Wisconsin Medicaid Eligibility and Enrollment
- Want to learn about Wisconsin Medicaid? Read on for everything you need to know about the different programs, eligibility requirements and how to apply.
Medicaid in Wisconsin helps provide health care to more than 1.6 million people through a range of programs that target different sections of the population. This helps ensure the people that need help are able to access it. Wisconsin Medicaid can help low-income people throughout the state access quality care.
What Is Wisconsin Medicaid?
Medicaid in Wisconsin is made up of a range of programs that offer comprehensive health insurance to certain populations within Wisconsin, including low-income adults, children, older adults and disabled people. It’s funded jointly by the state and federal government.
Each Medicaid program has different rules for eligibility. Some smaller programs cover very specific services, and the larger programs offer full health benefits, including dental care, mental health services and prescription drugs.
What Are the Different Medicaid Programs Available 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 state’s 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 state’s 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.
Who Is Eligible for Medicaid in Wisconsin?
Wisconsin's wide range of programs mean that there are a variety of specific eligibility criteria. Applicants must meet the requirements of their specific program. The larger programs, BadgerCare and Medicaid, have financial and other eligibility criteria that also relate to some other programs.
Wisconsin Medicaid’s primary eligibility criteria are financial. Both BadgerCare and Medicaid have income limits. Medicaid also has an asset limit, but there is no asset limit for BadgerCare.
The income limit for BadgerCare is based on the Federal Poverty Level (FPL). Childless adults and parents and caretakers of minors can earn up to the FPL. Pregnant women, children under 19, and those who only want family planning services can earn up to 306% of the FPL. The FPL changes based on the number of people in a family, and the current limits are available on the Wisconsin Medicaid website.
As of April 2023, the income limits for a single person applying for regular Medicaid are $1,616 per month, with an asset limit of $2,000. Married couples can have an income of up to $2,185 per month and $3,000 worth of assets. Wisconsin also has an "actual shelter allowance" that adds to the income limit. For singles, this is up to $261 per month, and for married couples, it’s $391.67. This allowance includes the cost of a mortgage, rent, property taxes and utilities.
People applying for nursing home Medicaid or a Home and Community Based Services waiver can have up to $2,742 per month for each person applying. This means that when both spouses of a married couple are applying, they can have up to $5,484 per month of income. If only one spouse is applying, the income limit only applies to the applicant’s income. The asset limit for singles is $2,000, and for married couples, it rises to $4,000 when both people are applying. When only one spouse is applying, the applicant can have assets of up to $2,000 and the non-applicant spouse can have up to $148,620 of assets.
For Medicaid purposes, there are countable and non-countable assets. Countable assets include cash, stocks, bonds, life insurance policies and investments. Assets that are exempt include personal belongings, furniture and funeral trusts. Houses are exempt if the applicant is living in it or they have a spouse still living there.
People who don’t meet these requirements may still be able to qualify through the medically needy pathway, which is designed to help people with high medical costs. The difference between an applicant’s income and the Medicaid income limit is referred to as a deductible. This amount is used to pay medical expenses, and once the deductible is spent, the individual is eligible for Medicaid for the rest of the six-month period. This program also has income limits. For a single applicant, that limit is $1,063.33 per month, and for a household of two, the limit is $1436.67. People using this pathway to access Medicaid must still meet the asset limit.
Other Eligibility Criteria
Beneficiaries of all programs must be a resident of Wisconsin and a U.S. citizen or legal immigrant. BadgerCare is available to the following segments of the population
- All children
- Pregnant women
- Parents and caretakers of children under 18
- Young adults leaving foster care
- Farmers and self-employed people
- Low-income adults
Medicaid is available to people over the age of 65 or those who have been assessed as blind or disabled by the Disability Determination Bureau.
Some programs, especially waiver programs, may have specific eligibility criteria that ensure help is reaching the correct people. These are generally called functional criteria. Most waiver programs state an applicant must need a nursing home or intermediate care facility level of care. Nursing home Medicaid recipients must require a nursing home level of care. Smaller programs may have narrower criteria, such as the Wisconsin Well Woman Medicaid program that provides assistance to those being treated for breast or cervical cancer.
How Do I Enroll in Medicaid in Wisconsin?
People wishing to enroll in Wisconsin Medicaid can do so online through the ACCESS website. Alternatively, applications can be made in person or by phone through an individual’s local income maintenance or tribal agency. Paper applications are also available from the Wisconsin Medicaid website and can be returned by mail or fax to addresses found on the forms.
Contact Information for Wisconsin Medicaid
The best point of contact for people wishing to know more about Wisconsin’s Medicaid program is their income maintenance or tribal agency. Alternatively, Member Services can be reached at (800) 362-3002.