A Guide to Wisconsin Medicaid

Medicaid is a federally funded program that allows state governments to supply qualified residents with much-needed healthcare benefits. Wisconsin Medicaid supports various health programs, like BadgerCare Plus, Family Care, and SeniorCare. Each program assists the elderly, disabled, and low-income populations in acquiring prescriptions, medical services, and professional healthcare.

Wisconsin residents who meet Medicaid eligibility requirements may apply for and use these benefits to improve their health and quality of life. As of May 2023, 1.47 million Wisconsinites were enrolled in Medicaid.

As a Wisconsin resident, you want affordable healthcare coverage to protect you and your family throughout each stage of life. Wisconsin Medicaid and its additional Badgercare Plus coverage might fit your needs. Like many candidates, you likely have several questions about what your state’s Medicaid program covers.

The following guide will answer those and other questions in-depth. It will also help you determine whether you need extended coverage options and direct you to where to find them. To avoid additional medical costs, many people using Wisconsin Medicaid also secure private health insurance to extend their coverage. Start your journey toward a healthier, happier family by diving deeper into Wisconsin Medicaid below.

    What Is Wisconsin Medicaid?

    Wisconsin Medicaid assists over 1 million state residents in accessing quality coverage for medical services and healthcare benefits. State and federal governments fund this program to help low-income individuals and families protect their health with much-needed medical assistance and maintenance services. Some commonly asked questions regarding the Medicaid program include:

    • What is BadgerCare Plus? Wisconsin’s primary Medicaid program, BadgerCare Plus, is a state and federally-funded healthcare program that covers adults and children who meet the state’s eligibility requirements.
    • Is Wisconsin Medicaid free? Wisconsin Medicaid coverage may provide free coverage for qualifying residents. Households with higher incomes that still qualify may pay a low-cost fee to obtain it.
    • How are Medicaid and BadgerCare Plus funded? The federal government funds Medicaid, the overarching healthcare program for United States citizens. The federal funds are earmarked to the Wisconsin state government to finance Badgercare Plus, Wisconsin’s state Medicaid plan.
    • Are BadgerCare Plus and Medicaid the same? Badgercare Plus and Medicaid are not the same. However, Medicaid supplies the monetary support Wisconsin needs to provide BadgerCare Plus.

    Your household’s Medicaid eligibility depends on various factors that include collective income, diagnosed disabilities, and age. Each qualifying person must have a Medicaid card to prove their eligibility and access program benefits.

    What Is a Wisconsin Medicaid Card?

    Wisconsin Medicaid

    A Medicaid card contains information about the cardholder and proves their certified program eligibility. When you apply for BadgerCare Plus coverage, you’ll receive a Medicaid or Forward Health card in the mail upon acceptance. You must keep this card on hand when seeking medical and health services at program-approved practices and facilities.

    Applying for Wisconsin Medicaid

    Ready to learn how to apply for BadgerCare Plus in Wisconsin? First, collect and keep basic identification information, such as social security number, marital status, citizenship status, and annual income, on hand throughout the process. Then, you can apply for Wisconsin Medicaid using one of four methods listed below:

    • Online: Create an account on the ACCESS website portal to provide and submit your application information. This method works faster than the others.
    • By mail and fax: Print and complete the BadgerCare Plus Application Packet. Then, mail or fax the packet to one of the addresses listed on the first page of the packet.
    • Phone call: Call the phone number associated with your area’s Income Maintenance or Tribal Agency. The Wisconsin Department of Health Services works directly alongside these agencies.
    • In-person appointment: Call the Income Maintenance or Tribal Agency associated with your area to make an application appointment. Use the directory listed in the bullet above.

    Eligibility Requirements

    Are you eligible for Wisconsin’s Medicaid coverage? Residents who meet the following qualifications can apply for and acquire government-funded health care:

    • Citizenship and residency: You must reside in Wisconsin and obtain documented state residency. You must also have U.S. citizenship.
    • Diagnosed disabilities: The Wisconsin Disability Determination Bureau must qualify you as blind or otherwise disabled.
    • Age: Senior adults over the age of 65 qualify for coverage. Adults from 19 to 64 years of age may also obtain BadgerCare Plus coverage if they have no dependents and make an income below 100% of the federal poverty level. Minors 18 years or younger may also qualify if they live at or below 300% FPL.
    • Familial disruption: Adults aged 26 and under who were in foster care, subsidized guardianship, or Kinship Care at 19 can access BadgerCare Plus.
    • Poverty level: Your income must meet or fall below 100% FPL at minimum. However, the income requirements fluctuate depending on other listed qualifications that apply to you.
    • Pregnant women: If you are pregnant and have an income of 300% FPL or less, you could access BadgerCare Plus and Wisconsin Medicaid benefits.

