Management (Income Maintenance) Home >> Customer
Help >> Medicaid Help
To see if you may be able to
enroll or to apply, go to access.wi.gov.
(PDF, 268KB) — To apply apply for Medicaid or you can apply online at access.wi.gov.
of Representative — F-10126 (English,
(PDF, 453KB) — Designate someone to apply for Medicaid for
Report — F-10137 (English,
(PDF, 544KB) — Report changes to the local agency or you can report
changes online at access.wi.gov.
Application — F-10112
(PDF, 234KB) — Use this application along with the F-10101 if you need
a disability determination.
Request — DHA
28 (PDF, 100KB) *(exit DHS)
Hearing Voluntary Withdrawal — DHA
DHS) — If you want to withdraw your request for a hearing.
Income Report (SEIRF) form —
(PDF KB) — Use this form to report self-employment
Statement of Identity — F-10154
(PDF, 91KB) — To provide proof of identity
for children under 18 years of age.
ForwardHealth Enrollment and Benefits handbook, P-00079, (English,
(PDF, 667KB) A handbook will be mailed to each
family who applies for a ForwardHealth Plan. Translations will be
available in the near future.
Guide to Applying for Wisconsin's Health and Nutrition
ACCESS/Marketplace Takeaway Card —
Start, Grow Smart: Baby's first year — one month at a time
Additional Information about Medicaid can be found at dhs.wisconsin.gov/medicaid
Directory - To find the telephone number and address of your local
dhs.wisconsin.gov/aging/EBS/counties.htm or call 1-800-362-3002 to
contact a Disability Benefit Specialist or Benefit Specialist at your
local Aging and Disability Resource Center (ADRC) or County Aging
a provider —
If you need to find a Medicaid provider in your area.
Limits - To find current income limits.
Legal Services — To find the name and telephone number of who in your area
can provide you with legal help. You may also go to:
Rights of Wisconsin — Disability Rights Wisconsin is a private non
profit organization which helps people across Wisconsin gain access to
services and opportunity through its advocacy and legal expertise.*(exit DHS)
November 18, 2013