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Eligibility
Management (Income Maintenance) Home >> Customer
Help >> SeniorCare Help >>
SeniorCare Help
To see if you may be able to
get SeniorCare or to
check your benefits, go to access.wi.gov.
At this time, you cannot apply for SeniorCare on ACCESS.
Forms
Application — F-10076
( PDF, 152KB) — To apply for SeniorCare Prescription Drug
Assistance
Authorization of Representative — F-10080
( PDF, 32KB) — Designate someone to apply for SeniorCare for
you.
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.
Publications
SeniorCare
Member Handbook — P-10079 — To learn more about your SeniorCare Prescription Drug
benefits.
Additional Links
Additional Information about SeniorCare can be found at
dhs.wisconsin.gov/seniorcare.
Agency
Directory - To find the telephone number and address of your local
agency.
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:
August 14, 2012 |
