Department of Health Services Logo

 

Wisconsin Department of Health Services

This is the logo for ForwardHealth

ACCESS

BadgerCare Plus for Families 

Family Planning Only Services

FoodShare

Medicaid

SeniorCare

Caretaker Supplement

Fair Hearing Request

Fair Hearing Withdrawal

Find a Provider

Eligibility Management (Income Maintenance) Home >> Customer Help >> Medicaid Help 

Customer Help - Medicaid

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, 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 (exit DHS) - To request a hearing if you don't agree with a decision about your benefits.

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 - April 2014
P-00079
(English) (PDF 2.6 MB)
ForwardHealth Enrollment and Benefits Handbook - November 2013
P-00079-P
(English, Spanish) (PDF 3.3 MB)
A handbook will be mailed to each family who applies for a ForwardHealth Plan.

Guide to Applying for Wisconsin's Health and Nutrition Programs P-16091 (English, Hmong, Spanish) (PDF, 181KB)

ACCESS/Marketplace Takeaway Card, P-05555 - (English, Spanish) (PDF, 549KB)

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.

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 Office.

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: April 11, 2014