Orlando Harmon
Wisconsin Medicaid is a joint federal and state program that helps over 1 million residents access high-quality healthcare coverage, long-term care, and other services promoting physical and mental health and well-being. Eligibility for Wisconsin Medicaid is based on income and assets, with specific criteria for long-term care programs. BadgerCare Plus, a subset of Medicaid, provides coverage for low-income children, pregnant women, and adults under 65, while older adults and people with disabilities fall under the standard Medicaid program with income and asset limits. To maintain benefits, recipients must renew their Medicaid annually by updating their household, income, and insurance information.
| Characteristics | Values |
|---|---|
| What is Wisconsin Medicaid? | A joint federal and state program that helps Wisconsin residents get access to high-quality health care coverage, long-term care, and other services that promote physical and mental health and well-being. |
| Who is eligible for Wisconsin Medicaid? | Children and adults with disabilities, children in foster care, pregnant women, people with low incomes, and older adults who meet certain federal and state eligibility rules. |
| What are the income and asset limits for Wisconsin Medicaid eligibility? | The income and asset limits for Wisconsin Medicaid eligibility vary based on the specific program and the applicant's circumstances. For example, for a single Nursing Home Medicaid applicant in 2025, the income limit is $2,901 per month, and the asset limit is $2,000. |
| How do I apply for Wisconsin Medicaid? | You can apply through the Wisconsin Department of Health Services (DHS). You will need to provide information about your household, income, and other insurance. |
| How do I renew my Wisconsin Medicaid coverage? | You will need to update your information annually through the Wisconsin DHS. You can renew online through ACCESS Wisconsin or by mail. |
| What does Wisconsin Medicaid cover? | Wisconsin Medicaid covers most medically necessary services, including over-the-counter medications with a prescription, transportation to appointments, and mental health services. It also provides wrap-around coverage for children with private health insurance to help reduce out-of-pocket costs. |
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What You'll Learn
Wisconsin Medicaid eligibility requirements
Wisconsin Medicaid is a joint federal and state program that provides healthcare coverage to over 1 million residents. There are many types of Medicaid programs, each with its own set of requirements for enrolment.
BadgerCare Plus
BadgerCare Plus is a Medicaid program that provides coverage for low-income children, pregnant women, and adults under 65. This program is available to pregnant women with a household income of up to 300% of the poverty level. Coverage for the mother continues for 60 days after giving birth, and Wisconsin is working to extend this to 90 days. BadgerCare Plus also covers low-income adults without minor children, with an income of up to the poverty level. In January 2025, almost 198,000 non-disabled adults in this category were enrolled in BadgerCare Plus.
Medicaid for Older Adults and People with Disabilities
Medicaid is also available for older adults and people with disabilities. This coverage has both income and asset limits. The Medicaid Purchase Plan provides healthcare coverage for certain people with disabilities, while the Qualified Disabled and Working Individual Program helps pay for Medicare Part A premiums for those with disabilities who are employed. Supplemental Security Income (SSI)-Related Medicaid provides healthcare coverage for adults 65 and older, as well as those who are blind or disabled.
Other Programs
Wisconsin Medicaid also includes programs such as Family Care, which is a long-term care program for older adults and people with disabilities. IRIS (Include, Respect, I Self-Direct) is a self-directed program for adults with disabilities and the elderly. It assists families with children under 18 and pregnant women who are experiencing homelessness in finding and maintaining stable housing. Wisconsin Well Woman Medicaid provides coverage for individuals under 65 with specific health conditions.
To enrol in Wisconsin Medicaid, individuals must apply through the Wisconsin Department of Health Services. Enrollees are required to update their household, income, and insurance information annually to maintain their benefits. Wisconsin Medicaid aims to ensure a seamless transition from Medicaid eligibility to premium subsidy eligibility, providing coverage or subsidies to all low-income residents.
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BadgerCare Plus
To be eligible for BadgerCare Plus, individuals can apply through the Wisconsin Department of Health Services. They must meet certain income requirements, with coverage based on household income (MAGI) rather than assets. For older adults and people with disabilities, the coverage is called Medicaid, which has both income and asset limits.
To enroll in BadgerCare Plus, individuals can visit https://access.wisconsin.gov/access/ and click "Apply for Benefits", or contact their local county or tribal Income Maintenance (IM) agency. It is recommended to have important information available when applying, such as household and income details, to ensure a smoother process.
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Medicaid SSI
Wisconsin Medicaid is a joint federal and state program that helps over 1 million residents access high-quality healthcare coverage, long-term care, and other services that promote physical and mental health and well-being. Wisconsin Medicaid has several programs, each with its own set of requirements for enrollment.
In most states, including Wisconsin, SSI recipients are automatically eligible for Medicaid. In these states, the SSI application is also the Medicaid application. However, in some states, while SSI guarantees Medicaid eligibility, a separate application must be filed for Medicaid. In a few other states, SSI does not guarantee Medicaid eligibility, but most SSI recipients still qualify.
