Wisconsin Medicaid

Updated August 2026

BadgerCare Plus is Wisconsin's main public health insurance program for low-income families, children, pregnant people, and adults. The Wisconsin Department of Health Services (DHS) administers it through its Division of Medicaid Services. More than 1 million Wisconsinites — approximately 1.1 million as of 2026 — are covered by BadgerCare Plus and Wisconsin's broader Medicaid programs.

Wisconsin did not expand Medicaid under the ACA — adult income limits are lower than in most states

Wisconsin covers adults up to 100% of the Federal Poverty Level, not 138% as in expansion states. Adults with income between 100% and 400% FPL are directed to marketplace coverage instead. Children and pregnant women have much higher limits. Visit access.wi.gov or call 800-362-3002 to check eligibility.

What is BadgerCare Plus?

Wisconsin is one of a small number of states that has not expanded Medicaid under the ACA. The Republican-led state legislature has declined expansion multiple times. As a result, Wisconsin covers childless adults only up to 100% FPL — not the 138% level available in expansion states. Adults earning above 100% FPL are directed to the federal marketplace at healthcare.gov instead.

Wisconsin operates BadgerCare Plus under a Section 1115 waiver called the BadgerCare Waiver. The waiver gives Wisconsin flexibility in how it structures coverage, including the 100% FPL adult limit. DHS revised the most recent waiver last updated March 31, 2026, per Wisconsin DHS.

Because BadgerCare Plus operates under this 1115 waiver, it is subject to the new federal community engagement (work) requirement created by H.R. 1 (signed July 4, 2025), even though Wisconsin never adopted ACA expansion. Starting in 2027, members ages 19–64 who are not pregnant, not disabled, and do not have dependent children under 19 living with them will generally need to show at least 80 hours a month of work, school, job training, or volunteering — or qualify for an exemption — to keep coverage. The requirement applies to new applicants beginning January 1, 2027, and to current members starting with their regular renewal, beginning March 2027. DHS will notify affected members in advance; details are at dhs.wisconsin.gov/medicaid/work.htm.

Who BadgerCare Plus covers

Children: Children up to age 19 whose family income is at or below 300% FPL. Wisconsin integrates its CHIP population into BadgerCare Plus — there is no separate CHIP program. Children at this income level receive BadgerCare Plus, not a separate CHIP card.

Pregnant individuals: Pregnant people up to 300% FPL for pregnancy-related services. Wisconsin's 300% FPL limit for pregnancy is unusually high — most non-expansion states set this limit well below 200%. Coverage continues through 60 days postpartum.

Adults without disabilities: Non-disabled adults with income at or below 100% FPL. Adults above 100% FPL are not eligible for BadgerCare Plus and are referred to marketplace coverage. This is the key difference from expansion states.

Seniors and individuals with disabilities: Seniors 65 and older and disabled individuals qualify under separate Medicaid eligibility rules with their own income and asset limits. Long-term care coverage is provided through Family Care managed care or the IRIS self-directed program.

How Wisconsin delivers BadgerCare Plus care

Most BadgerCare Plus members receive care through the ForwardHealth program. Wisconsin uses a mix of fee-for-service and managed care, depending on the member's program. HMOs (health maintenance organizations) are available for BadgerCare Plus members in most counties.

Members manage their benefits through ACCESS at access.wi.gov — Wisconsin's online benefits portal — or through the MyACCESS mobile app. The app allows members to check benefits, submit documents, update contact information, and view their digital ForwardHealth card without needing to log into a web browser.

Long-term care services are not part of standard BadgerCare Plus. Seniors and adults with disabilities who need LTSS access separate programs: Family Care (managed LTSS), IRIS (self-directed support), and PACE in areas where it is available.