ForwardHealth Medicaid


Wisconsin offers state-funded health care coverage to many residents with low incomes and special health needs. ForwardHealth is the organization that coordinates all of the state Medicaid and other health-related programs, such as FoodShare Wisconsin. Wisconsin Medicaid offers coverage for pregnant women, children, families, elderly, blind, and disabled individuals, and various income levels.

These health insurance programs cover a broad range of services from primary and preventive care, to hospitalizations, therapies, and medical supplies. As there are programs for people with typically higher incomes than other state Medicaid programs, there are sometimes small fees for services, but most Medicaid members will not pay a monthly premium or a copay of more than $3 for care.

ForwardHealth Medicaid administers BadgerCare Plus for children, parents, and pregnant women, and Medicaid Standard among other programs for aged, blind or disabled persons. Eligibility varies based on the age of the applicant, and their household size and income. Once qualified for coverage, members have access to a large statewide network of Medicaid providers, and a great level of care for any physical or mental health needs.

 

ForwardHealth Medicaid Eligibility

In order to qualify for Medicaid, applicants must live in Wisconsin, and be a U.S. citizen or legal immigrant. In most cases to receive full benefits, you cannot have access to group coverage through an employer, or any other medical insurance such as COBRA. Wisconsin’s Medicaid programs allow residents with a low income to receive the health benefits they require. Income is determined by the current federal poverty level and the number of people with whom you live.

 

Current Federal Poverty Level

 

Pregnant Women 300%

Family of 2: $3,783 monthly, $45,396 yearly

Family of 3: $4,773 monthly, $57,276 yearly

Family of 4: $5,766 monthly, $69,192 yearly

Family of 5: $6,753 monthly, $81,036 yearly

Add $990 for each additional family member.

 

Children Up to Age 19 300%

Family of 1: $2,793 monthly, $33,510 yearly

Family of 2: $3,783 monthly, $45,396 yearly

Family of 3: $4,773 monthly, $57,276 yearly

Family of 4: $5,766 monthly, $69,192 yearly

Family of 5: $6,753 monthly, $81,036 yearly

 

Parent or Caretaker 200%

Family of 1: $1,862 monthly, $22,344 yearly

Family of 2: $2,522 monthly, $30,264 yearly

Family of 3: $3,182 monthly, $38,184 yearly

Family of 4: $3,842 monthly, $46,104 yearly

Family of 5: $4,502 monthly, $54,024 yearly

Add $660 for each additional family member.

 

Single Aged, Blind, or Disabled 84%

$782 monthly, $9,383 yearly

*$2,000 Asset Limit

 

Couple Aged, Blind, or Disabled 94%

$1,185 monthly, $14,222 yearly

*$3,000 Asset Limit

 

Qualified Medicare Beneficiaries (QMB) 100%

Medicaid covers your premiums, coinsurance, and deductibles.

Single: $938 monthly, $11,170 yearly

Couple: $1,260 monthly, $15,130 yearly

 

Specified Low-Income Medicare Beneficiaries (SLMB) 120%

Medicaid covers your premiums only.

Single: $1,117 monthly, $13,404 yearly

Couple: $1,513 monthly, $18,156 yearly

 

Covered Services

Benefits vary based on the plan in which you enroll, however, all plans provide a medically appropriate, comprehensive selection. Some services may require a copay while others are free of charge, and certain members do not have to pay a copay for any services. Members can obtain their care through any Medicaid provider or health clinic in Wisconsin. The program covers:

  • Physician services
  • Preventive care
  • Hospitalization
  • Outpatient hospital services
  • Surgery
  • Prenatal and maternity care
  • Prescription medications
  • Family planning services
  • Dental care
  • Chiropractic services
  • Mental health and substance abuse services
  • Vision exams
  • Medical transportation
  • Medical supplies and equipment
  • Emergency care

 

Managed Care

Various managed care organizations operate throughout the state to provide a coordinated approach to health care. Medicaid members have access to many HMOs, such as UnitedHealthcare, Dean Health Plan, and Molina Healthcare which also vary based on the particular program. When you select an HMO, you will choose a primary care provider to be the main point of contact and manage your medical services. Using  managed care, members have the ability to receive care through any Medicaid-approved provider or facility in the HMO network.

 

BadgerCare Plus HMOs

Children’s Community Health Plan
1-800-482-8010
1-877-733-6456 TDD

CommunityConnect Health Plan
1-888-279-1227
1-800-947-3529 TDD

Compcare
1-888-203-7771 or (715) 552-4310
1-800-947-3529 TDD

Dean Health Plan
1-800-279-1301
1-877-733-6456 TDD

Group Health Cooperative of Eau Claire
1-888-203-7770 or (715) 552-4300
1-800-947-3529 TDD

Group Health Cooperative of Wisconsin – South Central
(608) 828-4853
(608) 828-4815 TDD

Gundersen Lutheran Health Plan
1-866-537-1477 or (608) 775-0150
1-800-947-3529 TDD

Health Tradition Health Plan
1-800-545-8499
1-800-407-2442 TDD

Managed Health Services
1-888-713-6180
1-800-446-6136 TDD

MercyCare Insurance Company
1-800-895-2421
1-800-947-3529 TDD

Molina Healthcare
1-888-999-2404
(414) 847-1789 TDD

Network Health Plan
1-888-713-6180
1-800-446-6136 TDD

Physicians Plus Insurance Corporation
1-800-545-5015 or (608) 282-8900
(608) 260-7998 TDD

Security Health Plan
1-800-791-3044
1-877-727-2232 TDD

UnitedHealthcare Community Plan
1-800-504-9660
1-800-947-6644 TDD

Unity Health Plan
1-800-362-3310
(608) 643-1421 TDD

 

Medicaid SSI HMOs

Compcare
1-888-203-7771 or (715) 552-4310
1-800-947-3529 TDD

Group Health Cooperative of Eau Claire
1-888-203-7770 or (715) 552-4300
1-800-947-3529 TDD

Independent Care Health Plan

1-800-777-4376

1-800-947-3529 TDD

Managed Health Services

1-888-713-6180

1-800-446-6136 TDD

Molina Healthcare
1-888-999-2404
(414) 847-1789 TDD

Network Health Plan
1-888-713-6180
1-800-446-6136 TDD

UnitedHealthcare Community Plan
1-800-504-9660
1-800-947-6644 TDD

 

How to Apply

Wisconsin residents who feel they may qualify for a ForwardHealth Medicaid program can apply online, by phone, in person, or by mail. Using the ACCESS portal is the most simple and effective way to apply for BadgerCare Plus, Medicaid, or any other public assistance benefits for which you may be eligible. If you complete a paper form, you must include all required documentation to support your eligibility when you mail in or otherwise fill out the application.

Contact your local health department to apply over the phone, or download an application here.

Apply online with ACCESS Wisconsin.

 

Resources

ForwardHealth

Wisconsin Medicaid

Apply for benefits

Find a county health department

DHS Contact Information

 

 

Sources:

 

1. Kaiser State Health Facts. “Medicaid & CHIP – Wisconsin.” http://www.statehealthfacts.org/profileind.jsp?cat=4&rgn=51.

2. August 2012. Wisconsin Department of Health Services. “Wisconsin Medicaid SSI HMO Choice Booklet.” P-12770A.

3. November 2012. Wisconsin Department of Health Services. “Wisconsin BadgerCare Plus HMO Choice Booklet.” P-12020A.