If you have Medicaid SSI in Wisconsin, you can continue your current coverage through MHS Health Wisconsin or Network Health. To renew your Medicaid SSI benefits, you must update your household, income, and insurance information annually. The Wisconsin Department of Health Services (DHS) will notify you when it is time for renewal. You can renew online through ACCESS Wisconsin or by mail.
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Medicaid renewal process
Wisconsin Medicaid is a joint federal and state program that provides health care coverage, long-term care, and other services that promote physical and mental health and well-being to more than 1 million residents. The state's largest Medicaid program is BadgerCare Plus, which provides health insurance benefits to people aged 0-64.
The Medicaid renewal process in Wisconsin involves the following steps:
- Notification of Renewal: The Wisconsin Department of Health Services (DHS) will notify you when it is time for you to renew your Medicaid coverage. They will try to reach you using the contact information they have on file, so it is important to ensure that your contact details, including address, phone number, and email, are up to date.
- Updating Information: When you first applied for Medicaid benefits, you provided information about your household, income, and other insurance. To renew your benefits, you need to update this information annually. This process is called a renewal, and it is important to verify your eligibility by your renewal date to avoid a gap in your coverage.
- Renewal Methods: You can renew your Medicaid coverage in Wisconsin through different methods:
- Online: The fastest and easiest way to renew is online through ACCESS Wisconsin. You can log in or create an account on the ACCESS Wisconsin website to initiate the renewal process.
- By Mail: If you prefer, you can renew by mail. Fill out the renewal application that was mailed to you and send it back to the appropriate address.
- In-Person or by Phone: You can also renew your Medicaid coverage in person or by phone at a local Wisconsin Income Maintenance Agency. You can find the address and phone number of your local office on their website.
- Renewal Status: After submitting your renewal application, you can check your renewal status on the ACCESS Wisconsin website or on the MyACCESS Wisconsin mobile app. The Wisconsin DHS will send you a letter informing you if your coverage has been renewed or if you need to find alternative coverage options.
- Continuation of Benefits: If you are enrolled in Supplemental Security Income Medicaid (SSI MA) or Foster Care Medicaid, your Medicaid coverage is automatically granted as long as you continue to receive SSI or are in out-of-home placement. There is no need for a renewal process for these specific programs.
- Transition Options: If you do not qualify for Medicaid renewal, you can explore other health insurance options. The Wisconsin DHS can assist you in finding alternative coverage through your employer, Medicare, or the health insurance marketplace. Websites like WisCovered, Covering Wisconsin, and Healthcare.gov can provide additional resources and information.
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Income and asset limits
Wisconsin Medicaid is a joint federal and state program that helps over 1 million residents access high-quality healthcare coverage, long-term care, and other services that promote physical and mental health and well-being.
To be eligible for Wisconsin Medicaid, applicants must meet certain income and asset limits, which change annually. These limits vary depending on the specific Medicaid program and the applicant's marital status. For instance, in 2025, a single Nursing Home Medicaid applicant in Wisconsin must have an income of less than $2,901 per month and assets worth less than $2,000, in addition to requiring a Nursing Home Level of Care.
The value of countable assets, such as cash, stocks, bonds, life insurance policies, investments, bank accounts, and real estate, is added together and counted towards the Medicaid asset limit. Certain assets, such as personal belongings, household items, automobiles, burial space, and primary homes, are exempt and do not impact Medicaid eligibility.
In Wisconsin, BadgerCare Plus is a form of Medicaid coverage for low-income children, pregnant women, and adults under 65. This population can qualify for coverage based on household income, regardless of assets. Pregnant women with household incomes up to 300% of the poverty level are eligible for BadgerCare Plus, and coverage for the mother continues for 60 days after birth.
For older adults and people with disabilities, the coverage is simply called Medicaid, and it has both income and asset limits. Wisconsin Medicaid also provides coverage for noncitizens who meet certain requirements.
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Frequently asked questions
You may have Wisconsin Medicaid insurance because you are a resident of Wisconsin who meets the eligibility criteria. Wisconsin Medicaid is a joint federal and state program that provides health care coverage and other services to over 1 million residents. Eligibility is determined by financial and personal circumstances, and there are various pathways to qualify.
Eligibility for Wisconsin Medicaid is based on factors such as income, assets, household composition, and specific personal circumstances. To determine your eligibility, you can check the Wisconsin Department of Health Services website or apply through Wisconsin ACCESS. There are also eligibility tests and calculators available to help you understand the requirements.
Wisconsin Medicaid provides comprehensive and affordable health care coverage, including long-term care and other services promoting physical and mental well-being. It covers most medically necessary services and helps with transportation costs to appointments. Additionally, it acts as a secondary payer if you have private insurance, reducing out-of-pocket expenses. Wisconsin Medicaid also offers specific programs like BadgerCare Plus, catering to low-income children, pregnant women, and adults under 65.
