Medical Assistance
Medical Assistance, also known as Medicaid, is a health insurance program that covers elderly, people with disabilities, low-income families with children, and certain other children and women. It is also called MA, Title 19, or Title XIX, and includes BadgerCare, Healthy Start, and Nursing Home Assistance.
Medical Assistance does not include the General Assistance Medical Program (GAMP). Please call 257-7200 for information about GAMP.
Medicaid is not Medicare, a health insurance program for people 65 and older and persons with long-term disabilities. The Medicare phone number is 1-800-772-1213 or TTY/TDD 1-800-325-0778.
Medicaid covers most health care services, including physicians, nurse practioners, midwives, clinics, chiropractors, inpatient and outpatient hospital care, lab tests and x-rays, screening, preventive, and rehabilitative services, mental health, family planning, medications, dental, vision, prosthetics, and transportation for covered appointments. It also pays for case management, home health and personal care, and in-home nursing, as well as nursing home, institutional, and hospice care.
Persons can apply at the Department's offices and at certain clinics and hospitals. Click here for locations and hours. Click here for information and documents you must have to apply.
Major Medicaid categories are:
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Family
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Elderly, Blind & Disabled
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Special Status
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| Covers pregnant women, and children under 19 and their parents or relative caretakers. There are income, but no asset limits. Family MA includes: |
For persons 65 and older, blind or disabled. Supplemental Security Income (SSI) recipients are automatically eligible. Both income and assets limits affect eligibility. Elderly, Blind & Disabled MA includes: |
Provides specialized coverage to unique populations. Income and asset limits vary. Special Status MA includes: |
| Low Income Families with children under 19 and incomes up to 150% of federal poverty level (FPL)*. |
Nursing Home or institutional care for persons 65 and over and, in some cases, persons under 22. |
Medical Deductible for higher-income persons and families with large medical bills. |
| BadgerCare for working families with children under 19 whose income is up to 185% of FPL*. Recipients remain eligible until family income exceeds 200% of FPL*. Families with income over 150% FPL* pay a small premium. |
Community Waivers, available through the Disabilities Services Division, 289-6660, TTY/TDD 289-8559 and Family Care, in the Department on Aging, 289-5950. |
Family Planning Waiver for women 15-44 whose gross family income does not exceed 185% of FPL*. For teens, only their income is counted. |
| Healthy Start for newborns and pregnant women with incomes up to 185% of FPL* who remain eligible until at least 60 days after the last day of pregnancy. |
Medicaid Purchase Plan (MAPP) for persons with disabilities who work. |
Tuberculosis Treatment for qualified persons. |
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Medicare Premium Payments for poor seniors and coverage for health care Medicare does not cover. |
Well Woman for women 35-64 with breast or cervical cancer |
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SeniorCare (1-800-657-2038) provides prescription drug assistance for indigent elderly. |
Burial costs (289-6714) up to $3,500 for qualified persons. |
*Federal Poverty Level (FPL) is $9,570 a year for one person and $3,260 for each additional person in the family.
Coverage begins the month of application, but in some cases can be backdated. Recipients get a plastic "Forward" card they must show each time they get treatment. The card is permanent and reused if a person goes on and off Medicaid. Recipients get notice by mail if their eligibility changes. Call 1-800-362-3002 to check your eligibility if you are unsure.
Recipients in health maintenance organizations (HMO) have no out-of-pocket costs. Others must make a small co-payment. Some services require pre-authorization for Medicaid to pay.
Some Medicaid benefits to persons 55 and older and recipients in institutions are repaid through "Estate Recovery" by placing a claim on their estate when deceased or a lien on their home. It is not exercised until the recipient's spouse has passed away and there no longer are dependent children.
For more information, visit the State's Medicaid website, or call 1-800-362-3002.