Waiver or Family Care program, which helps people who are elderly, blind, or disabled get services needed to remain living in their own homes. You might also qualify for the Medicare Savings Program, which enables Medicaid to pay some or all of your Medicare Part A and/or Part B premiums each month.
Medicaid Purchase Plan
If you are disabled and working, but your adjusted family income is still less than 250% of the federal poverty level and you have countable assets that equal less than $15,000, you have the option of enrolling in the Medicaid Purchase Plan. This plan allows you to purchase Medicaid coverage at a discounted rate. The premium amount you pay is based on your income.
Well Woman Medicaid
Wisconsin’s Well Woman Medicaid program allows women who have been diagnosed and are in need of breast or cervical cancer treatment to receive full Medicaid benefits. To qualify for this program, you must:
- Be enrolled in the Wisconsin Well Woman program through a Well Woman local coordinating agency
- Be under the age of 65 and have had a screening for breast and/or cervical cancer by the Wisconsin Well Woman Program
- Live in Wisconsin
- Be a US citizen or qualified immigrant
- Have or apply for a social security number
- Have a diagnosis of breast or cervical cancer, or have a precancerous condition of the cervix that needs treatment
BadgerCare+ is Wisconsin’s Medicaid program for individuals and families who aren’t elderly, blind, or disabled. To qualify, families and individuals need to:
- Live in Wisconsin
- Be a US citizen or qualified immigrant
- Have or have applied for a social security number
- Meet the program’s income requirements
Tuberculosis Only Related Services Program
If you have Tuberculosis and don’t 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
- Prescription drugs
- Laboratory test and x-rays
- 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.
Emergency Services Program
If you don’t qualify for Medicaid or BadgerCare+ because of your immigration or citizenship status, you might still qualify for Wisconsin’s Emergency Services Program. To qualify you must:
- Be age 65 or older or…
- Be blind or disabled or…
- Be under the age of 19 or….
- Be pregnant or…
- Have children under the age of 19 in the home
You also need to meet all other program requirements, including the income limits. Keep in mind, the Emergency Services Program only pays for emergency medical services. The service begins on the first day of treatment and ends when your condition is no longer considered an emergency. If you’re pregnant, you can apply for services one month before delivery. The Emergency Services Program helps cover the cost of delivery and any emergency situations. It doesn’t cover pre- or post-natal care.
Medicaid Deductible Plus Plan
If you are denied Medicaid or BadgerCare+ services because your income exceeds the limit for your household, you might still qualify for the Medicaid Deductible Plus Plan. This plan creates a deductible using the amount of income that exceeds your limit, and once that deductible is reached, your Medicaid or BadgerCare+ benefits kick in. Deductibles are created in six-month increments. For example, if your monthly income is only $100 over the program’s maximum income limits, you would have a six-month deductible of $600. Once you’ve spent $600 on medical care, you’d get your program’s full Medicaid benefits.
How to Apply for Medicaid in in Wisconsin
To apply for Wisconsin’s Medicaid or BadgerCare+ benefits, you have the option of applying in person, by phone, or online.
To apply in person or by phone, you need contact your local county or tribe agency. If you prefer to apply by mail or fax, you need to print the application for Medicaid for the elderly, blind, or disabled or the BadgerCare+ application and it or fax it to the proper agency.
If you live in Milwaukee County, mail or fax your application to:
PO Box 05676
Milwaukee, WI 53205
If you don’t live in Milwaukee County, mail or fax your application to:
PO Box 5234
Janesville, WI 53547
Fax number: 1-855-293-1822
If you prefer to apply for benefits online, visit Wisconsin’s Apply for Benefits website.
Wisconsin Medicaid Application
The application for Wisconsin’s Medicaid programs requires you to list information about the people in your household, including their names, birth dates, and social security numbers, as well as information about your household’s monthly income and any assets you have.
What Does Medicaid Cover in Wisconsin?
While some of Wisconsin’s smaller plans only cover specific services, the state’s complete Medicaid program provides full health benefits. So if you qualify for Medicaid for the elderly, blind, or disabled or BadgerCare+, your program covers:
- Visits to your primary care doctor
- Specialty care — if you have a referral from your primary care doctor
- Family planning services
- Behavioral health and substance abuse treatment services
Income Requirements for Wisconsin Medicaid
Wisconsin provides medical benefits in some form to individuals and families with monthly incomes ranging from 100 percent below federal poverty level to 300 percent of federal poverty level. The type of benefits you qualify for, including whether or not you have a deductible, depends on your monthly gross income and the income thresholds for the state’s Medicaid programs.
How Much Does Medicaid Cost in Wisconsin?
Wisconsin’s main Medicaid programs are free to those who qualify. However, the Medicaid Deductible Plan requires people to meet their deductible requirements before their full benefits kick in.
Prescription Drugs with Medicaid in Wisconsin?
Wisconsin’s 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.
Which Medicaid plan is best in Wisconsin?
You don’t have an option to choose between multiple Medicaid programs in Wisconsin. Each plan has it’s own qualifications and coverages, and applicants are placed in the program that they qualify for and fits their medical needs.