    Getting a Wisconsin Medicaid Card

    After receiving your application for Wisconsin Medicaid, the Wisconsin DHS processes it. Upon acceptance, the department will automatically provide a ForwardHealth identification card in the mail. The card contains your unique ID number. You must present your ForwardHealth card to medical personnel during appointments and emergency services.

    Renewing or Replacing Your Wisconsin Medicaid Card

    You must renew your Wisconsin Medicaid membership annually. Otherwise, your coverage may lapse, leaving you or your household without what BadgerCare Plus covers alongside Medicaid.

    The DHS will mail a renewal notice to your home address. Otherwise, you can check your ACCESS portal for pertinent notifications.

    What should you do if you lose or damage your card? Call Wisconsin’s Member Services at 800-362-3002. Verify your information with the associate who responds to your call, and you’ll receive a new card in the mail. You can still access health services by supplying your 10-digit membership number and documents proving your identification.

    Wisconsin Medicaid Coverage

    What is BadgerCare Plus coverage? Qualifying members can use their plan to cover the costs of several necessary medical services, such as primary care, medications, and procedures.

    Explore some of the details of what BadgerCare Plus Covers to better understand what you can access with your ForwardHealth card.

    Dental

    Wisconsin Medicaid covers full or partial costs for limited dental services for residents using their standard benefits. If you qualify for BadgerCare Plus or additional government programs, you may access a broader range of oral health services. Most members can access basic services like cleanings and evaluations without prior authorization.

    If you are pregnant or aged 21 or younger, you’ll access a bigger pool of dental and oral health procedures and services.

    If you have more serious dental issues, and anticipate requiring more trips to the dentist, investing in private dental plans in Wisconsin is advisable.

    Prescription Drugs

    Wisconsin Medicaid covers a diverse variety of prescription drugs ranging from acne medication to antidepressants and antibiotics. Restrictions and prior authorizations may apply to some prescriptions. You may also use your coverage to purchase specific over-the-counter drugs by your general practitioner's recommendations.

    If you need additional financial assistance to afford your much-needed prescription medications, you can explore Wisconsin’s additional programs developed to improve prescription access. For example, Wellcare by Allwell offers captive pharmacy benefits to qualifying members. SeniorCare offers senior adults assistance in affording various generic and brand-name prescriptions alongside some over-the-counter products at participating pharmacies.

    Extended Healthcare

    An extended healthcare service refers to long-term treatment programs to improve an individual’s quality of life. If you struggle with mental health conditions, substance addictions, or chronic conditions that affect your independence, you may benefit from extended services to help you manage and rehabilitate from these obstacles. Wisconsin Medicaid covers the following extended healthcare treatments for qualifying individuals:

    • Addiction recovery: Medicaid and BadgerCare Plus cover long-term rehabilitation and addiction treatment for people who struggle with substance abuse.
    • Mental health care: You can use Wisconsin’s Medicaid benefits to access most mental and behavioral health treatments in outpatient settings. Children may qualify for inpatient treatment coverage through BadgerCare Plus.
    • Long-term care: Some individuals may require long-term care to manage age-related health concerns or significant disabilities. Nursing Home Medicaid, family partnerships, and Home and Community Based Services can help families access the professional care their affected loved ones need.

    While extended healthcare options through Wisconsin are comprehensive, they do not cover your finances should a temporary or permanent illness arise. Consider investing in quality disability insurance to protect your finances.

    Travel and Out-of-State Coverage

    What happens if you need assistance when traveling out of state? You can use Wisconsin Medicaid and BadgerCare Plus benefits to access and pay for medical emergencies. This coverage applies to all United States, American territories, Mexico, and Canada.

    However, you cannot schedule out-of-state services and cover the costs via your Wisconsin Medicaid assistance or accompanying programs. You must schedule doctor’s appointments and planned treatments within Wisconsin borders at facilities that accept your coverage.

    If you are traveling outside of the coverage areas, always purchase proper travelers insurance.

    Students & Seniors

    College students who meet the previously listed eligibility requirements can apply for and use Wisconsin Medicaid and other healthcare programs for in-state services.

