Medicaid Eligibility in Wisconsin

Calendar Icon Updated February 11, 2019
Medicaid

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+

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:

MDPU

PO Box 05676

Milwaukee, WI 53205

Fax number:1-888-409-1978

If you don’t live in Milwaukee County, mail or fax your application to:

CDPU

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
  • Dental
  • Vision
  • 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.

Eligibility Team

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