Wisconsin Medicaid Office
Find Wisconsin Medicaid contact information, eligibility requirements, income limits, and how to apply.
Wisconsin Medicaid agency
- Agency
- Wisconsin Department of Health Services (ForwardHealth)
- Website
- https://www.dhs.wisconsin.gov/medicaid
- Phone
- 1-800-362-3002
- Address
- 1 W. Wilson Street Madison, WI 53703
- Hours
- Member Services: Monday–Friday, 8 a.m.–6 p.m. Central (1-800-362-3002 or memberservices@wisconsin.gov)
Wisconsin Medicaid office (ForwardHealth)
Wisconsin's Medicaid program runs under the brand ForwardHealth, the umbrella the Department of Health Services (DHS) uses for Medicaid, BadgerCare Plus, SeniorCare, FoodShare, and other related benefits. Member-facing questions about coverage and providers route to a single statewide Member Services line; enrollment paperwork, document submission, and change reporting route to a local county or tribal income-maintenance agency rather than a central office.
How to reach ForwardHealth
- Member Services — 800-362-3002 or email memberservices@wisconsin.gov, Monday through Friday, 8 a.m. to 6 p.m. Member Services can help you find a provider, request a new ForwardHealth card, or understand covered services and copays.
- Local county or tribal agency — the agency in your area handles enrollment questions, eligibility determinations, change reports, and proof submissions. DHS maintains a county-by-county and tribal-agency locator at dhs.wi.gov.
- HMO enrollment specialist — 800-291-2002 for help picking, switching, or understanding an HMO assignment.
- HMO ombudsman — 800-760-0001 for independent help understanding HMO rules or resolving disputes with a plan.
- Provider Services — 800-947-9627 for health care providers and HMOs, not for members.
- Katie Beckett Medicaid eligibility specialists and SeniorCare have their own dedicated contact lines through the DHS website.
The split between Member Services and the local income-maintenance agency is structural: a member with a benefit question gets the same answer anywhere in the state, but an eligibility determination depends on the local agency that handles the household's case file.
Who qualifies for Wisconsin Medicaid?
BadgerCare Plus and Wisconsin Medicaid together cover more than one million residents. DHS sorts applicants into five groups, each with its own rules: children, older adults, adults, pregnant people, and people with disabilities. The single most important quirk to understand is that Wisconsin did not take the ACA Medicaid expansion to 138% FPL — instead, BadgerCare Plus covers adults (including childless adults) only up to 100% of the federal poverty level. That ceiling is much lower than expansion states and creates a gap for adults with incomes between 100% FPL and the Marketplace subsidy floor.
Coverage categories
- Children — covered through BadgerCare Plus at higher income limits than adults. The premium threshold for children is 201% FPL; above that, families may owe a monthly premium up to the program's overall ceiling.
- Pregnant people — qualify up to 306% FPL for BadgerCare Plus coverage during pregnancy and the 12-month postpartum period (extended through Wisconsin's Section 1115 Postpartum Coverage Demonstration Waiver).
- Adults — both parents/caretakers and childless adults qualify through BadgerCare Plus at or below 100% FPL. No ACA expansion to 138% FPL.
- Older adults (65+) — separate non-MAGI category. SeniorCare (a state-funded prescription drug program) is a separate benefit for older adults who don't qualify for full Medicaid.
- People with disabilities — multiple pathways including SSI-Related Medicaid, the Medicaid Purchase Plan for working adults with disabilities, and Family Care (the managed long-term care program).
Resources and assets
MAGI categories (children, pregnant people, parents, BadgerCare Plus adults) carry no asset test. Non-MAGI categories for older adults and people with disabilities apply both income and resource limits — verify the current standard with your local income-maintenance agency before applying.
Renewals run every 12 months
DHS attempts an ex parte (paperwork-free) renewal first, using federal and state data. If the data confirms continuing eligibility, coverage continues automatically. If not, the household receives a pre-populated renewal packet — return it by the printed deadline or coverage stops. Sign up for MyACCESS notifications so renewal alerts reach you by text or email.
BadgerCare Plus income limits (effective February 1, 2026)
DHS publishes BadgerCare Plus income limits on a single chart with three thresholds: the adult ceiling, the children's premium line, and the pregnant-people/children income ceiling. The chart below is effective February 1, 2026 through January 31, 2027. The federal poverty figures update each January, so DHS reissues the chart annually.
BadgerCare Plus monthly income limits — 2026
| Family size | Adult limit (100% FPL) | Children premium threshold (201% FPL) | Pregnant people & children limit (306% FPL) |
|---|---|---|---|
| 1 | $1,330.00 | $2,673.30 | $4,069.80 |
| 2 | $1,803.33 | $3,624.69 | $5,518.19 |
| 3 | $2,276.67 | $4,576.11 | $6,966.61 |
| 4 | $2,750.00 | $5,527.50 | $8,415.00 |
| 5 | $3,223.33 | $6,478.89 | $9,863.39 |
| 6 | $3,696.67 | $7,430.31 | $11,311.81 |
| 7 | $4,170.00 | $8,381.70 | $12,760.20 |
| 8 | $4,643.33 | $9,333.09 | $14,208.59 |
| Each additional person, add | $473.33 | $951.39 | $1,448.39 |
What the three columns mean: adults qualify only up to 100% FPL; children qualify up to 306% FPL, with a monthly premium applied above 201% FPL; pregnant people qualify up to 306% FPL with no premium.
