ForwardHealth Wisconsin Medicaid


 

ForwardHealth Medicaid

Medical Assistance for Low-Income Individuals and Families

Wisconsin’s state-funded program for the needy and uninsured is known as ForwardHealth Medicaid, which has not expanded under the Affordable Care Act, but still provides health insurance and medical care to select residents. The ForwardHealth Medicaid program is available to individuals age 65 of older, or those who are blind or disabled. ForwardHealth Medicaid also provides services for breast cancer prevention and treatment to low-income women under Well Woman Medicaid. Wisconsin’s Medicaid program also provides emergency care to non-citizens, services for people with tuberculosis, long-term care for the elderly, and health care for disabled workers.

Additional state programs such as BadgerCare Plus (which is similar to Medicaid programs in other states and also a ForwardHealth operation) accommodate children, families and pregnant women. BadgerCare Plus offers free family planning services and coverage for children of all incomes in need of low-cost health services. If you fall into one of these groups, please visit their respective pages.

 

ForwardHealth Medicaid

 

Eligibility

Aged, Blind, Disabled, and Long Term Care

In order to qualify for full medical benefits or long-term care under ForwardHealth Medicaid, you must have a physical or mental disability, loss of vision, or be at least 65 years old. Additionally, you must be a U.S. citizen or legal resident, and a resident of Wisconsin: a requirement for all state-funded health programs.

Income is also considered when applying for Elderly, Blind or Disabled Medicaid and Long Term Care. Requirements vary for each of these groups, depending on your income per household size based on the current federal poverty level, which changes each year.

 

Aged, Blind or Disabled Individual: 84% FPL

 

Aged, Blind or Disabled Couple: 94% FPL

 

Qualified Medicare Beneficiary (QMB): 80-100% FPL

Medicaid covers your coinsurance, premiums and deductibles.

 

Specified Low-Income Medicare Beneficiaries (SLMB): 100-120%

Medicaid covers only monthly Medicare premiums. Not eligible for full Medicaid.

 

Specified Low-Income Medicare Beneficiaries (SLMB+): 100-120%

Medicaid covers Medicare premiums only. Eligible for full Medicaid.

 

Emergency Services Plan

To qualify for emergency care under ForwardHealth Medicaid, you must be a resident of Wisconsin without legal immigration status who has income up to 300% FPL. You can access this short-term coverage only when experiencing medical emergencies. The program defines an emergency medical condition as one that places your health at risk if you do not seek immediate attention. This plan only pays for care you receive as an emergency room patient, but does not guarantee all emergency care will be paid for by the program.

 

Tuberculosis-Related Services Only Medicaid

If you have tuberculosis (TB), live in Wisconsin and earn below the income limit for ForwardHealth Medicaid, you may be eligible for covered care for your condition. This program covers physician services, prescription drugs, care received at a clinic, laboratory testing and X-rays, services related to side effects of TB medications, and services encouraging the completion of treatment.

You must have been infected with TB and earn no more than $1,505 per month with no more than $2,000 in assets to qualify. For residents under age 18 and living with a parent or guardian, a portion of the parents’ income and assets are counted.

 

Benefits

If you qualify for full Medicaid, you’ll receive coverage for various typical health care services including the following. They may be offered for free or for a modest copay, depending on the type of care and the plan in which you’re enrolled. Your ForwardHealth coverage applies to any provider accepting Medicaid benefits or public health center.

  • Preventive care
  • Hospitalization
  • Physician services
  • Outpatient hospital care
  • Prescription drugs
  • Surgical procedures
  • Emergency care
  • Medical transportation
  • Durable medical supplies and equipment
  • Dental care
  • Vision tests
  • Mental health and substance abuse treatment
  • Chiropractic care
  • Maternity services
  • Family planning

 

 

How to Apply

To apply for Aged, Blind or Disabled Medicaid, tuberculosis services, emergency care, the Medicaid Purchase Plan (MAPP), or Institutional Medicaid in Wisconsin, you can submit a paper application by mail, fill one out over the phone, or complete the process online at ACCESS.wi.gov. To apply for Long Term Care services, you must apply through the Home and Community Based Waivers program, Family Care, Partnership or PACE. Such applications can be found at your local Aging and Disability Resource Center (ARDC). To locate your nearest ARDC, visit the Human Services Department website or call 800-362-3002.

 

Resources

ForwardHealth Enrollment Information and Benefits (PDF)

Medicaid

Medicare