Health Care Coverage

The following information provides information about the public assistance health care coverage options for low-income Wisconsin residents:

Adults and children (Individuals who are not disabled)
Medicaid for the elderly, blind or disabled (EBD Medicaid)
Coverage for children with disabilities
Prescription drug programs
Programs and services for women
Free and low-cost health and dental care
Mental health and substance abuse services
Non-emergency medical transportation
Private health insurance coverage
Finding a health care provider or facility
Medicare

Adults and children (Individuals who are not disabled)

BadgerCare Plus: A health care coverage program for low-income Wisconsin residents including children, pregnant women, and adults.
HealthCheck: A preventive health check-up program for BadgerCare Plus members who are under age 21.
Non-Emergency Medical Transportation: Wisconsin's non-emergency medical transportation manager, MTM, Inc., schedules and pays for rides to covered Medicaid and BadgerCare Plus appointments if members have no other way to get a ride to their medical appointment.
BadgerCare Plus HMO Enrollment Resources:
- BadgerCare Plus HMO Program Guide (PDF)
Wisconsin Chronic Disease Program (WDCP): The WCDP offers assistance to Wisconsin residents with chronic renal disease, hemophilia, and adult cystic fibrosis.
Family Planning Only Services Program: A limited coverage program for men and women to prevent unplanned pregnancies.
Estate Recovery Program: Wisconsin is required by state and federal laws to recover some of the money used to pay for certain services for Medicaid members.

Medicaid for the elderly, blind or disabled (EBD Medicaid)

EBD Medicaid: EBD Medicaid provides health care coverage to people who are age 65 and older, blind or who have a disability. Disability and blindness determinations are made by the Disability Determination Bureau.
Wisconsin Medicaid Disability (PDF): If you are blind or disabled and you want to receive health care coverage through EBD Medicaid, you must have your disability or blindness determined by the Disability Determination Bureau. The Wisconsin Medicaid Disability (PDF) fact sheet provides information about how to get a disability determination.
EBD Medicaid HMO Enrollment Resources:
- Medicaid SSI HMO HMO Program Guide (PDF)
Medicare Savings Programs: Wisconsin's Medicaid program may be able to help pay for certain Medicare costs for individuals that enroll in a Medicare Savings Program.
Medicaid Purchase Plan (MAPP): MAPP offers people with disabilities who are working or interested in working with the opportunity to buy health care coverage through the Wisconsin Medicaid Program.
Wisconsin Chronic Disease Program (WDCP): The WCDP offers assistance to Wisconsin residents with chronic renal disease, hemophilia, and adult cystic fibrosis.
Estate Recovery Program: Wisconsin is required by state and federal laws to recover some of the money used to pay for certain services for Medicaid members.
Non-Emergency Medical Transportation: Wisconsin's non-emergency medical transportation manager, MTM, Inc., schedules and pays for rides to covered Medicaid and BadgerCare Plus appointments if members have no other way to get a ride to their medical appointment.

Coverage for children with disabilities

EBD Medicaid: EBD Medicaid provides health care coverage to people who are age 65 and older, blind or who have a disability. Disability and blindness determinations are made by the Disability Determination Bureau.
- EBD Medicaid Income Limits
- How to Apply for EBD Medicaid
Katie Beckett Program: A program for children under age 19 with long-term disabilities or complex medical needs. Children who are not eligible for other Medicaid programs because the income or assets of their parents are too high, may be eligible for Medicaid through the Katie Beckett Program.
Children's Long-Term Support Waivers: Program for children and young adults under the age of 22 with significant developmental, physical, or emotional disabilities. Funding is available to help support children to remain living in their home or community.
- Program Eligibility
- How to Apply
Client Rights: Anyone who is receiving services for mental illness, a developmental disability, or substance abuse in the state of Wisconsin has specific rights under Wisconsin Statute 51 (State Alcohol, Drug Abuse, Developmental Disability and Mental Health Act) subsections 51.61 and 51.30 (PDF).
- List of Client Rights

Prescription drug programs

SeniorCare: Wisconsin's Prescription Drug Assistance Program for Wisconsin residents who are 65 years of age and older and meet program rules.
- Income Limits
- Fact Sheet: SeniorCare - General Program Information (PDF)
- Fact Sheet: SeniorCare/Medicare Part D (PDF)
- Resources: SeniorCare Publications and Member Handbook (PDF)
- Application (PDF)
- Application Instructions (PDF)
Medicare Part D Information
Prescription Drug Assistance Programs

Programs and services for women

BadgerCare Plus: A health care coverage program for low-income Wisconsin residents including children, pregnant women, and adults.
Temporary BadgerCare Plus Coverage: Pregnant women may be able to get Temporary BadgerCare Plus Coverage while they complete their full BadgerCare Plus application so they can immediately begin receiving prenatal health care services.
BadgerCare Plus Prenatal Care Coordination: A benefit that helps pregnant women get the support and services they need to have a healthy baby.
BadgerCare Plus Prenatal Services: Pregnancy-related health care coverage for women who cannot get BadgerCare Plus because of immigration status or who are inmates or a public institution.
Family Planning Only Services Program: A limited coverage program for men and women to prevent unplanned pregnancies.
Wisconsin Well Woman Program: Provides preventive health screening services to women with little or no health insurance coverage.

Free and low-cost health and dental care

Please note: There are links on the individual County and Tribe pages that provides a link to the financial assistance programs for the hospitals and health care networks in that area.

Mental health and substance abuse services

Mental Health Services: The Department works with counties to provide mental health services to Wisconsin residents with mental illness.
Suicide Prevention Resources
Substance Abuse Services: Substance Abuse Services are for those persons who use alcohol and drugs and their family members who are affected. Services can range from education to treatment and include prevention, intervention, outpatient, day treatment, detoxification, inpatient, residential and recovery.
Client Rights: Anyone who is receiving services for mental illness, a developmental disability, or substance abuse in the state of Wisconsin has specific rights under Wisconsin Statute 51 (State Alcohol, Drug Abuse, Developmental Disability and Mental Health Act) subsections 51.61 and 51.30 (PDF).
- List of Client Rights

Non-emergency medical transportation

Non-Emergency Medical Transportation: Wisconsin's non-emergency medical transportation manager, MTM, Inc., schedules and pays for rides to covered Medicaid and BadgerCare Plus appointments if members have no other way to get a ride to their medical appointment.

Private health insurance coverage

Federal Health Insurance Marketplace (PDF): Individuals and families that are not able to enroll in BadgerCare Plus may be able to purchase private health insurance coverage through the Marketplace. Depending on the household income, individuals and families may be eligible for tax credits and help paying for out of pocket expenses.
Consumer Information About Wisconsin Insurance (PDF): The Office of the Commissioner of Insurance ensures that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens.

Finding a health care provider or facility

Online tool to locate a BadgerCare Plus or Medicaid Health Care or Dental Provider
Directories of Health and Community Care Providers: Locate a Wisconsin health or community care provider.
Provider Search: Locate a health or community care provider and obtain compliance history information about community care providers.

Medicare

Medicare is a federal health care coverage program for people who are age 65 and older. DHS does not administer Medicare.

Medicare: 800-MEDICARE (800-633-4227)
State Health Insurance Assistance Program (SHIP) - SHIP counselors are screened, trained, and certified. They provide one-on-one, confidential Medicare guidance based on needs.