Copay exemption thresholds
Some BadgerCare Plus members pay no copays regardless of income — kids under 19, foster youth (including former foster youth up to age 26), tribal members, hospice patients, pregnant people, and people within 60 days postpartum. Other adult members may have copays. The income table below shows the no-copay threshold by family size.
| Family size | Monthly income for no copay |
|---|---|
| 1 | $627.50 |
| 2 | $851.67 |
| 3 | $1,075.83 |
| 4 | $1,300.00 |
| 5 | $1,524.17 |
| 6 | $1,748.33 |
If you do owe a copay, the schedule is $0.50 for services under $10, $1.00 for services $10–$25, $2.00 for $25–$50, $3.00 for services over $50, and $8.00 for an emergency-room visit that is not actually an emergency (childless adults 19–64 only). Your monthly out-of-pocket copays will never exceed 5% of total gross household income — DHS sends a letter once you hit that cap.
How to apply for Wisconsin Medicaid
Wisconsin uses a single benefits portal — ACCESS — to apply for and manage BadgerCare Plus, Wisconsin Medicaid, SeniorCare, FoodShare, and several other state programs from one account. The portal pairs with a mobile app (MyACCESS) for renewals, document submission, and status checks. In-person and phone help is available through the local county or tribal income-maintenance agency.
Apply online: ACCESS Wisconsin
access.wisconsin.gov handles new applications, renewals, document uploads, and case-status checks. A "See if you can get help" tool screens for eligibility before you start the full application. The site is available in English and Spanish; for language assistance in other languages, call 800-362-3002.
Mobile: MyACCESS
The free MyACCESS mobile app (iOS and Android) shows the programs you're enrolled in, the date of your next renewal, reminders about pending actions, and document upload with real-time status tracking.
By phone or in person: local agency
Your county or tribal income-maintenance agency is the place to apply by phone or in person, send proof and verification, and report changes. DHS publishes a county-by-county locator at dhs.wi.gov. Walk-in availability varies — call ahead.
Guide to Applying
DHS publishes a Guide to Applying with tips on what proof you may need to provide, the letters you'll receive after applying, and resources to help. The guide is the right starting point if you've never applied for state benefits before.
What to gather before you apply
- Names, dates of birth, and Social Security numbers for everyone in the household
- Proof of income for each working household member (recent pay stubs, self-employment records)
- Information on any current health insurance
- Citizenship or immigration status documentation
- Pregnancy documentation if pregnant (counts the unborn child in the household size)
How long does a decision take?
Federal rules give states up to 45 days to decide most Medicaid applications and up to 90 days when the basis is disability. Pregnancy and presumptive-eligibility decisions can be same-day at qualified hospitals and clinics. Coverage can be retroactive up to three months before the application month for qualifying medical bills.
What BadgerCare Plus and Wisconsin Medicaid cover
BadgerCare Plus covers a comprehensive set of health care services, with the exact mix and any copays depending on the member's category. The state organizes coverage into six buckets: basic medical needs, care settings, pregnancy and family planning, mental health, assisted living, and a small "other" group that includes transportation and smoking cessation.
Basic medical needs
- Physician services, nurse and nurse-practitioner visits
- HealthCheck — Wisconsin's EPSDT benefit for kids and young adults age 20 and under
- Lab work and X-rays; medical supplies and equipment
- Prescription drugs and over-the-counter drugs
Care settings and specialty services
- Hospital inpatient and outpatient care; intermediate care facilities; rural health clinics
- Specialty care, chiropractic, dental, eye care (including eyeglasses), foot care
- Physical, occupational, and speech/hearing/language therapy
- Respiratory care for ventilator-dependent members
- Tuberculosis care
Pregnancy and family planning
Doctor and clinic visits, family planning supplies, labor and delivery, nurse midwife care, prenatal care, and prenatal care coordination for high-risk pregnancies.
Mental health
- Mental health and medical day treatment
- Mental health and psychosocial rehab services, including case management through certified community support programs
- Treatment in institutions for mental disease for members under 21 (or under 22 if care started before 21), or 65 and over
Assisted living and long-term care
BadgerCare Plus and Medicaid cover home and community-based services, home health (with nursing services as backup), hospice care, personal care for help with day-to-day living, and skilled nursing home care. Long-term care for older adults and adults with disabilities runs through Family Care (the managed long-term care program) and the self-directed IRIS option, both of which sit alongside BadgerCare Plus.
Medically tailored meals
For HMO-enrolled BadgerCare Plus members (not fee-for-service), DHS covers two medically tailored meals per day for up to twelve weeks (or longer if medically necessary) at no cost. Qualifying conditions: a high-risk pregnancy or postpartum period, diabetes within 90 days of hospital discharge, or cardiovascular disease within 90 days of hospital discharge.
Other services
Case management with a social worker, smoking cessation treatment, non-emergency medical transportation to covered appointments, and substance use disorder treatment.
Who is exempt from copays
BadgerCare Plus charges modest copays (50¢ to $3 on most services, $8 on a non-emergency ER visit for childless adults) but exempts many members entirely:
- Children under 19
- Foster youth — and former foster youth through age 26
- American Indian or Alaska Native tribal members (and their dependents) eligible for Indian Health Services or Purchase and Referred Care
- Members enrolled by Express Enrollment
- Hospice patients (for hospice services)
- Pregnant people and those within 60 days postpartum