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Eligibility
Management (Income Maintenance) Home >> Customer
Help >> Medicaid Help
Medicaid Help
To see if you may be able to
enroll or to apply, go to access.wi.gov.
Forms
Application
— F-10101
(English,
Hmong, Spanish)
(PDF, 268KB) — To apply apply for Medicaid or you can apply online at access.wi.gov.
Authorization
of Representative — F-10126 (English,
Hmong, Spanish)
(PDF, 453KB) — Designate someone to apply for Medicaid for
you.
Change
Report — F-10137 (English,
Hmong, Russian,
Spanish)
(PDF, 544KB) — Report changes to the local agency or you can report
changes online at access.wi.gov.
Disability
Application — F-10112
(English,
Spanish)
(PDF, 234KB) — Use this application along with the F-10101 if you need
a disability determination.
Fair Hearing
Request — DHA
28 (PDF, 100KB) *(exit DHS)
Fair
Hearing Voluntary Withdrawal — DHA
17 (PDF,
10KB) *(exit
DHS) — If you want to withdraw your request for a hearing.
Self-Employment
Income Report (SEIRF) form —
F-00107,
(English, Hmong,
Spanish)
(PDF KB) — Use this form to report self-employment
income.
Statement of Identity — F-10154
(English,
Hmong,
Russian,
Spanish),
(PDF, 91KB) — To provide proof of identity
for children under 18 years of age.
Publications
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
Programs —
P-16091 (English,
Hmong, Spanish)
(PDF, 181KB)
Healthy
Start, Grow Smart: Baby's first year — one month at a time
Additional Links
Additional Information about Medicaid can be found at dhs.wisconsin.gov/medicaid
Agency
Directory - To find the telephone number and address of your local
agency.
Aging
and Disability Resource Center Directory - To find the telephone number and address of your
Aging and Disability Resource Center (ADRC).
Find
a provider —
If you need to find a Medicaid provider in your area.
Income
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:
Disability
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)
Last Revised:
June 21, 2011
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