    For example, you attend a university in a bordering state. While your coverage won’t assist you with regular doctor’s appointments, it can help with emergencies. You must return to Wisconsin to purchase covered prescriptions or undergo other treatments.

    Alternatively, you can:

    • Remain on your parents’ healthcare plan until your 26th birthday.
    • Inquire about whether your university of choice offers affordable plans for qualifying students.
    • Purchase additional coverage that offers more lenience.

    Comprehensive healthcare coverage might be at the top of your priority list if you are a senior citizen. You can access various programs to help you manage your healthcare needs, including:

    • Family Care Partnership: Like many aging Wisconsin residents, you want to remain in your home for as long as possible. Family Care Partnership helps you achieve this with state-funded long-term care professionals who work with your family to keep you at home.
    • IRIS: Include, Respect, I Self-Direct further enables your independence as a senior adult by improving your quality of life with adaptive technology, property modifications, employment support, vocational assistance, nursing services, and more.
    • PACE: The Program of All-Inclusive Care for the Elderly helps persons aged 55 or older prepare for an independent, at-home lifestyle as they grow older. You can access benefits like prescriptions and long or short-term care and assistance through this program.
    • SeniorCare: As you age, you’ll likely integrate medications into your daily lifestyle. SeniorCare helps you maintain your health with affordable access to prescription medicines and vaccinations.
    • SSI-Related Medicaid: If you draw social security to fund your lifestyle, you may qualify for supplemental health care benefits in addition to your current coverage.

    Coverage for Subgroups

    Senior adults and children are not the only groups that can receive coverage from Wisconsin Medicaid and related programs. If you fall into one of the following categories, you might qualify for access to supplemental benefits for free or at a low cost.

    Indigenous Americans

    Wisconsin DHS recognizes and values the culture of Indigenous American tribes. Therefore, the department designed state-backed Medicaid services to meet the unique needs of its native tribes.

    Indigenous Americans with a tribal membership automatically qualify for full Medicaid coverage with no out-of-pocket copays. Your benefit entitlement might also extend to assistance from the Indian Health Service.

    Military

    Veterans and qualifying family members can use Medicaid coverage to supplement benefits from Veterans Affairs, TRICARE, and the Civilian Health and Medicare Program of the Department of Veterans Affairs. As a veteran, you might be eligible for military-specific plans and Wisconsin Medicaid programs according to your disability status and age group.

    If you are the spouse or child of a veteran, you may qualify for CHAMPA assistance if:

    • You cannot access TRICARE.
    • Your veteran spouse or parent died in the line of duty.
    • Your veteran spouse or parent was permanently disabled and/or died due to their disability.

    Immigrants

    Qualifying immigrants can access Wisconsin Medicaid and its associated programs.Immigrants who do not meet the eligibility requirements might qualify for assistance from Emergency Services. Unqualified pregnant immigrants can also gain benefits from the BadgerCare Plus Prenatal Plan. The Wisconsin DHS will not share your immigration status with the U.S. Citizenship and Immigration Services.

    What Wisconsin Medicaid Does Not Cover

    Noncovered services are medications, equipment, treatments, and visits that a Wisconsin Medicaid plan will not cover. Some examples of noncovered services include:

    Fees for missed appointments
    Experimental treatments and services
    Autopsies
    Authorized services where authorization was previously denied or not yet provided
    Court-ordered behavioral or mental evaluations
    Document-processing or call fees
    Services and treatments designated for infertility in males or females
    Surgical repairs for piercings or tattoo removal services
    Hormone therapies for nonessential procedures
    Out-of-state medical services for nonemergencies
    Purely cosmetic procedures, including hair transplants, medically unnecessary plastic surgery, and tattooing services
    Funerals

    Although some aid is provided through WCMEA, the funding will not cover the entire cost of funerals. Consider investing in funeral insurance to protect your family.

    Additionally, many procedures require authorization from the DHS to qualify for Medicaid coverage. Speak with your primary care physician and other practitioners to determine whether you need authorized treatments to maintain your health.

    Common Procedures and Wisconsin Medicaid Eligibility

    What procedures, prescriptions, and treatments can you expect to access through your Medicaid-approved provider? Discover how your plan enhances your day-to-day health.

