YOU MAY BE ELIGIBLE FOR ASSISTANCE
Persons with limited income/assets may be eligible for programs offered through the Wisconsin Medicaid ForwardHealth Program.
These Medicaid (also known as Title 19) programs can help with paying the premiums for Medicare and/or covering the out of pocket costs with Medicare (deductibles, co-insurances). There are also programs that can assist with the costs of health care prior to an individual becoming eligible for Medicare. There are many types of Medicaid programs. Each program has its own qualifications for eligibility. Some programs may require a premium and/or co-pays for covered services.
See resource links at the end of each section for more detailed information about covered services, program eligibility and/or how to apply.
General Resources
Wisconsin Department of Health Services – Online program enrollment website
Full Coverage Health Care Plans
Badger Care Plus
BadgerCare Plus is a health care coverage program for low-income Wisconsin residents. Low premiums and/or co-pays may apply.
To qualify, a person must be a U.S. Citizen or qualifying immigrant and one of the following:
• a child age 18 or younger with income at or below 300% of the federal poverty level
• an adult with income at or below 100% of the federal poverty level
• a pregnant woman with income at or below 300% of the federal poverty level
• a young adult, under age 26 who was in a foster home, court-ordered Kinship Care, or subsidized guardianship when turned 18 (regardless of income)
Wisconsin Well Woman Medicaid
Provides medical treatment for women under age 65, who are not covered by other private or public health insurance, who have been diagnosed with breast or cervical cancer or certain precancerous conditions of the cervix. Other program qualifiers must be met.
Wisconsin Medicaid for the Elderly, Blind, or Disabled
Health care programs for people who live in Wisconsin who are elderly (age 65 or older), blind, or disabled. A person may qualify if a U.S. Citizen or qualifying immigrant and have income/assets at or below the program limits. Programs include:
Provides health care coverage for individuals who meet program qualifiers (financial and non-financial). This program is also known as Supplemental Security Income (SSI)-Related Medicaid.
An individual whose income is over the income limit for Standard Medicaid, but meets other program requirements, may be able to qualify for Medicaid by meeting a deductible. This deductible is calculated for a six-month period based on the difference between their monthly counted income and the program income limit.
The cost of unpaid and recently paid bills for medical expenses can be used to meet the deductible. Examples of medical costs include health insurance premiums, personal medical bills, and medical bills of a child or spouse (after Medicare and private insurance has paid).
Medicaid Purchase Plan (MAPP)
The Medicaid Purchase Plan provides health care coverage for people with a disability (age 18 or older) who are working or interested in working (even just a few hours a month). Depending on an individual's income, a premium payment may be required. Visit the website Medicaid Purchase Plan for more information.
Long Term Care Services
Many people who are elderly, blind, or disabled need help in accomplishing everyday tasks and caring for their health. Long term care services may include personal care, housekeeping, or nursing. These services may be provided in a person’s home, residential care facility or group home, or in a nursing facility. Long term care service programs are designed to meet these needs.
Home and Community-Based Service Waiver Programs
These programs help persons who are elderly, blind, or disabled continue living in their own homes or the community instead of a state medical facility or nursing home. They pay for community services not usually covered by Medicaid. Programs include Family Care, Family Care Partnership, and IRIS (Include, Respect, I Self-direct). To be eligible, a person must meet all the non-financial and financial requirements. A cost-sharing may apply.
Institutional Medicaid
This program provides Medicaid coverage of medical services for those who reside in a medical care facility which include skilled nursing facilities (SNF), intermediate care facilities (ICF), institutions for mental disease (IMD), and hospitals.
Spousal Impoverishment Protection
Special financial provisions in Medicaid that affect how income/assets are counted for a married person’s determination of eligibility when applying for/receiving nursing home or community waiver services. This provision may allow the spouse to keep assets and income that are above the Medicaid program financial limits.
Limited Coverage Health Care Plans
Medicare Savings Programs (MSP)
These programs are for Medicare beneficiaries who have limited income and assets and need help with paying Medicare Part A and B premiums, deductibles, and coinsurance.
Qualified Medicare Beneficiary (QMB)
If eligible, the first day of the month after the application is approved, this program pays Medicare Part A and Part B premiums, deductibles, and coinsurance.
Specified Low-Income Medicare Beneficiary (SLMB)
If eligible, up to three months before the application date, this program pays the Medicare Part B premium.
Specified Low-Income Medicare Beneficiary Plus (SLMB+ or QI-1)
If eligible, up to three months before the application date, this program pays the Medicare Part B premium. (Eligibility includes not being enrolled in Medicaid.)
Qualified Disabled Working Individual (QDWI)
If eligible, up to three months before application date, this program pays Part A premiums. (Eligibility includes not being enrolled in Medicaid.)
Wisconsin Medicaid and BadgerCare Plus – Emergency Services
Emergency Services is a limited health care coverage program for people who have an emergency medical condition and cannot get Medicaid or BadgerCare Plus because of immigration or citizenship status.
This program only pays for health care services received for an emergency medical situation. A medical emergency is a medical problem which could put an individual’s health at serious risk or harm if they do not get medical care right away.
Wisconsin Chronic Disease Program (WCDP)
WCDP offers help to Wisconsin residents with chronic renal disease, hemophilia, and adult cystic fibrosis. The program pays health care providers for disease-related services and supplies provided to a WCDP enrollee after all other sources of payment have been made. Deductibles, co-payments, and other out-of-pocket costs may apply. The State seeks repayment of WCDP benefits provided to enrollees under the Estate Recovery Program.
Wisconsin AIDS/HIV Assistance Programs
The Wisconsin HIV Program is the lead agency in Wisconsin government responsible for coordinating the State's public health response to the HIV epidemic. Programs include the Wisconsin AIDS/HIV Drug Assistance Program (ADAP) and the Insurance Assistance Program.
The ADAP is designed to maintain the health and independence of eligible persons living with HIV infection in Wisconsin by providing payment for antiretroviral and other HIV-related prescription drugs.
The Insurance Assistance Program assists eligible individuals to maintain access to health insurance by covering all or part of the cost of their health insurance policy premiums. Under this program, types of policies may include: Basic Medicare Supplement policies, Silver-Level Individual Health Insurance Marketplace plans, and Employer-Sponsored Health Insurance.
