Medicaid is a joint federal-state program that helps cover medical costs for some people with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state runs its own program. This means eligibility requirements and benefits can vary by state. Wisconsin has several Medicaid programs available for individuals who meet both income and asset requirements.
More information about Medicaid in Wisconsin: Wisconsin Department of Health Services (External Link)
Full Coverage HealthCare Plans
Wisconsin Medicaid for the Elderly, Blind, or Disabled (EBD Medicaid)
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.
Social Security Income (SSI) Related Medicaid
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.
Medicaid Deductible (Spend Down)
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 in six-month increments, 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.
Home and Community-Based Service Waiver Programs (Family Care, IRIS)
These programs help individuals to 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. Visit
Find an Aging and Disability Resource Center (External Link) (ADRC) to learn more about eligibility and enrollment.
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.
BadgerCare Plus
BadgerCare Plus is a health care program for low-income Wisconsin residents typically between the ages of 0 and 65. Household size and income limits are the primary requirements to obtain this coverage.
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 to obtain coverage.
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. The avaliable Medicare Savings Programs in Wisconsin can be found within the below table.
Qualified Medicare Beneficiary (QMB)
| Entitled to Medicare Part A
| Medicare Part A and B Premiums, Deductibles, and Coinsurance
|
Specified Low-Income Medicare Beneficiary (SLMB)
| Entitled to Medicare Part A
| Medicare Part B premiums
|
Specified Low-Income Medicare Beneficiary Plus (SLMB+)*
| Entitled to Medicare Part A;
Not enrolled in full, Family Planning, or Tuberculosis Only Medicaid | Medicare Part B premiums
|
| Qualified Disabled and Working Individual (QDWI)
| Entitled to Medicare Part A;
Disabled and employed; Not enrolled in Medicaid | Medicare Part B premiums
|
*Note: Other states refer to this eligibility category as Qualified Individual (QI) and SLMB+ as eligibility for SLMB and full 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 that 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.
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