    Dental
    Oral evaluations Your dentist can perform oral evaluations every six months to three years, depending on the type of examination.
    Fluoride treatments Medicaid covers an annual topical fluoride treatment for adults. Children may undergo treatments twice annually.
    Restoration procedures You can access various restorative treatments like crowns and composites.
    Minor emergency treatments If you have a small dental emergency, don’t hesitate to contact your dentist and cover the treatment with your plan.
    Find a list of other covered oral treatments here.
    Vision
    Low-vision exams Has your physician or ophthalmologist diagnosed you with low vision? If so, Wisconsin Medicaid covers one annual exam.
    Glasses prescriptions If your eye-care provider determines you need glasses, they can supply them without authorization. Your plan should cover your prescription.
    Contact lenses Do you have keratoconus or aphakia? You can request contact lenses or replacement lenses from your provider with the authorization necessary.
    Surgery
    Inpatient procedures Wisconsin Medicaid programs cover most inpatient surgeries in full.
    Outpatient procedures Outpatient treatments may require authorization to qualify for coverage.
    Multiple surgeries If your surgeon performs numerous procedures simultaneously, your plan may cover most costs with a small copay.
    Pre-operative and post-operative care Medicaid covers care requirements associated with surgery.
    You can find more information about surgical coverage here.
    Hospital
    Emergency visits BadgerCare Plus and Emergency Services will cover costs associated with medical emergencies at any time.
    Non-emergency visits Wisconsin Medicaid covers transportation and appointment fees for qualified members.
    Therapy and Counselling
    • Evaluations: If you need a diagnosis or more information about your mental health condition, you can undergo a covered evaluation to improve your treatment regimen.
    • Prescriptions and medication management: You might need prescription medications to help you manage your condition or disorder. Access those much-needed medicines and learn how to use them through Wisconsin Medicaid.
    • Crisis intervention: Your mental healthcare provider may determine that crisis intervention will improve your treatment plan. If so, your Medicaid coverage will help you access it when you need it the most.
    • Substance abuse education and treatment: Some mental health conditions exacerbate substance addictions. Medicaid programs help patients access long-term rehabilitation and treatment programs alongside educational materials regarding how addiction and mental illness feed into one another.
    • Skill development and related therapies: You or a family member might struggle to develop and use everyday skills because of a behavioral or mental condition. Use skill therapies and developmental resources to improve your quality of life, find employment, and solve problems.
    • Counseling and guidance: Access individual and group counseling settings to improve communication and constructively solve everyday problems.

    Learn more details regarding mental health treatment here.

    Sexual Health
    Gynecologist Protect your reproductive and sexual health with vaccines targeting sexually transmitted viruses, contraceptives, pap smears, sterilizations, and STI tests.
    Pregnancy The BadgerCare Plus Prenatal Plan helps expectant mothers access the care they need throughout their pregnancy.
    Fertility Treatment Family Planning Only Services allow members to acquire fertility trackers to determine the best time to conceive. You cannot access fertility treatments beyond this.
    Erectile dysfunction Wisconsin Medicaid does not cover treatments for erectile dysfunction and similar conditions.
    Specialist Services
    Dermatologists Medicaid cardholders can visit a dermatologist who accepts program assistance to treat acne and other skin conditions.
    Physiotherapy Treat qualifying injuries, chronic conditions, and disabilities with assistance from a physiotherapist.
    Massage Therapist Medicaid typically will not cover the costs of a massage therapist unless your doctor deems it medically necessary.
    Podiatrists Ask your primary provider whether your foot condition requires a podiatrist’s opinion. If it does, you could qualify for treatment from a foot and leg specialist.
    Allergist and allergy Testing If your doctor deems allergy testing medically necessary, Wisconsin Medicaid may pay for it.
    Sleep Physician Services and CPAP Machines Medicaid often covers the costs of essential medical devices. However, your primary care physician must deem it medically necessary, including sleep equipment.
    Your primary doctor can refer you to these and other specialists when they find that your health concern warrants a specific focus. Keep your doctor informed about your needs to ensure you can quickly access these services.

    Extending Wisconsin Medicaid Coverage

    While Wisconsin Medicaid programs offer generous benefits, they still have significant limitations. However, you can work with your plan provider or other third party to extend your health insurance coverage and improve your quality of life. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.

