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.

Application Form F-10076: Available in English (PDF, 152KB). To apply for SeniorCare Prescription Drug Assistance.

Enrollment and Benefits handbook Publication P-10079: Available in English (PDF, 100 KB). To learn more about your SeniorCare Prescription Drug benefits.

Authorization of Representative Form F-10080: Available in English (PDF, 32 KB). Designate someone to apply for SeniorCare for you.

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.

Additional Links

Agency Directory: Locate the telephone number and address of your local agency.

SeniorCare: Visit the web site for more information. 

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:

• Legal Action of Wisconsin, Inc. at http://www.legalaction.org/ (exit DHS) or

• The Wisconsin Judicare, Inc. at www.judicare.org/ (exit DHS).

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