Medicaid Help
To see if you may be able to
enroll or to apply, go to access.wi.gov.
Application Packet Form F-10101 Available in English,
Hmong or Spanish
(PDF, 189 KB). Use this form to apply for Medicaid or you can apply online at access.wi.gov.
Authorization of Representative Form F-10126: Available
in English,
Hmong
or Spanish
(PDF, 600 KB). Use this form to appoint someone to
apply for Medicaid for you.
Change Report Form F-10137: Available in English,
Hmong, Russian
or,
Spanish
(PDF, 544 KB). Use this form to report changes to your local agency or
you can report changes online at access.wi.gov.
Disability
Application Form F-10112: Available in English
or Spanish
(PDF, 234KB). Use this application along with the F-10101 if you need
a disability determination.
ForwardHealth Enrollment and Benefits Publication P-00079: Currently
available in English
(PDF, 667 KB). This handbook is mailed to each family who applies for a
ForwardHealth Plan. Translations will be available in the near future.
Fair Hearing Request Form DHA-28: Available in English
(PDF, 100 KB; exit DHS). Use this form to
request a hearing if you don't agree with a decision about your
benefits.
Fair Hearing Voluntary Withdrawal Form DHA-17: Available in English
(PDF, 10 KB; exit DHS).
Use this form to withdraw your request for a hearing.
Guide
to Applying for Wisconsin's Health and Nutrition Programs Publication
P-16091: Available in English,
Hmong
or Spanish
(PDF, 181 KB).
HMO Ombuds Brochure Publication P-12002:
Available in English,
Hmong,
Russian
or Spanish) (PDF).
Self-Employment Income Report (SEIRF) Form F-00107: Available
in English
(PDF, 54 KB). Use this form to report self-employment income.
Statement of Identity Form F-10154: English,
Hmong,
Russian
or Spanish
(PDF, 91KB). Use this for to provide proof of identity for children
under 18 years of age.
Additional Links
Agency
Directory: Locate the telephone number and address of your local
agency.
Aging
and Disability Resource Center Directory: Find the telephone number and address of your
Aging and Disability Resource Center (ADRC).
Medicaid:
Visit the web site for more information.
Find
a Provider: Find a Medicaid provider in your area.
Income
Limits: To find current income limits.
Legal
Services: Find the name and telephone number of someone who is in
your area and 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:
July 29, 2010 |