    You should consider supplemental policies for:

    • Doctors and treatments not available through your coverage: Wisconsin Medicaid offers a limited provider network that can only provide covered treatment options. You can unlock alternative treatments, experimental procedures, and other uncovered benefits with a supplemental plan.
    • Prompt reimbursements: Medicaid reimbursements take time. Third-party providers pay faster.
    • Peace of mind when traveling: If you visit relatives or enjoy vacations for long periods, you can request medications or visit doctors outside of emergencies.
    • Managing conditions with benign symptoms: Issues like erectile dysfunction may not directly threaten your health, but they can affect your sense of well-being and relationships.
    • Extended family planning: Although contraception is essential to creating manageable families, fertility treatments may provide a family’s foundation. Third-party coverage can help you begin a new life.

    Insurdinary can help you find the perfect healthcare match to work with your budget and current Wisconsin Medicaid coverage. Compare quotes in your area for free to improve your life, health, and financial capabilities.

    FAQ’s

    How long is the approval process for Wisconsin Medicaid?

    Approval times for Wisconsin Medicaid can vary based on individual circumstances. On average, the process takes approximately 30 to 45 days. Expedited processing is available for urgent cases.

    What are the application methods for Wisconsin Medicaid?

    You can apply for Wisconsin Medicaid online, in person, by mail, or at a local Department of Health Services office. Ensure you submit necessary documents, including proof of income, household size, and residency, with your application.

    Does Wisconsin Medicaid cover funeral expenses?

    No, Wisconsin Medicaid primarily provides healthcare coverage and does not include benefits for funeral expenses. If you require assistance with funeral costs, consider exploring options like funeral insurance.

    Who is eligible for Wisconsin Medicaid?

    Eligibility for Wisconsin Medicaid is based on factors such as income, household composition, and other considerations. The program typically covers low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.

    What is Wisconsin Medicaid?

    Wisconsin Medicaid is a program designed to provide medical coverage to eligible low-income residents of the state. Funded jointly by federal and state resources, its goal is to ensure access to essential healthcare services for qualifying individuals.

    What other types of insurance does Insurdinary offer?

    Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:

    References

    1. https://www.dhs.wisconsin.gov/medicaid/index.htm
    2. https://www.dhs.wisconsin.gov/badgercareplus/member-info.htm
    3. https://www.dhs.wisconsin.gov/forwardhealth/apply.htm
    4. https://www.dhs.wisconsin.gov/forwardhealth/imagency/index.htm
    5. https://access.wisconsin.gov/access/
    6. https://www.dhs.wisconsin.gov/library/collection/f-10182
    7. https://www.benefits.gov/benefit/1616
    8. https://www.dhs.wisconsin.gov/ddb/index.htm
    9. https://www.dhs.wisconsin.gov/publications/p1/p10049.pdf
    10. https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=44&s=6&c=34&nt=ForwardHealth+Identification+Cards
    11. https://www.forwardhealth.wi.gov/wiportal/content/provider/medicaid/pharmacy/resources.htm.spage#
    12. https://www.mhswi.com/providers/pharmacy.html
    13. https://www.dhs.wisconsin.gov/publications/p1/p10084.pdf
    14. https://www.dhs.wisconsin.gov/aoda/hccindex.htm
    15. https://www.dhs.wisconsin.gov/publications/p8/p80016.pdf
    16. https://www.medicaidlongtermcare.org/eligibility/wisconsin/
    17. https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=43&s=6&c=38&nt=Members+Traveling+Out+of+State
    18. https://www.dhs.wisconsin.gov/medicaid/seniors.htm
    19. https://www.healthcare.gov/american-indians-alaska-natives/coverage/
    20. https://longtermcare.wi.gov/Pages/Medigap/MilitaryCoverages.aspx
    21. https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=17&s=2&c=8&nt=Definition+of+Noncovered+Services
    22. https://docs.legis.wisconsin.gov/code/admin_code/dhs/101/107/03
    23. https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=15&s=2&c=10&nt=BadgerCare%2FMedicaid+Diagnostic%2C+Preventive%2C+Restorative%2C+Endodontics%2C+Periodontics%2C+General+Codes
    24. https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=50&s=5&c=30&nt=Surgical+Procedures
    25. https://www.dhs.wisconsin.gov/forwardhealth/emergency-services.htm
    26. https://www.dhs.wisconsin.gov/nemt/index.htm
    27. https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=1&s=2&c=61&nt=
    28. https://www.dhs.wisconsin.gov/fpos/index.htm
    29. https://access.wi.gov/s/account-creation?landingPage=afb&language=en_US
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