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Wisconsin Medicaid Program Eligibility & Benefits

Wisconsin Medicaid provides free or low-cost health care coverage to eligible residents. Eligibility and benefits depend on your age, health, income and program type. While most plans cover pregnant women, children, elderly adults, disabled individuals and families, Wisconsin also offers a Medicaid plan for low-income childless adults. Apply for Medicaid at your county Department of Social Services or call Member Services at 1-800-362-3002 for more information.

  1. General Eligibility Requirements

    • Wisconsin Medicaid is open to U.S. citizens and legal residents. You must provide proof of income, identity and residence. Families with one absent parent may need to cooperate with child support services. Excluding childless adults, you may have private or employer health insurance and Medicaid jointly. Childless adults age 19 to 64 must be uninsured to qualify for benefits. Depending on your age, health and program type there may be asset limits. Assets include cash on hand, bank accounts, stocks and bonds, some property and extra vehicles.

    Income Limits

    • As of 2011, you may qualify for Medicaid if your household income does not exceed 300 percent of the Federal Poverty Level. Possible premiums or copays may apply depending on your income. The income limit for childless adults and adults with children is 200 percent of the FPL. Medicaid coverage and availability is limited for childless adults. A percentage of your earned income, childcare, child support, housing costs and some medical payments are deducted or excluded when determining eligibility.

    Copays and Premiums

    • Excluding pregnant women, you may be responsible for copays or premiums if your income exceeds 100 percent of the FPL. Children up to age 5 receive free coverage if their income does not exceed 150 percent of the FPL. Member responsibility is based on income and Wisconsin Medicaid offers a "spenddown" option for individuals with high medical costs. Spenddown subtracts qualifying medical bills, private insurance premiums and other health care costs from your countable income before determining Medicaid co-pays and premiums.

    Medicaid and Medicare

    • Medicare recipients and those eligible for Medicare Part A may qualify for help paying for some medical costs under the Medicare Savings Program. The income limit for most applicants is 100 to 135 percent of the FPL with an asset limit of $6,680 for individuals or $10,020 for couples. Employed disabled adults may qualify if their income is at or below 200 percent of the FPL and their countable assets do not exceed $4,000 for individuals or $6,000 for couples.

    Benefits

    • Depending on your program and eligibility, Medicaid benefits include, but are not limited to, doctor visits, emergency services, dental, vision, chiropractic services, medical supplies, prescriptions, well-child checkups, hospice, hospital services, physical therapy, prenatal care and specialty treatments. Disabled and elderly individuals may qualify for additional benefits such as nursing or home health care services. (see ref 2)

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